http:// ijp.mums.ac.ir Original Article (Pages: 2229-2239) Assessment of the Epidemiology and Factors Associated with the Malaria among Children in Sistan and Baluchistan Province, South East of Iran (2013-2016) Mujtaba Shuja1, Hamid Salehiniya2, Salman Khazaei3, Erfan Ayubi4, Mahdi Mohammadian5, Khadijah Allah Bakeshei 6, Mohammad Dadkah7, Mohsen Shuja8, Ali Asghar Valipour9, *Abdollah Mohammadian-Hafshejani101 1Researcher, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan,Iran.2Zabol University of Medical Sciences, Zabol AND Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.3Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. 4 PhD Candidate of Epidemiology, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 5Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran. 6MSc in Midwifery, Faculty of Nursing and Midwifery, Dezful University of Medical Sciences, Dezful, Iran. 7Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 8Esfarayen Faculty of Medical Sciences, Esfarayen, Iran. 9 MSc in Epidemiology, Abadan School of Medical Science, Abadan, Iran. 10 Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran AND PhD Candidate, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Abstract Background Malaria is one of tropical and semi-tropical and vector-borne parasitic diseases produced by the protozoan parasites of the genus and species Plasmodium. The aim of this study was to assess the epidemiology and the factors associated with the malaria in children in Sistan and Baluchistan province in 2013-2016. Materials and Methods This cross-sectional study was conducted between March 2013 to March 2016 on 247 child cases of malaria in Sistan and Baluchistan province. Descriptive statistics were used to describe demographic and clinical status of malaria in children. The Chi-square test and Fisher's exact test were used to identify factors affecting malaria in children using SPSS 18, software. Results: Of 247 cases, 51.8% were boys, 70.9% were in rural areas and 64.4 % were Iranian. Plasmodium Vivax with 83.8 % of cases was the most common species of the plasmodium. The relationship between parasite species and treatment failure, illness severity and type of treatment were statistically significant as (P<0.05). Conclusion Children are at high risk for malaria in Sistan and Baluchestan province; therefore, it is necessary that the primary and second level of prevention programs be done with more emphasis; as a result, prevent the occurrence or at least reduce the number of disease cases. Key Words: Children, Epidemiology, Iran, Malaria. *Please cite this article as: Shuja M, Salehiniya H, Khazaei S, Ayubi E, Mohammadian M, Allah Bakeshei Kh, et al. Assessment of the Epidemiology and Factors Associated with the Malaria among Children in Sistan and Baluchistan Province, South East of Iran (2013-2016). Int J Pediatr 2016; 4(7): 2229-39. *Corresponding Author: Abdollah Mohammadian- Hafshejani (MSc, PhDc), Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Email: [email protected] Received date: Feb 11, 2016 Accepted date: Mar 22, 2016 Int J Pediatr, Vol.4, N. 7, Serial No.31, Jul 2016 2229 Epidemiology of Malaria among Children, Iran 1- INTRODUCTION accomplishments have been prepared in Malaria as a vector-borne parasitic malaria –eliminating. So, during the last 5 diseases in tropical and semi-tropical years, more countries such as Morocco, regions produced by genus of parasitic Armenia, Turkmenistan and the United protozoans and species of Plasmodium. Arab Emirates have been certified as This disease is considered as one of most malaria free(6). Epidemiological studies important public health problem with great showed that yearly in the world, range of morbidity and mortality. Estimated 0.7 to2.7 million people died by malaria incidence for infection with Plasmodium infection, that out of them, above 75 % Falciparum in the African area in year occurred among African children (10). 2000 was 214 million (1), and for other More deaths from malaria are due to years was as follow; 365 million in 2002 infection with Plasmodium Falciparum (2). (2), 226 million in 2004 (3), 261milion in Iran is one of the foci of malaria in the world. In recent years, the incidence of the 2007 (4) and 173 million in 2009 (5). Also, according to the WHO worldwide report in disease has fallen sharply (11-13). One of 2014, around 200 million cases of malaria important part of Iran that involved with are reported yearly(6). Malaria spread malaria is Sistan and Baluchestan across 108 countries in the world, and Province. The epidemiological pattern of makes a deep impact on the socio- malaria in this province is similar to two economic status (SES) of the people who countries of Afghanistan and Pakistan that live in these countries (2, 3, 7). About are eastern neighbors of Iran. However, the 85% of malaria morbidity and 90% of number of imported malaria from these malaria mortality have occurred in sub- two countries to Sistan and Baluchestan Saharan Africa (3). In the conducted study Province are remarkable. In Pakistan in in 2009 by Cibulskis and et al., totally, 225 2014, about 29 %of population lived in million malaria cases were reported (5th– high transmission region, 69 lived in low 95th centiles were 146–315 million), out transmissions and 2% lived in malaria free of them, 78%, 15% and 5% were reported region. Reported confirmed cases were from World Health Organization (WHO) 275,149 and numbers of reported deaths African Region, WHO South-East Asia were 56 cases. Also, in Afghanistan in Region and the WHO Eastern 2014, about 27% of population lived in Mediterranean Region respectively. In high transmission region, 49% in low Africa region, estimated cases per 1000 transmission region and 24% in malaria population at risk were 214 (95% free region. Reported confirmed cases confidence interval [CI] 133–302), in the were 61,362 and numbers of reported Eastern Mediterranean region were 23 deaths were 32 cases(13). (95% CI 17–34) and in the Southeast Asia However, malaria remains as a serious region were 19 (95% CI 14–26). health problem in Iran, particularly in Based on WHO report, worldwide malaria South and Southeastern of country, incidence rate reduced by 37% and especially in Hormozgan, Sistan and Baluchistan, and Kerman provinces. mortality rate by 48 %between 2000 and 2015(6). Although the highest of Whole number of individuals at risk in investments and efforts for malaria these regions according to the National elimination have been conducted in high- Census held in 2011 were 7051498 burden countries (8, 9), in region such as (Kerman = 2,938,988, Hormozgan = southern Africa(10, 11), Mesoamerica, 1,578,183, Sistan and Baluchistan = central Asia(12), and the Asia-Pacific 2,534,327) (14, 15). As a result, malaria is region(13, 14), remarkable health priority in these areas (16). We Int J Pediatr, Vol.4, N.7, Serial No.31, Jul 2016 2230 Shuja et al. haven’t specific information on Malaria cases were detected by two demographic, clinical and laboratory methods of Microscopic Diagnosis and characteristics of malaria in children in this Serology: area; therefore implementation research in 2-2-1. Microscopic diagnosis this area is essential. Given that in recent years none study have conducted among In this method as gold standard for children in Sistan and Baluchistan laboratory confirmation of malaria, province as one of the foci of the malaria Malaria parasites is identified by in Iran, the aim of this study was to examining under the microscope a drop of assessment of the epidemiology and the the patient's blood that spread out as a factors associated with the malaria among blood smear on a microscope slide. The children in Sistan and Baluchistan specimen is stained with the Giemsa stain province during 2013 to 2016. to give the parasites a distinctive appearance. 2- MATERIALS AND METHODS 2-2-2. Serology 2-1. Study Design and Population Serology detects antibodies against In a cross-sectional study, all malaria Malaria parasites, using either indirect cases in children under 7 years old in immunofluorescence (IFA) or enzyme- Sistan and Baluchistan province were linked immunosorbent assay (ELISA). recruited. The province located in South 2-3. Eligibility criteria East of Iran, neighboring Pakistan and Afghanistan and its capital is Zahedan city. All patients of equal or less than 7 years Sistan and Baluchestan is broadest included in present study they were province in Iran, with an area of confirmed as malaria cases and during the 187,502 km². The population of Sistan and past month have lived in the study area. Baluchistan according to the National The patients with no information about Census held in 2011 was 2,534,327 disease history; diagnosis and treatment in people. Sistan and Baluchestan province surveillance system were excluded from consist of 15 counties including Chabahar, the study. Qasar-qand, Dalgan, Hirmand, Iranshahr, 2-4. Ethical considerations Khash, Konarak, Nikshahr, Saravan, Sarbaz, Soran, Zabol, Zaboli, Zahedan and With masking information about name, Zehak. Sistan and Baluchistan includes surname and residency address, other two sections, Sistan in the North of the information including gender, age, province and Baluchistan in the South of nationality, residency, history of disease, the province. Today, Sistan and treatment failure, illness severity, type of Baluchistan province consider as one of treatment, epidemiologic classification, the driest areas of Iran. The province has stage of Parasites, Plasmodium species and common borders with Pakistan )900km) type of slide were identified. and Afghanistan )300 km). 2-5. Data analyses In this province, the maximum annual In descriptive analysis step, distribution of temperature is 51°C.