Iranian J Publ Health, Vol. 42, No.3, Mar 2013, pp. 326-333 Narrative Review Determination of Malaria Epidemiological Status in Iran’s Malarious Areas as Baseline Information for Implementation of Malaria Elimination Program in Iran Ahmad RAEISI 1,2 , Mohammad Mehdi GOUYA 2, Abolhassan NADIM 3, Mansour RANJBAR 2, Abdolghafar HASANZEHI 4, Mojtaba FALLAHNEZHAD 5, Mohammad SAKENI 6, Reza SA- FARI 7, Mehdi SAFFARI 8, Minoo MASHYEKHI 9, Assadalah AHMADI KAHNALI 10, Vahid MIRKHANI 2, Elham ALMASIAN 2, Leila Faraji 2, Bita PAKTINAT JALALI 2 , *Fatemeh NIK- POUR 1 1. Dept. of Medical Entomology and Vector Control, Tehran University of Medical Sciences, Tehran, Iran 2. Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran 3. Iranian Medical Council, Tehran, Iran 4. Dept. of Vector Control, Zahedan University of Medical Sciences, Zahedan, Iran 5. Razi Science Researchers Institute, Tehran, Iran 6. Dept. of Communicable Disease Control, Zahedan University of Medical Sciences, Zahedan, Iran 7. Dept. of Communicable Disease Control, Bandar Abbas University of Medical Sciences, Bandar Abbas, Iran 8. Dept. of Communicable Disease Control, Kerman University of Medical Sciences, Kerman, Iran 9. Dept. of Vector Control, Kerman University of Medical Sciences, Kerman, Iran 10. Dept. of Communicable Disease Control, Jiroft University of Medical Sciences, Jiroft, Iran *Corresponding Author: Email: [email protected] (Received 18 May 2012; accepted 21 Dec 2012) Abstract Background: According to willingness of the Ministry of Health, Iran and presence of appropriate conditions for disease elimination, national malaria control program decided to conduct a research to clarify malaria status in 2007 and to provide required information to perform the elimination program. This review is comprised of the basis of national malaria elimination program in vision of 2025, which was started in 2010. Methods: In this descriptive study, data were analyzed by applications of different variables at district level. All districts in the three south eastern provinces, in which malaria has local transmission, were considered. Malaria cases has been determined and studied based on the national malaria surveillance system. Results: Since vivax malaria is predominant in Sistan & Baluchestan Province, number of vivax cases is equal to malaria positive cases approximately. The important point is that Nikshahr contains the maximum number of local vivax cases in this province and the maximum number of falciparum cases is reported from Sarbaz district. Among all districts of Hormozgan Province, no case of autochthonous falciparum was detected except in Bandar Jask and one case in Minab. There was no case of autochthonous falciparum in Kerman Province, except in Kahnoj and Ghale Ganj that each of them had one case in 2007. Conclusion: It appears that the report of locally transmitted cases in Iran is increasing over the past few years, before starting malaria elimination plan. Since the Afghan refugees started to return to their own country so the main source of reporting of imported malaria cases reduced and local cases would be demonstrated more clearly. Keywords: Malaria, Autochthonous case, Epidemiology, Iran 326 Available at: http://ijph.tums.ac.ir Raeisi et al.: Determination of Malaria Epidemiological Status … Introduction Malaria is one of the most serious hygienic con- and proposing programs for controlling it. These cerns around the world. Annually, 0.6 to 1 million programs included insecticide spraying, entomol- people of 196 to 297 million malaria infected ogy survey and environment management. Malaria population lose their lives, mostly children under control program had the highest priority among five and pregnant women (1). In Eastern all programs of Health Cooperation Organization Mediterranean regions, over 10 million clinical (6, 7). malaria cases occur each year, of which 50 thou- Initially, cooperation between Iran and USA in sand lead to death. Totally, 287 million which is technical and public health fields was called the about 60% of Eastern Mediterranean population “June the Forth” Principle; afterwards, this name is at risk of malaria infection. Fifteen percent of changed into Technical Cooperation with USA. this population lives in areas with P. vivax parasite The health section of the program was extracted transmission and 45% of lives in areas with from collaborative programs between USA and simultaneous transmission of both P. vivax and P. Latin American countries, known as Service falciparum parasites (2). Organization. The Health Cooperation Organiza- Iran with population of more than 72 million tion was active until 1964; from that time on, the people is located in West Asia. It has approx- name of the organization changed into Central imately 1.648 million square km area of which Health Department and the American technical mountainous regions and arid deserts comprise experts supported the program as consultant. 50% and 25%, respectively. The Institute of Malariology was established by The Malaria Control Program started extensively Faculty of Medicine, Tehran University and Ira- in 1951. By 1953, the program covered 5 million nian Ministry of Health with technical support of of the total population (18 million). The main duty WHO and USA. Scientific data of malaria was of the program was DDT Indoor Residual Spray- constantly collected by the institute and employed ing and with massive use of DDT considerably in control programs. Furthermore, the institute decreased malaria infection rate in most endemic was responsible for teaching malaria courses to areas (3, 4). Based on Iranian’s estimations before executive managers involved on the control pro- the starting of the program, there was an infection gram. Nevertheless, years later, the institute rate of 4 million people per year. The involved started to work independently (8). areas were mainly of southern areas beside Persian Subsequent to starting and actively performing Gulf, Azerbaijan and coastal areas of Caspian Sea. malaria control programs, which in the first years Subsequent malaria metric studies of Institute of was named “Malaria Eradication”, the disease was Malariology demonstrated that the disease has dis- eliminated in most parts of the country. In such a persed in many villages all over the country (3,5). way that, after 1972 the disease was under control The Health Cooperation Organization was estab- in most parts of the country and local transmis- lished based on a contract that was signed on De- sion were limited to some endemic parts. These cember 31, 1952 between Iranian Ministry of areas were located mainly in Sistan & Baluchestan, Health and Technical Cooperation of United Hormozgan and Kerman Provinces (9). States of America (USA). In early 1949, the health National program for malaria control in Ministry section of Budget and Planning Organization inte- of Health and Medical Education has divided grated malaria control program to the other devel- areas of infected regions into two categories. Cate- opment programs. In 1948 and 1949, following gory No.1: areas with malaria transmission at the request of Iranian government, three officials of moment and category No.2: areas in which mala- public health service attended in Iran for a period ria transmission existed in the past but now it of two months for evaluating status of Malaria Available at: http://ijph.tums.ac.ir 327 Iranian J Publ Health, Vol. 42, No.3, Mar 2013, pp. 326-333 does not exist due to prevention measures or so- In this descriptive study, relying on raw data; data cio-economic development. were analyzed by applications of different va- According to willingness of Ministry of Health riables at district level. All districts in the three and presence of proper conditions for disease south eastern provinces, in which malaria has local elimination, national malaria control program de- transmission, were considered. Malaria cases has cided to conduct a research to clarify malaria sta- been determined and studied based on the na- tus in 2007 and to provide required information to tional malaria surveillance system. perform the elimination program. This review is comprised of the basics of national malaria Malaria surveillance elimination program in vision of 2025, which was It is noteworthy that all of diagnosis and treat- started in 2010 (10). ment services are free of charge in Iran. District hospitals, urban/rural health centers and malaria Materials and Methods passive laboratories posts are considered as mala- ria service providers. Malaria surveillance based on A questionnaire was designed in seven titles in two main methods; passive and active case finding cooperation with peripheral staff and provincial (Table1). authorities. The titles which set by national 1. Passive surveillance: In this method, the patient coordinator were: demographic information, refers to the nearest health care center to take diagnosis, the epidemiologic information, out- malaria blood slide. Main features of this me- break control, consistent with new definitions of thod are full time coverage but its problem is WHO, information on the vectors. The question- deficient location coverage. naire was completed with collaboration of peri- 2. Active surveillance: This method of surveil- pheral levels in cooperation with malaria experts lance is divided into two subcategories; routine and technicians in 20 health centers of malarious surveillance and case follow up. provinces.