BackgroundMalaria is one of the leading causes of sickness and death in the developing world, causing more than a million deaths and around 250 million new cases annually worldwide. The aim of this comprehensive survey was to provide information on malaria indicators at household level in high-risk malaria areas in Iran.MethodsIn a cluster randomized cross-sectional survey data were collected from 5,456 households in both rural and urban areas of 20 malaria-affected districts of Iran. All the fieldwork was done by trained interviewers and a validated questionnaire. The questionnaire comprised baseline characteristics of the study population, the knowledge of people about different aspects of malaria (such as clinical symptoms, transmission and prevention) and their practice to prevent illness (such as using mosquito nets, spraying houses). The data were analysed and descriptive statistics (i.e. frequencies, percentages) were used to summarize the results.ResultsThe results of this survey showed that 20% (95% CI: 17.36 - 22.24) of households owned at least one mosquito net, whether treated or untreated. Consequently, the use of mosquito nets was considerably low among both children under age five [5.90% (95% CI: 5.14 - 6.66)] and pregnant women [5.70% (95% CI: 3.07 - 8.33)]. Moreover, less than 10% of households reported that the interior walls of their dwelling had been sprayed in the previous year [8.70% (95% CI: 6.09 - 11.31)]. Data also suggest that 63.8% of the participants recognized fever as a sign of malaria, 56.4% reported that mosquito bites cause malaria and about 35% of participants mentioned that the use of mosquito nets could prevent malaria.ConclusionFindings from this study indicate that low access to treated nets along with low understanding of the role of nets in malaria prevention are the main barriers to utilization of bed nets. Therefore, the use of insecticide-treated mosquito nets should be encouraged through health education on the importance of the use along with increasing access to it.

Background: Indoor residual spraying (IRS), as one of the malaria control techniques, requires high spraying coverage and acceptance rate by householders, to be effective. Objectives:The main aim of the study was to assess the spraying acceptability and coverage rates in relation to acceptance and rejection reasons of the IRS program. Also, the householders' perception about IRS benefits and satisfaction with the malaria prevention and knowledge of transmission pathways were estimated. Materials and Methods: A cross-sectional survey was performed in endemic districts of Sistan-and Baluchistan province (south-east of Iran), in two years of 2013 and 2014. Data were collected by a validated questionnaire, through interviewing 834 household heads that were randomly selected from 40 villages, of four malarial sub-districts. To analyze the data, chi-squire test was performed, by using SPSS software (Version 18). The significance level was set at P ≤ 0.05. Results: A total of 834 households' heads were interviewed, with the mean age of 39.5 ± 15.4 years, 73.3% males and 26.7% females. The main sources of information, concerning IRS, were health care workers (51.4%). The IRS coverage and acceptance rates were 96.5% and 94%, respectively. Of the total number of participants, 95.3% of householders associated the disease transmission with mosquito bites and reported the use of insecticidal bed nets (90%) and IRS (74.1%), as important ways of malaria prevention. Conclusions:The study showed that IRS coverage and acceptance rates were relatively high, which is essential in reaching malaria elimination. The information on malaria transmission and knowledge prevention measures showed that householders were, to a certain extent, familiar with the malaria control activities conducted by the health care service.

BackgroundMalaria continues to be a global public health challenge, particularly in developing countries. Delivery of prompt and effective diagnosis and treatment of malaria cases, detection of malaria epidemics within one week of onset and control them in less than a month, regular disease monitoring and operational classification of malaria are among the major responsibilities of the national malaria programme. The study was conducted to determine these indicators at the different level of primary health care facilities in malaria-affected provinces of IranMethodsIn this survey, data was collected from 223 health facilities including health centres, malaria posts, health houses and hospitals as well as the profile of all 5, 836 recorded malaria cases in these facilities during the year preceding the survey. Descriptive statistics (i.e. frequencies, percentages) were used to summarize the results and Chi square test was used to analyse data.ResultsAll but one percent of uncomplicated cases took appropriate and correctly-dosed of anti-malarial drugs in accordance to the national treatment guideline. A larger proportion of patients [85.8%; 95% CI: 84.8 - 86.8] were also given complete treatment including anti-relapse course, in line with national guidelines. About one third [35.0%; 95% CI: 33.6 - 36.4] of uncomplicated malaria cases were treated more than 48 hours after first symptoms onset. Correspondingly, half of severe malaria cases took recommended anti-malarial drugs for severe or complicated disease more than 48 hours of onset of first symptoms. The latter cases had given regular anti-malarial drugs promptly.The majority of malaria epidemics [97%; 95% CI: 90.6 - 100] in study areas were detected within one week of onset, but only half of epidemics were controlled within four weeks of detection. Just half of target districts had at least one health facility/emergency site with adequate supply and equipment stocks. Nevertheless, only one-third of them [33% (95% CI: 0.00 - 67.8)] had updated inventory of malaria foci on quarterly basis.ConclusionTo sum up, malaria case management still constitutes a public health problem in Iran. Additionally, data suggest scarcity in management and evaluation of malaria foci, detection and control of malaria epidemics as well as assignment of emergency sites across different regions of the country. Consequently, massive and substantial investments need to be made at the Ministry of Health to coordinate national malaria control programmes towards achieving determined goals and targets.

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Introduction: Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked genetic disorder with a relatively high frequency in malaria-endemic regions. It is an obstacle to malaria elimination, as primaquine administered in the treatment of malaria can cause hemolysis in G6PD-deficient individuals. This study presents information on the prevalence of G6PD deficiency in Sistan and Balouchetsan province, which hosts more than 90% of Plasmodium vivax malaria cases in Iran. This type of information is needed for a successful malaria elimination program. Methodology: A total of 526 students were randomly recruited through schools located in southeast Iran. Information was collected by interviewing the students using a structured questionnaire. Blood samples taken on filter papers were examined for G6PD deficiency using the fluorescent spot test. Results: Overall, 72.8% (383/526) of the subjects showed normal G6PD enzyme function. Mild and severe G6PD deficiency was observed in 14.8% (78) and 12.2% (64) of subjects, respectively. A total 193/261 males (73.9%) and 190/265 (72%) females had normal enzyme activity. Mild G6PD deficiency was observed in 10.8% (28) and 18.9% (50) of male and female subjects, respectively. However, in comparison with females, a greater proportion of males showed severe enzyme deficiency (15.3% versus 9.1%). All these differences were statistically significant (p < 0.006). Conclusions: G6PD deficiency is highly prevalent in southeast Iran. G6PD-deficient individuals are susceptible to potentially severe and lifethreatening hemolytic reactions after primaquine treatment. In order to achieve malaria elimination goals in the province, G6PD testing needs to be made routinely available within the health system.

BackgroundAppropriate supervision, along with availability of an effective system for monitoring and evaluation, is a crucial requirement to guarantee sufficient coverage and quality of malaria vector control procedures. This study evaluated the efficacy of self-assessment practice as a possible innovative method towards achieving high coverage and excellent quality of larviciding operation in Iran.MethodsThe research was conducted on the randomly selected rural health centre of Kanmbel Soliman with 10 staff and 30 villages, in three main steps: (i) assessment of effectiveness of larviciding operations in the study areas before intervention through external assessment by a research team; (ii) self-assessment of larviciding operations (intervention) by staff every quarter for three rounds; and, (iii) determining the effectiveness of applying self-assessment of larviciding operations in the study areas. Two toolkits were used for self-assessment and external evaluation. The impact of self-assessment of larviciding operations was measured by two indicators: percentage of missed breeding habitats and cleaned breeding habitats among randomly selected breeding sites. Moreover, the correlation coefficients were measured between self-assessment measures and scores from external evaluation. The correlation coefficient and Mann Whitney test were used to analyse data.ResultsFollowing the utilization of self-assessment, the percentage of missed breeding habitats decreased significantly from 14.23% to 1.91% (P <0.001). Additionally, the percentage of cleaned breeding habitats among randomly selected breeding sites increased from 66.89% to 95.28% (P <0.001). The external evaluation also showed significant effects of self-assessment in performance of vector control; the maximum effect of intervention were seen in an action plan for monitoring and evaluation of larviciding operations at field level, geographical reconnaissance for the registration of breeding habitats and worker skills related to larviciding.Before intervention, the results of self-assessment practice were compatible with external evaluation in 76.3% of 139 reviewed reports of self-assessment. After intervention, the findings of self-assessment and external evaluation were similar in the vast majority of reviewed reports (95%).ConclusionThe self-assessment tool seems to be valid and reliable in improving effectiveness of larviciding operations. Furthermore, the result of self-assessment is more compatible with external evaluation results if it would be applied frequently. Therefore, it can be used as an alternative assessment technique in the evaluation of larviciding operations in addition to traditional assessment methods.

in four geographic regions (central, north, northeast , and south). We analyzed these data using a previously described approach of epidemic reconstruction to derive estimates of how the effective reproduction number, Rt, varied with region and over time. Confidence intervals were calculated using a bootstrap procedure. Results: We found that the estimated Rt values for the first wave peaked at 1.5 (with 95% CI, 1.4-1.7) in the central region and 1.6 (95% CI, 1.4-1.9) in the north, whilst the corresponding values in the northeast and the south were close to 1.3. By the time that the Rt estimate in the central region was below one, the value of Rt in the rest of Thailand had started to increase above one. The value of Rt in the first wave was estimated to be above one continuously for 30 days in all regions. For the second wave, the Rt estimates were only marginally above one within the first three months in all regions except the south. Conclusion: The estimate values of Rt for the first and the second waves of the influenza A H1N1pdm epidemic in Thailand varied by region, with higher estimates obtained from the central and northern regions in the first wave. Accounting for regional variation in transmission potential is important for helping to predict the course of future pandemics and for analysing potential control measures (i.e. regionally-targeted control policies).