Search

Background Malaria elimination is one of the important health priorities for the government of the I.R. of Iran. In 2010, the National Strategic Plan for Malaria Elimination was ratified by the High Council for Health and the Governor Generals of three malarious provinces (i.e. Sistan & Balouchestan, Hormozgan and Kerman) were assigned as the core persons for leading the program, dealing with potential challenges, administrative arrangements and financial support. The number of malaria reported cases were 11,000.

The concept of malaria elimination is becoming more and more important. Among countries with malaria transmission in 2015, eliminating malaria from 35 countries including those in the Great Mekong has been targeted by 2030. In the journey to elimination through the foci classification procedure, a limited number of “hotspots” among a large number of foci should be precisely defined to be covered by effective controlling measures. There is a common consensus that foci and case classification are fundamental principles of malaria elimination and prevention of reintroduction. However, there are numerous ambiguities and controversies in almost all aspects of foci classifications. These uncertainties result in misclassification that, in turn, wastes lives, time, and money thereby violating value for money principles. New progress in the literature such as ignoring “new potential” foci and using the class of “active foci” instead of the two classes of “new active” and “residual active” is in opposition to the philosophy of foci classification. In this paper, we seek to elaborate the controversies and ambiguities around the concept of foci classification and ultimately suggest some solutions. Some of the ways forward include: (a) foci classification should be done by parasite type; (b) a set of foci classes includes “cleared up”, “new potential”, “new active”, “residual active”, and “residual nonactive”; (c) The number and population of various foci classes should be regularly updated and monitored as the basis for measuring progress toward elimination and it can be considered as the basis for needs assessment and planning response; (d) The coverage and completeness of the controlling interventions by foci classes should be regularly monitored; and (e) The criteria for early detection of outbreaks should be defined. Furthermore, two applicable models for foci classification by parasite have been proposed.

The Islamic Republic of Iran is in the pre-elimination phase of malaria control, but malaria epidemics are still a concern in the south of the country. This retrospective study presents the epidemiological characteristics and predisposing factors of 60 of the malaria epidemics reported in Sistan va Baluchestan province during 2005-09. A zero-truncated negative binomial model was used to investigate the relation between predictor variables and the total number of malaria cases. Malaria epidemics occurred mainly in the southern part of the province, mostly between July and October, peaking in August. Most malaria epidemics were small-scale (68.3% were < 100 cases) and short (51.7% lasted < 1 month). Plasmodium falciparum was present in 46.7% of the epidemics. An increase in the rainfall rate as well as population movements were the most significant predisposing factors. The results may help inform an epidemic investigation and reporting system as the country approaches the malaria elimination phase.