Zahedan University of Medical Sciences is on the track of Malaria Elimination

Malaria has long been a health problem in Sistan and Balouchestan (1). Despite socio economic development and very low incidence of malaria cases in other parts of the country, malaria is still a health challenge in Sistan and Baluchestan.Sistan and Balouchestan province accounts for 60 to 80 percent of total cases of malaria in Iran. Furthermore, more than 80% of local transmission has been reported in this province (2). Except for the years 1995, 2003, 2007 and 2008, there has been a decrease in malaria rate in the province in recent years. In such a way that malaria Annual Parasite Incidence (API) has decreased from 36.9 in 1991 to 0.09 to 2016, respectively.

Zahedan University of Medical Sciences on the track of Malaria Elimination

Malaria has long been a health problem in Sistan and Balouchestan (1). Despite socio__ economic development and very low incidence of malaria cases in other parts of the country, malaria is still a health challenge in Sistan and Baluchestan. Sistan and Balouchestan province accounts for 60 to 80 percent of total cases of malaria in Iran. Furthermore, more than 80% of local transmission has been reported in this province (2). Except for the years 1995, 2003, 2007 and 2008, there has been a decrease in malaria rate in the province in recent years. In such a way that malaria Annual Parasite Incidence (API) has decreased from 36.9 in 1991 to 0.09 to 2016, respectively.
Malaria Elimination Program:
"Elimination" is an epidemiologic concept which has been frequently used in health documents and scientific articles. Based on the World Health Organization definition, malaria elimination is "the interruption of local transmission of a specified malaria parasite species in a defined geographic area" (3).
WHO aims at elimination of malaria in at least 10 countries by 2020 and its elimination in another 35 countries by 2030. Seventeen countries have already eliminated malaria between 2000 and 2015. In the elimination phase, unlike control phase which aims at decreasing the incidence of malaria, the elimination of malaria transmission in a certain geographical area is targeted. During this phase much emphasized is laid on malaria foci surveillance, timely reporting, investigation of every cases and intensive surveillance on the reported cases and also population movement.
Considering advances made in decreasing malaria burden in most regions of the country and the fact that malaria is mainly confined to Southeast region of the country, elimination of malaria is on the agenda of Ministry of Health, Treatment and Medical Education of Islamic Republic of Iran.
The goal of elimination of malaria, which is in line with the 20-Year Perspective Document of Iran, was approved by Policy Making Council of the Ministry of Health in late 2009 and implementation stage of malaria elimination started in 2010. According to World Health Organization"s assessment, Iran is one of the few countries in the East Mediterranean region capable of eliminating malaria by 2020. Conducted studies have revealed that interventions made in the Elimination Program have been effective and have resulted in acceleration in decreasing the trend of malaria incidence which started prior to Elimination Program.
The ultimate goal of the Elimination Program is to interrupt local transmission of the disease. The imported cases of malaria during the years of program implementation and even after it may be present as has been happening prior to the commencement of the Elimination Program. . In this phase all attempts are focused on prevention from the re-introduction of transmission in local residents.

Malaria elimination targets:
• Elimination of local transmission of falciparum in Iran by 2118.
• A Decrease in the annual incidence of indigenous malaria to less than one case in 10000 population by the end of 2019 in all districts.
• Elimination of local transmission (all kind of malaria parasites) by the end of 2021.
• Achieving the WHO prerequisite s to start the process of obtaining Elimination Certificate by the end of 2024.
It should be noted that Zahedan University of Medical Sciences is moving ahead of malaria elimination program.

Achievements of ZAUMS Elimination Program in 2017
• Zero malaria deaths
• A decrease in total malaria cases by 89% (166 cases in 2017 as compared with 1468 cases in 2010)
• A decrease in malaria indigenous cases by 96% (29cases in 2017 as compared with 178 cases in 2010)
• A decrease in Falciparum cases by 87% (36 cases in 2017 as compared with 274 cases in 2010)
• A decrease in Falciparum indigenous cases by 94% (3 cases in 2017 as compared with 47 cases in 2013)
• Increase in non-Iranian cases (32% in 2010 as compared with 61% in 2017)
• A decrease in API from 1.7 in 2010 to 0.1 in 2017 (1468 cases as compared with 164 cases)

Figure 1- Total malaria cases in ZAUMS as compare with the national figures (2010 - 2017)

Figure 2- The trend of API in ZAUMS (2010 - 2017)

Figure 3- Falciparum rate in ZAUMS (2010 - 2017)

Figure 4- Malaria cases (%) in ZAUMS by transmission routes (2010 - 2017)

Figure 5- Malaria case finding indices (SPR & ABER) in ZAUMS (2010 -2017)

Figure 6- Malaria cases (%) in ZAUMS by nationality (2010 - 2017)

References:

1. Ranjbar M, Shoghli A, Kolifarhood G, Tabatabaei SM, Amlashi M, Mohammadi M. Predicting factors for malaria re-introduction: an applied model in an elimination setting to prevent malaria outbreaks. Malar J. 2016;15:138.
2. Sheikhzadeh K, Haghdoost AA, Bahrampour A, Zolala F, Raeisi A. Assessment of the impact of the malaria elimination programme on the burden of disease morbidity in endemic areas of Iran. Malar J. 2016;15:209.
3. World Health Organization. A framework for malaria elimination: World Health Organization,; 2017.

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