Provincial clustering of malaria in Iran between 2005 and 2014

Objective: To reveal the provincial clustering of malaria in Iran between 2005 and 2014 based on the epidemiologic factors and the climatic indicators affecting the disease. Methods: This was a descriptive-analytical study using malaria and meteorological data from the Malaria Elimination Programme of the Ministry of Health and Medical Education and National Meteorological Organization. After standardization, the aggregate data was used to produce 10-year means for each province. The data analysis included grouping the provinces with respect to factors using hierarchical clustering method and Kruskal-Wallis test to examine the difference between clusters using SPSS ver.23. Results: The hierarchical clustering stratified the provinces' in 5 clusters. Kruskal-Wallis H test revealed a significant difference in the incidence rate per 100 000 population (P=0.001), male gender (P=0.001), Iranian nationality (P=0.001), Afghan nationality (P=0.003), Pakistani nationality (P=0.001), urban residence (P=0.006), rural residence (P=0.004), autochthonous cases (P=0.007), average minimum temperature (P=0.001), average maximum temperature (P=0.007), average relative humidity (P=0.011), average pressure level (P=0.038), prevailing wind direction (P=0.023), average wind speed (P=0.031) and average precipitation sum (P=0.002) among the clusters. Conclusions: The results of this study and stratification of the provinces could help health policy makers to better manage malaria by allocating resources accordingly.

Wash resistance and bio-efficacy of Olyset

Objective To determine the wash resistance of Olyset

Wash resistance and bio-efficacy of Olyset Plus, a long-lasting insecticide-treated mosquito net with synergist against malaria vector, Anopheles stephensi

OBJECTIVE@#To determine the wash resistance of Olyset Plus using World Health Organization Pesticide Evaluation Scheme standard washing procedure and to assess the value of knock down and mortality rates of Anopheles stephensi at different regimens of long lasting insecticide treated nets washings.@*METHODS@#The study was conducted at the Bioassay Laboratory of Culicidae Insectary, School of Public Health, Tehran University of Medical Sciences, Iran. The net was made of polyester impregnated with permethrin and piperonyl butoxide at a ratio of 2:1. The washing resistance was assessed using Le Chat soap and a shaker incubator set at a speed of 155 r/min, 30 °C for 10 min. The cone bioassay test was carried out according to World Health Organization recommended guideline with tolerant field strain of female Anopheles stephensi to pyrethroids.@*RESULTS@#The knockdown and mortality rates of female mosquitoes exposed to Olyset Plus from un-washed nets to 2 washings were 79.7% and 88.8% respectively. Mortality was dropped to zero while active ingredient estimated 0.532 μg/100 cm to 0.481 μg/100 cm after 15 washings. A positive correlation was seen between residues of permethrin on nets, knockdown rate and mortality rate of female Anopheles stephensi exposed to different regimes of washed Olyset Plus (r = 0.954, P = 0.001).@*CONCLUSIONS@#It is recommended that a preliminary survey conducted on resistance level of Anopheles vectors before the distribution of Olyset Plus in malaria endemic communities.

Bio-ecology of malaria vectors in an endemic area, Southeast of Iran

Objective: To determine some bio-ecological aspects of malaria vectors in Jask County, where is targeted for malaria elimination in the national program. Methods: Mosquitoes were collected monthly during 2013-2014 using different collection methods. Subsequently, ELISA test was used to detect the human blood index of mosquitoes. The susceptibility status of Anopheles stephensi was evaluated against the diagnostic dosages of seven WHO recommended insecticides. Results: A total of 3. 650 female and 4. 736 Anopheles larvae were collected including Anopheles stephensi, Anopheles culicifacies s.l., Anopheles dthali, Anopheles fluviatilis s.l., Anopheles moghulensis and Anopheles turkhodi species. Anopheles stephensi was the dominant collected species on human baits and indoors with high rate of unfed and gravid specimens in internal and external window traps. Human blood index was calculated as 14.3% for this species. It was also found to be resistant to DDT and Dieldrin. Conclusions: The collected species had a wide range of habitats, and resting behaviors. With regarding to the presence of most important malaria vectors in Jask, control of the disease may be so complicated; as based on the weather condition it can be transmitted during the whole year, expect for cold months. With this strong potential of transmission, existing population movements in the area may lead to imported cases of malaria and local outbreak(s). So, more specific studies on malaria vectors in high risk areas of Jask County are recommended.

Epidemiological status of malaria in Iran, 2011–2014

Objectives To aim to determine the status and epidemiological aspects of malaria in Iran in favour of gaining a better understanding of the national control of malaria. Methods This epidemiological study examined the status of malaria from 2011 to 2014 in Iran. Data were collected from the Ministry of Health's protocol for controlling and eliminating malaria, which is currently in use. This malaria information reporting system is automated in all Iranian provinces and cities, and all information is submitted online to the center for communicable disease control in the Ministry of Health. Information about malaria is available for researchers to evaluate. Results The incidence rates decreased from 2011 to 2014. There were 4.76, 2.12, 1.80, and 1.59 per 100 000 people, respectively from 2011 to 2014. During the four-year period (2011–2014), the highest numbers of cases occurred in those aged 16–25 years, by age, and in men, by sex. Most of the cases were workers and located in rural areas. An average 52.58% of cases were Iranian. The highest incidence rates from 2011 to 2014 were located in Sistan and Baluchestan province. There were 89.94, 43.9, 38.3, and 30.66 per 100 000 people. The highest numbers of malaria cases were recorded in the cities Sarbaz, Nickshahr, and Chabahar in Sistan and Baluchestan province and Bandar Abbas, Bandar Jask, and Bandar Lengeh in Hormozgan province. During the four-year period, 57.05% of cases were caused by imported factors. The majority of cases were related to the trophozoite lifecycle of parasites. Regarding surveillance, there was inactive care in the majority of cases. Vivax malaria was the most prevalent. Conclusions Despite the recently declining trend in reported cases, the expansion of local transmission, especially in areas with cross-border travel, is very worrying. Improved malaria control interventions can be effective for elimination of malaria in Iran; these can include programs to control border travel and focused interventions for high incidence areas and high-risk groups such as rural residents, men, workers, and people <35 years old.

Bio-ecology of malaria vectors in an endemic area, Southeast of Iran

OBJECTIVE@#To determine some bio-ecological aspects of malaria vectors in Jask County, where is targeted for malaria elimination in the national program.@*METHODS@#Mosquitoes were collected monthly during 2013-2014 using different collection methods. Subsequently, ELISA test was used to detect the human blood index of mosquitoes. The susceptibility status of Anopheles stephensi was evaluated against the diagnostic dosages of seven WHO recommended insecticides.@*RESULTS@#A total of 3650 female and 4736 Anopheles larvae were collected including Anopheles stephensi, Anopheles culicifacies s.l., Anopheles dthali, Anopheles fluviatilis s.l., Anopheles moghulensis and Anopheles turkhodi species. Anopheles stephensi was the dominant collected species on human baits and indoors with high rate of unfed and gravid specimens in internal and external window traps. Human blood index was calculated as 14.3% for this species. It was also found to be resistant to DDT and Dieldrin.@*CONCLUSIONS@#The collected species had a wide range of habitats, and resting behaviors. With regarding to the presence of most important malaria vectors in Jask, control of the disease may be so complicated; as based on the weather condition it can be transmitted during the whole year, expect for cold months. With this strong potential of transmission, existing population movements in the area may lead to imported cases of malaria and local outbreak(s). So, more specific studies on malaria vectors in high risk areas of Jask County are recommended.

Epidemiological status of malaria in Iran, 2011-2014

OBJECTIVES@#To aim to determine the status and epidemiological aspects of malaria in Iran in favour of gaining a better understanding of the national control of malaria.@*METHODS@#This epidemiological study examined the status of malaria from 2011 to 2014 in Iran. Data were collected from the Ministry of Health's protocol for controlling and eliminating malaria, which is currently in use. This malaria information reporting system is automated in all Iranian provinces and cities, and all information is submitted online to the center for communicable disease control in the Ministry of Health. Information about malaria is available for researchers to evaluate.@*RESULTS@#The incidence rates decreased from 2011 to 2014. There were 4.76, 2.12, 1.80, and 1.59 per 100000 people, respectively from 2011 to 2014. During the four-year period (2011-2014), the highest numbers of cases occurred in those aged 16-25 years, by age, and in men, by sex. Most of the cases were workers and located in rural areas. An average 52.58% of cases were Iranian. The highest incidence rates from 2011 to 2014 were located in Sistan and Baluchestan province. There were 89.94, 43.9, 38.3, and 30.66 per 100000 people. The highest numbers of malaria cases were recorded in the cities Sarbaz, Nickshahr, and Chabahar in Sistan and Baluchestan province and Bandar Abbas, Bandar Jask, and Bandar Lengeh in Hormozgan province. During the four-year period, 57.05% of cases were caused by imported factors. The majority of cases were related to the trophozoite lifecycle of parasites. Regarding surveillance, there was inactive care in the majority of cases. Vivax malaria was the most prevalent.@*CONCLUSIONS@#Despite the recently declining trend in reported cases, the expansion of local transmission, especially in areas with cross-border travel, is very worrying. Improved malaria control interventions can be effective for elimination of malaria in Iran; these can include programs to control border travel and focused interventions for high incidence areas and high-risk groups such as rural residents, men, workers, and people <35 years old.

rate of plasmodium vivax infectivity within gloucose-6-phosphate dehydrogenase [G6PD] deficient individuals in hor-mozgan province, Iran

One of the most important enzymatic disorders that interact with malaria is deficiency of G6PD [Gloucose-6-phosphate dehydrogenase]. This enzyme protects red blood cells from hydrogen peroxide and other oxidative damages. Distribution of this enzyme deficiency usually accompanies with low level distribution of malaria disease in most malarious areas. So this hypothesis may be considered that the G6PD deficiency could be protective against malaria. Totally 160 samples were taken from vivax malaria infected and non-infected individuals. Preparing blood smears and quantitative test for G6PD deficiency were employed for all of the samples. To ensure accuracy of the malaria in negative samples besides using microscopical examination, semi-nested multiplex PCR was also performed for the two groups. In microscopical examination 36 and 124 samples were vivax malaria positive and negative respectively. Out of 36 P.vivax positive cases 3 [8.3%] cases were detected to be G6PD deficient versus 30 [24.2%] cases out of 124 P. vivax negative cases. The results showed a significant differentiation between P. vivax positive and P. vivax negative cases in the rate of G6PD deficiency [3/36 in positive cases versus 30/124 in negative cases] [P<0.05]. vivax malaria positive individuals with G6PD deficiency showed too mild symptoms of Malaria or even asymptomatic

Molecular characterization, biological forms and sporozoite rate of Anopheles stephensi in southern Iran

<p><b>OBJECTIVE</b>To identify the biological forms, sporozoite rate and molecular characterization of the Anopheles stephensi (An. stephensi) in Hormozgan and Sistan-Baluchistan provinces, the most important malarious areas in Iran.</p><p><b>METHODS</b>Wild live An. stephensi samples were collected from different malarious areas in southern Iran. The biological forms were identified based on number of egg-ridges. Molecular characterization of biological forms was verified by analysis of the mitochondrial cytochrome oxidase subunit I and II (mtDNA-COI/COII). The Plasmodium infection was examined in the wild female specimens by species-specific nested-PCR method.</p><p><b>RESULTS</b>Results showed that all three biological forms including mysorensis, intermediate and type are present in the study areas. Molecular investigations revealed no genetic variation between mtDNA COI/COII sequences of the biological forms and no Plasmodium parasites was detected in the collected mosquito samples.</p><p><b>CONCLUSIONS</b>Presence of three biological forms with identical sequences showed that the known biological forms belong to a single taxon and the various vectorial capacities reported for these forms are more likely corresponded to other epidemiological factors than to the morphotype of the populations. Lack of malaria parasite infection in An. stephensi, the most important vector of malaria, may be partly due to the success and achievement of ongoing active malaria control program in the region.</p>

Timeliness of malaria surveillance system in Iran

We aimed to evaluate the timeliness of reporting of malaria surveillance system and understanding the existing problems. The timeliness of malaria surveillance system of Iran was evaluated in four provinces of Iran including Sistan and Baluchistan, Hormozgan, Kerman [as provinces with local malaria transmission] and Khuzestan [without local malaria transmission]. In this descriptive-analytic cross-sectional study two levels of Primary Health Care service providers including first level [Health Houses] and second level [Urban or Rural Health care units] were evaluated with regard to reporting of malaria surveillance system. Forms number 1 [87% reported within one day] and number 2 [reporting median: 2 days] are reported from first level to second level, and forms number 4 [median: 4 days], number 3 [median: 6 days], number 7 [median: 9 days], number 5 [median: 11 days] and number 6 [median: 19 days] are reported from second level to the third level respectively in a shorter time. Independent variables such as distance, local malaria transmission level, and case finding type, are the factors affecting the reporting delay. Reporting in the first level compared to the second level is done with lower delay. In the areas where there is a deadline set for reporting, reporting is done more timely. Whatever number of malaria cases is decreased, sensitivity and subsequently timeliness reduced. It is recommended that the studies of timeliness be done with sensitivity and usefulness analysis of surveillance system

Determination of malaria epidemiological status in Iran's malarious areas as baseline information for implementation of malaria elimination program in Iran

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. 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. Since vivax malaria is predominant in Sistan and 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. 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

Effects of educational intervention on long-lasting insecticidal nets use in a Malarious area, Southeast Iran

Long-lasting insecticidal nets [LLINs] have been advocated as an effective tool against malaria transmission. However, success of this community based intervention largely depends on the knowledge and practice regarding malaria and its prevention. According to the national strategy plan on evaluation of LLINs [Olyset nets], this study was conducted to determine the perceptions and practices about malaria and to improve use of LLINs in Bashagard district, one of the important foci of malaria in Southeast Iran. The study area comprised 14 villages that were randomized in two clusters and designated as LLINs and untreated nets. Each of households in both clusters received two bed nets by the free distribution and delivery. After one month quantitative data collection method was used to collect information regarding the objectives of the study. On the basis of this information, an educational program was carried out in both areas to increase motivation for use of bed nets. Community knowledge and practice regarding malaria and LLIN use assessed pre- and post-educational program. The data were analyzed using SPSS ver.16 software. At baseline, 77.5% of respondents in intervention and 69.4% in control area mentioned mosquito bite as the cause of malaria, this awareness increased significantly in intervention [90.3%] and control areas [87.9%], following the educational program. A significant increase also was seen in the proportion of households who used LLINs the previous night [92.5%] compared with untreated nets [87.1%]. Educational status was an important predictor of LLINs use. Regular use of LLIN was considerably higher than the targeted coverage [80%] which recommended by World Heaths Organization. About 81.1% and 85.3% of respondents from LLIN and control areas reported that mosquito nuisance and subsequent malaria transmission were the main determinants of bed net use. These findings highlight a need for educational intervention in implementation of long-lasting insecticidal nets; this should be considered in planning and decision-making in the national malaria control program during the next campaigns of LLINs in Iran

Spatial outline of malaria transmission in Iran

OBJECTIVE@#To conduct for modeling spatial distribution of malaria transmission in Iran.@*METHODS@#Records of all malaria cases from the period 2008-2010 in Iran were retrieved for malaria control department, MOH&ME. Metrological data including annual rainfall, maximum and minimum temperature, relative humidity, altitude, demographic, districts border shapefiles, and NDVI images received from Iranian Climatologic Research Center. Data arranged in ArcGIS.@*RESULTS@#99.65% of malaria transmission cases were focused in southeast part of Iran. These transmissions had statistically correlation with altitude (650 m), maximum (30 °C), minimum (20 °C) and average temperature (25.3 °C). Statistical correlation and overall relationship between NDVI (118.81), relative humidity (⩾45%) and rainfall in southeast area was defined and explained in this study.@*CONCLUSIONS@#According to ecological condition and mentioned cut-off points, predictive map was generated using cokriging method.

Genetic structure of Plasmodium vivax population assessed by sequence analysis of the merozoite surface protein 3 beta gene

The endemicity and transmission intensity levels of malaria are related to genetic diversity of the parasites. Merozoite surface protein 3beta [MSP3beta] is an important marker for assessing the polymorphic nature of Plasmodium vivax while it is also a vaccine candidate against the parasite. In this study we investigated the genetic structure of P. vivax population by sequence analysis of a polymorphic region of the P. vivax MSP3beta gene in isolates from Iran. Blood samples were collected from 100 patients with clinical symptoms. DNA was extracted and the target gene was amplified by polymerase chain reaction [PCR]. The sequences of 17 samples were used for sequence analysis using nucleotide Blast search and ClustalW multiple alignment. Phylogenetic tree was derived to describe the geographical branching and relationships. A large number of nucleotide insertions and deletions were observed in the sequences of polymorphic region of PvMSP3beta gene that were not specific in each biotype. Single nucleotide polymorphism [SNP] was found extensively in the sequences. The phylogenetic analysis did not show any significant geographical branching. The lack of any geographical branching and extensive polymorphism in MSP3beta gene of P. vivax isolates suggests that more investigations are needed to find a more suitable gene in order to develop a vaccine

Monitoring pyrethroid insecticide resistance in major malaria vector anopheles culicifacies: comparison of molecular tools and conventional susceptibility test

Anopheles culicifacies is a main malaria vector in southeastern part of Iran, bordering Afghanistan and Pakistan. So far, resistance to DDT, dieldrin, malathion and partial tolerance to pyrethroids has been reported in An. stephensi, but nothing confirmed on resistance status of An. culicifacies in Iran. In current study, along with WHO routine susceptibility test with DDT [4%], dieldrin [0.4%], malathion [5%], permethrin [0.25%], lambadacyhalothrin [0.1%], and deltamethrin 0.025, we cloned and sequenced segment VI of domain II [SII6] in voltage-gated sodium channel [vgsc] gene of An. Culicifacies specimens collected in Sistan and Baluchistan province [Iran]. A 221-bp amplified fragment showed 91% and 93% similarity with exon I and exon II of An. gambiae. The size of intron II in An. culicifacies is 62 bp, while in An. gambiae is 57 bp. The major difference within An. culicifacies specimens and also with An. gambiae is in position 29 of exon I, which led to substitution of Leu to His amino acid. This data will act as first report on partial sequence of vgsc gene and its polymorphism in An. culicifacies. A Leu to His amino acid substitution detected upstream the formerly known knockdown resistance [kdr] mutation site could be an indication for other possible mutations related to insecticide resistance. However, the result of WHO susceptibility test carried out in Baluchistan of Iran revealed a level of tolerance to DDT and dieldrin, but almost complete susceptibility to pyrethroids in An. culicifacies. We postulate that the molecular diagnostic tool developed for detection and identification of kdr-related mutations in An. culicifacies, could be useful in monitoring insecticide resistance in Iran and neighbouring countries such as Pakistan and Afghanistan. A phylogenetic tree also constructed based on the sequence of exon I and II, which readily separated An. culicifacies populations from An. stephensi, An. fluviatilis and An. gambiae

[ investigation of the managers' need to learn management skills and principles in health care networks in Esfahan province in 1380]

Introduction: management is a specialized science and since most of the health managers are not familiar with scientific management methods and direct their organization on the basis of their own experiences and assumptions , it is necessary to devise comprehensive educational programs according to the results of needs assessment in order to promote the quality of health care services

Materials and methods: the health network managers, deputy managers, health care assistants, the managers of rural and urban health care centers of nineteen health networks in Isfahan province were selected. To evaluate their educational needs, the researcher asked them to fill in questionnaires

Results: the majority of the managers [54%] were between 25 to 35 years old. Most of them [34.7%] had between five to nine years of service and 59% worked as manages between one to four years. 52% did not receive any training and 30% had participated in training courses. They mostly required executive [48.5%] and planning [46%] skills. There was a meaningful relationship between years of management services and all aspects of management skills

Discussion: since the years of management services are related to all management skills, the level of experience can influence the individuals ' skills. The years of service affect the executive skills and participation in training courses affect the planning quality