Laboratory and field evaluation of two formulations of Bacillus thuringiensis M-H-14 against mosquito larvae in the Islamic Republic of Iran, 2012

Due to low efficacy in the field of a local commercial product of Bacillus thuringiensis M-H-14 [Bioflash[registered sign]], a study was designed to assess its efficacy in laboratory, glass standard aquarium, semi-field and field conditions at both target and higher dosages against immature stages of Anopheles spp. and Culex spp. In laboratory conditions, the LC[50] values of wettable powder and granule formulations were 227 and 1031 ppm respectively against a susceptible strain of An. stephensi. Following application of wettable powder and granules at 56.1 mg/aquarium, the survival rates of the exposed larvae to the granule formulation were 65.6% and 54.2% on days 6 and 8 respectively. In the artificial ponds, the larval density was reduced to 38.9%, 39.3% and 65.1% at dosages of 2, 4 and 8 g/m[2] respectively. In rice fields, at a dosage of 2 kg/ha, the density of immature larvae were reduced to 33.1% and 28.6% 7-days post-treatment. Further investigations are needed for the reasons for the low efficacy of this larvicide

Vector ecology and susceptibility in a malaria-endemic focus in southern Islamic Republic of Iran

This study aimed to carry out a malaria situation analysis, species composition and susceptibility levels of the main malaria vector, Anopheles stephensi, to different insecticides in Bashagard. A longitudinal survey was conducted in 2 randomly selected villages in Bashagard. Malaria vectors were sampled by dipping method for the larvae and hand catch, night-biting catch, total catch, and shelter pit collection for the adults. Standard WHO susceptibility tests were used for a variety of insecticides on F1 progeny of An. stephensi reared from wild-caught females. In total, 693 adult anopheline mosquitoes and 839 third and fourth-instar larvae were collected and identified. They comprised 7 species; the most abundant adult and larvae anopheline mosquito was An. Dthali [40.7% and 30.5% respectively]. An. Culicifacies[24.2%] and An. Stephensi [16.7%] were the next most common species for adult mosquitoes. An. Stephensi was fully susceptible to malathion and pyrethroid insecticides but resistant to DDT and tolerant to dieldrin

Lessons learnt from malaria epidemics in the Islamic Republic of Iran

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 [8.3% 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

In vivo susceptibility of plasmodium vivax to chloroquine in Southeastern Iran

Plasmodium vivax is the predominant species causes of malaria with about 90% total annual reported malaria in Iran. This study conducted to determine the susceptibility of Plasmodium vivax isolates to chloroquine in Sistan and Balochistan Province, southeastern Iran. A total 270 subjects with symptomatic malaria and confirmed P. vivax infection completed the designed 28-day in vivo study. The thick and thin film blood smears were screened for malaria parasites by microscopy. The nested PCR was applied using the Plasmodium 18 subunit ribosomal ribonucleic [Ssr RNA] genes for detecting mixed infections and diagnosis of parasites in the samples with low parasite on days 0, 5, 6, 7, and 28. P. vivax was cleared in 15%, 50%, 95%, and 100% of patients on days 1, 2, 3, 4 respectively by microscopy assessment. Six patients were exhibited specific P. vivax band in nested PCR on day 5. No recurrence was observed on days 7, 14 and 28. Mean [ +/- standard deviation] parasite clearance time was 2.41 [ +/- 0.8] days. P. vivax is still susceptible to chloroquine in Southeastern Iran. This finding is compatible with results of neighboring countries Pakistan and Afghanistan

Ecology of malaria vector Anopheles culicifacies in a malarious area of Sistan va Baluchestan province, south-east Islamic Republic of Iran

A study was done of the bionomics, insecticide susceptibility and irritability status of Anopheles culicifacies in Sistan va Baluchestan province. Sampling was performed to determine the following parameters: species identification, seasonal activity, adult and larval susceptibility tests, irritability tests, anthropophily index and sporozoite rate. An. culicifacies adults were susceptible to all tested pyrethroid insecticides. An. culicifacies started to appear indoors in late May, showing 2 peaks in June and September. Fenitrothion, cyfluthrin and permethrin had the least irritancy effect and DDT the highest. Only 2/860 females tested were infected with Plasmodium spp. [sporozoite rate: 0.25%]. EL1SA testing of 250 blood meals derived from night-biting collections of female mosquitoes from humans and cows revealed that only 12.5% were human-fed

Absence of asymptomatic malaria infection in endemic area of Bashagard district, Hormozgan province, Iran

A successful malaria elimination program calls for enough attention to parasite carriers, especially asymptomatic malaria, as well as the diagnosis and treatment of clinical cases. Asymptomatic malaria is an infection that patients do not show any symptom; thus, these patients play critical role in the concept of an elimination program. The current investigation was conducted to evaluate the presence of these cases in Bashagard District, formerly a high malaria transmission area in Hormozgan Province, Iran. Blood samples [n=500] were collected from symptomless individuals residing in Bashagard to evaluate Plasmodium infection by using microscopic, serological and nested-PCR techniques. Regarding the microscopic and nested-PCR analysis, no asymptomatic infection was detected among studied individuals. Totally, 1% of the studied population [5 of 500] had anti PvMSP-119-specific IgG antibody; however, only 0.2% [1 of 500] of the individuals was seropositive to recombinant PfMSP-119, using ELISA. This study showed no asymptomatic malaria infection in the studied population; hence malaria elimination is feasible and can be successfully carried out in this region

Molecular monitoring of plasmodium vivax infection after radical treatment in southeastern Iran

The aim was to evaluate the relapse risk of vivax malaria in patients who received radical treatment in Hormozgan Province, a malarious area located on southeast of Iran. A total of 95 symptomatic vivax malaria infected patients were enrolled in urban health centers of Bandar-Abbas, Minab, Bandar-Jask and Bashagard districts of Hormozgan Province, southeast of Iran from January 2008 to March 2009 for consideration as a case-series study. DNA was extracted from parasite infected whole blood samples. A polymorphic region of Plasmodium vivax merozoite surface protein 1 [pvMSP1] was selected and a PCR method was employed for all the samples to amplify the specific variable gene fragment. The obtained fragments in primary and secondary samples were sequenced. Both nucleotide and amino acid sequences of the samples were investigated for returned patients. 3.2% of the patients experienced a second attack between 83-199 days after the initial episode of infection. Alignment of nucleotide and their deduced amino acid sequences between pair sequences of primary and secondary isolates revealed 8 and 6 dissimilarities respectively for the first case, and 9 and 7 dissimilarities for the second case. Although microscopical examination of recurrent thick blood smear of the third patient confirmed new P. vivax infection, the venous blood sample was accidentally missed. Sequencing results of primary and returned isolates 1P, 1S, 2P, 2S and 3P in this study showed an identity with BP13, T117, BP13, TC28 and Chesson genotypes respectively. The returned [secondary] isolates may account to be for the sake of reinfection

Residual effects of deltamthrin WG 25% as a new formulation on different surfaces against anopheles stephensi, in Southeastern Iran

Indoor residual spraying [IRS] is functioned as national interventions against malaria in southeastern foci of Iran and deltamethrin WP one of the insecticides have been used since past decade. In this study, the residual activity of the wettable granule [WG] was studied on different surfaces in hut scale trial against Anopheles stephensi in Iranshahr district, southeastern Iran. Three dosages of 25, 40 and 50 mg a.i./m2 of deltamethrin WG 25% formulation were applied on plaster, cement, mud, and wooden surfaces using Hudson[Registered] X-pert compression sprayer having 10 litters capacity. The residual effects of deltamethrin WG 25% on different surfaces was assessed based on reduction of mortality An. stepehnsi from 100% to about 70%. At 25, 40 and 50 mg a.i./m2 the WG formulation of deltamethrin had a bioefficacy for about 2, 3 and 4 months respectively. There was an expectable fluctuation in mortality of An. stephensi at different sprayed surfaces as well as dosages. The proposed 50 mg/m2 WG is the longest activity for up to 4 months which needs to be applied for two spraying cycles per year at the climatically condition of southwestern Iran

[Seroparasitological evaluation of Plasmodium vivax malaria and stability of the anti-plasmodial antibodies in Parsabad, Ardabil province]

Malaria is one of the most important parasitic diseases in the world and a major health problem in some areas of Iran. In addition to endemic areas in the south and south-eastern part of Iran, a new threat of Plasmodium vivax malaria importation emerged from the Parsabad district, which is located in Ardabil province in the north western part of the country. Malaria in this area may have originated from Azerbaijan, Armenia or southern part of Iran. This study has been carried out to clarify seroparasitological results from Indirect Fluorescence Assay [IFA], stability of antiplasmodial antibodies and its comparison with those of confirmed direct microscopy in Parsabad district during 2003-2005. This seroparasitological study has been carried out on 250 samples from malaria infected patients which was previously confirmed by microscopy and treated with routine antimalarial agents, and 250 samples of healthy control with no history of malaria in Parsabad during two years [2003-2005]. Sera of collected blood samples were assessed for the presence of anti-plasmodial antibodies using IFA assay. Statistical analysis was applied by using ANOVA and Students t-tests with Graph Pad Prism. The results of this study indicated that all blood smears of test group were detected as positive by observation of P. vivax by direct microscopy and no positive smears were found among control group. Moreover, no mixed-infection was observed among collected samples. In addition, serological results revealed that 47 cases [19%] from test group and 4 cases [1.6%] from control group had antibodies against P. vivax malaria [P<0.001]. The results of this study demonstrated that the rate of antiplasmodial antibodies is not stable in malaria infected patients which was previously confirmed by microscopy and can not be used for epidemiological evaluation for malaria in this area. Therefore, more investigation is needed for evaluation and detection of the malaria

Plasmodium vivax MSP-3 beta gene as a genetic marker for the parasite detection in comparison with SRNA gene

The importance of accurate diagnosis of all of major diseases cannot be underestimated and efficient laboratory testing is vital to identifying and treating life-threatening illnesses including malaria. In this study, we compared the potential of one of merozoite surface protein genes, PvMSP-3 beta, for detection of Plasmodium vivax in blood samples by PCR with routinely used marker, ssrRNA gene. One hundred P. vivax microscopy-positive blood samples were simultaneously tested with two genetic markers, including PvMSP-3 beta gene and ssrRNA gene by PCR and nestedPCR method, respectively, and their sensitivity and specificity in detection of P. vivax was compared. An important difference was seen in sensitivity between the 2 genetic markers, 100% in case of ssrRNA gene vs. 95% of PvMSP-3 beta gene. The specificity of the two markers was same [100%]. Microscopic diagnoses of thick and thin blood smears was used as "golden standard" method. Due to critical importance of accurate detection of the parasite in malarious area, the PvMSP-3 beta gene cannot be a suitable marker for detection of P. vivax in blood sample by PCR. More investigations are needed to find other valid markers

[Detection of plasmodium vivax by nested PCR in marious areas of western north of Iran]

Malaria is one of the most important parasitic diseases in tropical and sub-tropical areas of the world and kills a large number of People annually. Diagnosis of the disease is preformed by microscopic and molecular methods. This study has been designed for detecting of latent/sub-patent infection caused by plasmodium vivax in individuals with history of vivax malaria without any clinical signs by means of microscopic and molecular methods. In this descriptive study, the blood samples of 38 individuals from Parsabad [Ardabil province] and Kaleiber [East Azarbayejan province] has been collected one year after primary diagnosis of vivax malaria and effective treatment of the diseases, based on the standard country's protocol, as well as upon primary microscopic detection of thin and thick blood smears. They were assessed by Nested-PCR method in Pastor Institute of Iran. All samples were negative by microscopic method; we found one vivax positive case via Nested-PCR. Microscopic examination is a selective and standard method in malaria diagnosis. Due to the probability of existence of latent/sub-patent infection in endemic areas and microscopic misdiagnosis of thin and thick blood smears and epidemiologic importance of malaria diagnosis, the use of molecular methods such as Nested-PCR in individuals with history of vivax malaria to detect any latent/sub/patent infection seems to be beneficial

Partial sequence analysis of merozoite surface protein-3 alpha gene in plasmodium vivax isolates from malarious areas of Iran

Approximately 85-90% of malaria infections in Iran are attributed to plasmodium vivax, while little is known about the genetics of the parasite and its strain types in this region. This study was designed and performed for describing genetic characteristics of plasmodium vivax population of Iran based on the merzoite surface protein-3 alpha gene sequence. Through a descriptive study we analyzed partial P. viva merozoite surface protein-3 alpha gene sequences from 17 clinical P. vivax isolates collected from malarious areas of Iran. Genomic DNA was extracted by Q1 Aamp DNA blood mini kit, amplified through nested PCR for a partial nucleotide sequence of PvMSP-3alpha gene in P. vivax. PCR-amplified products were sequenced with an ABI Prism Perkin-Elmer 310 sequencer machine and data were analyzed with clustal W software. Analysis of PVMSP-3alpha gene sequence demonstrated extensive polymorphisms, but the sequence identity between isolates of same types was relatively high. We identified specific insertions and deletions for the types A, B and C variants of vivax in our isolates. In phylogenetic comparison of geographically separated isolates, there was not a significant geographical branching of the parasite populations. The highly polymorphic nature of isolates suggests that more investigations of the PvMSP-3alpha gene are needed to explore its vaccine potential

Deltamethrin impregnated bed nets in a malaria control program in Chabahar, southeast Baluchistan, I.R. Iran

A field trial was carried out in the Chabahar District of Sistan and Baluchistan Province, southeastern Iran on the efficacy of mosquito nets treated with a suspension formulation of deltamethrin [K-O THRIN[R]] against malaria vectors. Treated nets were used in three villages, and in the two control villages, one used untreated nets and the other used indoor spraying with deltamethrin [WP 10%], without nets. Treatment of polyester mosquito net with a target dose of 25 mg/m[2] active ingredient, carried out in mid-April 2005. Bioassays repeated on domestically used nets over 7 months showed persistence of almost 100% mortality of Anopheles Stephensi over this period. Adult mosquitoes were collected by pyrethroid space spray catch of living quarters and stables, cattle bait and pit shelter catches. Overall, An. culicifacies Giles s.l. predominated [49.8%], followed by An. stephensi Liston s.l.[36.9%], An. pulcherrimus Theobald [7.3%], An. dthali Patton [5.7%] and An. fluviatilis James [0.3%]. Acknowledge, Attitude and Practice [KAP] study showed that about 97% of respondents in communities agreed that they would like to participate in malaria control activities such as personal protection using impregnation bed net. Therefore, in planning for future large scale trials, comparison of new compounds and formulations such as tablets and long lasting insecticides impregnated bed net is recommended

Diversity of merozoite surface protein-3beta gene of plasmodium vivax isolates from Iran

Plasmodium vivax malaria accounts for approximately 88% of malaria cases in Iran. There is limited information on genetic diversity of P. vivax in the country and a need to develop and apply an effective vaccine against the disease is necessary. Among many potential candidates, MSP -3beta gene is promising target. This study was designed and carried out to determine the variation of this gene as genetic marker in population of malarious areas of Iran. Blood sample of 85 P. vivax isolates from four southern and east-southern provinces of the country assessed for polymorphism of PvMSP-3beta gene by PCR/RFLP method. Based on the size of PCR product of the gene, 7 genetically different types of parasite has been distinguished. Two alleles were simultaneously visible in 19% of the cases. Results from PCR/RFLP analysis of PvMSP-3beta gene showed at least 15 allelic groups. Multiple infections have been found in 2.4% of the cases. PvMSP-3beta gene was highly diverse in P. vivax isolates of malarious areas of Iran, and can be a suitable marker for population genetic studies of P. vivax. More investigations on PvMSP-3beta genes are needed to reveal genetic structure of P. vivax in Iran

[Comparison of knowledge, attitude and practice [KAP] regarding malaria transmission and protection between afghan refugees and Iranian residents in Iranshahr, 2005-2006]

The aim of present study is to compare Afghan refugees and Iranian residents in terms of their knowledge, attitude and practice concerning malaria transmission and protection in an endemic area in Southeast Iran. This cross sectional study was conducted over a period of 10 months [2004-2005] and involved a total of 775 people, including Iranian and Afghan subjects. The age range of participants was 15 to 55 years. Data collection was done through a structured questionnaire consisting of open and close questions and comprising several, namely personal characteristics details, history of malaria infection and treatments, type of residence, mobility, self protection, facilities, and access to health services. Both Iranians and Afghans were familiar with the three typical symptoms of the disease [fever, chills and muscle aches]: 67.1% of Iranians and 78% of Afghans were able to name least one of the three typical symptoms. In both groups the majority of subjects were aware that malaria transmission occurs through mosquito bite but there was a significant difference regarding knowledge of malaria transmission [CHI2 = 142.2, P<0.001]. Chi-square test for goodness of fit showed that the distribution of symptom indicators is significantly different between the two groups. For Iranians, the most important source of information about malaria was the health facilities [44.5% of the total] while most Afghans [65.3%] had obtained the information through friends and relatives. In both groups, the mass media had acted as the source of information in only 3.4%. Altogether, 24% of the participants reported the use of mosquito bed nets; almost 90% of Afghans and 62% of Iranians said that they did not used bed nets at all. However, the number of Iranians who used bed nets was four times greater than the Afghans who did so. Although the majority of subjects were familiar with malaria transmission and protection methods, they largely neglected safety precautions. Moreover, it seems that the high prevalence of malaria among Afghans is due to their life style rather than cross-border travel. The study also revealed that Afghan people have poor communication with the local health facilities, a point that must receive special attention in future malaria control programs

comparative study on accreditation models in Europe and the USA

The scientific, technological and economic development of a society is closely related to its public health. Therefore; improvement of health service quality along with increasing the number of health facilities is one of the main concerns of health care authorities in developed countries. This study was designed to compare accreditation models of health care organizations in Europe and the United States. This was a comparative-review study in which a wide range of paper and electronic data sources related to different accreditation models in all European countries and the US were collected. The origins, underlying principles and the application of various accreditation models in health care were compared. Our findings showed that four models of health care accreditation were applied in European countries. The ISO and EFQM models had industrial origins, and were more frequently used in technical fields such as laboratories and administrative department of hospitals. Other accreditation models, however, had health care origins and were used for the accreditation of all sections of hospitals as well as for specialized clinical groups. One of the main challenges facing countries whishing to establish an accreditation system is to reach an agreement on the concept and characteristics of the accreditation model

Molecular evidence of mixed P. vivax and P. falciparum infections in northern Islamic Republic of Iran

This study compared basic microscopy with molecular detection of Plasmodium species. According to thick-film microscopy, 100% of 142 malaria cases in Pars-Abad, Ardebil province, were infected with a single species, P vivax. However, nested polymerase chain reaction [PCR] detected mixed species infections of both P. vivax and P. falciparum in 7.0%. In Maz and eran province, 2/20 blood films were diagnosed with only P. falciparum and 18/20 with only P. vivax. However, nested PCR detected 17/20, 2/20 and 1/20 with P. vivax only, P. falciparum only and mixed species respectively. The unexpected presence of P. falciparum urges prompt investigation and immediate treatment of malaria cases in this region