The Challenges of the Malaria Elimination Program in the South East of Iran, a Qualitative Study
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Abstract
Background: Despite all the efforts made to control and eliminate malaria in Iran, this disease is still considered as a priority health problem in the South East of Iran. We aimed to determine the cultural obstacles which have prevented the elimination of malaria in this region.
Method: This study was carried out through qualitative content analysis.
Purposeful sampling was done from people who had malaria or were involved with malaria patients in 2015, in Sarbaz City, Sistan and Baluchestan Province, Eastern Iran. Data were collected through interviews using open questions and continued until data saturation.
Results: The most important barriers in malaria prevention was delay in visiting health centers, delay in diagnosis and treatment due to superstitious beliefs, lack of information about the disease, misdiagnosis and fake doctors. Other obstacles were lack of trust and cooperation with interventions offered by the health system, lack of proper use of the available facilities to prevent malaria and commuting in the high-risk neighbor countries.
Conclusion: Raising awareness in people, officials and health workers about malaria and preventive health interventions as well as health risks associated with fake doctors, following up and re-examination of peripheral blood smear in suspected cases, establishing malaria control stations in border areas and specific measures to refer immigrants and people crossing the border toward malaria diagnosis stations is suggested.
1. World Health Organization (2016) World Malaria Report. World Health Organization, Geneva, Switzerland. Available at: http://www.who.int/gho/malaria/epidemic/cases/en/ (accessed on 10 February 2018).
2. World Health Organization (2012) World Malaria Report. World Health Organization, Geneva, Switzerland. Available at: http://www.who.int/gho/malaria/epidemic/cases/en/ (accessed on 27 September 2014).
3. Holakouie Naieni K, Nadim A, Moradi G, Teimori S, Rashidian H, Kandi Kaleh M (2012) Malaria Epidemiology in Iran from 1941 to 2006. SJSPH. 10(1): 77–90.
4. Halimi M, Farajzadeh M, Delavari M, Bagheri H (2014) Climatic Survey of Malaria Incidence in Iran during 1971–2005. SJSPH. 12(1): 1–11.
5. Halimi M, Delavari M, Jafarymadrak M (2013) Modeling the spatial spread of malaria in Baluchistan province by geographically weighted regression model. JSP. 17(3): 85–108.
6. Raeisi A, Nikpoor F, Ranjbar Kahkha M, Faraji L (2009) The trend of Malaria in Iran from 2002 to 2007. Hakim Res J. 12(1): 35–41.
7. Ministry of Health and Medical Education (2010) Malaria Elimination, in Islamic Republic of Iran (Horizon 1404). Ministry of Health and Medical Education, Tehran, Iran.
8. Dial NJ, Ceesay SJ, Gosling RD, Alessandro U, Baltzell KA (2014) A qualitative study to assess community barriers to malaria mass drug administration trials in the Gambia. Malaria J. 13(1): 47–55.
9. Newell I, Wiskin C, Anthoney J, Meza G, de Wildt G (2018) Preventing malaria in the Peruvian Amazon: a qualitative study in Iquitos, Peru. Malar J. 17(1): 31–41.
10. Pilkington H, Mayombo J, Aubouy N, Deloron P (2004) Malaria, from natural to supernatural: a qualitative study of mothers’ reactions to fever (Dienga, Gabon). J Epidemiol Commun Health. 58 (10): 826–830.
11. Yavari P (2013) Epidemiology Textbook of Prevalent Diseases in Iran. Vol. 1. Gap Publishers, Tehran, Iran.
12. Azizi F, Janghorbani M, Hatami H (2011) Epidemiology and Control of Commom Diseases in Iran, Vol. 1. Khosravy Publications, Tehran.
13. Nejati J, Sakeni M, Tabatabai SM, Kiani M, Daneshmand Naroey N (2012) The General Principles of Malaria with an Approch to its Elimination in Sistan and Baluchistan Province. Vol. 1. Nehzat Poya Publishers, Tehran.
14. Sedaghat MM, Nadim A, Goudarzi A, Holakouie Naieni K, Nateghpour M, Ladonni H, Khamis-Abadi K (2013) Entomological research and its specific course in Iran from 1935 to 2008. SJSPH. 11(1): 99–112.
15. Krefis AC, Schwarz NG, Nkrumah B, Acquah S, Loag W, Sarpong N, Adu-Sarkodie Y, Ranft U, May J (2010) Principal component analysis of socioeconomic factors and their association with malaria in children from the Ashanti Region, Ghana. Malaria J. 9(1): 201–207.
16. Koram KA, Bennett S, Adiamah JH, Greenwood BM (1995) Socio-economic risk factors for malaria in a periurban area of The Gambia. Trans R Soc Trop Med Hyg. 89(2): 146–150.
17. Masoumi Asl H, Motabar M, Zamani G, Naserinejad D, Vatandoost H (2003) A case-control study of determinative factors on malaria morbidity in Minab, Jask and Roodan Counties, in Hormozgan Province, southern Iran, 2001. Iran J Publ Health. 32(3): 14–18.
18. Sartipi M, Khosravi A, Khalaji K, Shamsipour M, Kazemi Galougahi MH, Sakeni M, Holakouie Naieni K (2014) Examining the risk factors of Malaria: A matched case-control study. Journal of Nurse and Physician within War. 25: 10–16.
19. Hanafi-Bojd AA, Vatandoost H, Oshaghi MA, Eshraghian MR, Haghdoost AA, Abedi F, Zamani G, Sedaghat MM, Rashidian A, Madani AH, Raeisi A (2011) Knowledge, attitudes and practices regarding malaria control in an endemic area of southern Iran. Southeast Asian J Trop Med Public Health. 42(3):
491–501.
20. Jadgal KM, Zareban I, Rakhshani F, Shahrakipour M, Sepehrvand B, Alizadeh Sivaki H (2012) The effect of health education according to the theory of planned behavior on malaria preventive behavior in rural men of Chabahar. J Research Health. 2(2): 236–245.
21. Fekri S, Vatandoost H, Daryanavard A, Shahi M, Safari R, Raeisi A, Omar AS, Sharif M, Azizi A, Ali AA, Nasser A, Hasaballah I, Hanafi-Bojd AA (2014) Malaria Situation in an Endemic Area, Southeastern Iran. J Arthropod Borne Dis. 8(1): 82–90.
22. Baseri HR, Holakoei Naeini K, Raeisi A, Shahandeh K, Akbarzadeh K, Ranjbar M, Parvin A (2008) Comparison of knowledge, Attitude and Practice (KAP) Regarding Malaria Transmission and Protection between Afghan Refugees and Iranian Residents in Iranshahr, 2005–2006. Iran J Epidemiol. 3(4): 7–13.
23. Poudat A, Ladoni H, Raissi A (2006) Probable effective factors on malaria situa¬tion and morbidity in Bandar. Hormozgan Medical J. 10(2): 101–110.
24. Vatandoost H, Hanafi-Bojd AA (2012) Indication of pyrethroid resistance in the main malaria vector, Anopheles stephensi from Iran. Asian Pacific J Trop Med. 5(9): 722–726.
25. Hanafi-Bojd AA, Vatandoost H, Oshaghi MA, Haghdoost AA, Shahi M, Sedaghat MM, Abedi F, Yeryan M, Pakari A (2012) Entomological and epidemiological attributes for malaria transmission and implementation of vector control in southern Iran. Acta Trop. 121(2): 85–92.
26. Gorouhi MA, Vatandoost H, Oshaghi MA, Raeisi A, Enayati AA, Mirhendi H, Hanafi-Bojd AA, Abai MR, Salim-Abadi Y, Rafi F (2016) Current Susceptibility Status of Anopheles stephensi (Diptera: Culicidae) to Different Imagicides in a Malarious Area, Southeastern of Iran. J
Arthropod Borne Dis. 10(4): 493–500.
27. Edrissian G (2006) Malaria in Iran, Past and Present Situation. Iranian J Parasitol. 1(1): 1–14.
28. Oloo AJ, Mudegu JV, Ngare DK, Ogutu RO, Ondijo SO, Odada PS, Adungo NI, Githeko AK, Ekisa WS, Mahadevan S (1993) The effect of permethrin impregnated sisal curtains on vector density and malaria incidence: a pilot study. East African Medical Journal. 70(8): 475–477.
29. Mbogo CN, Kabiru EW, Glass GE, Forster D, Snow RW, Khamala CP , Ouma JH, Githure JI, Marsh K, Beier JC (1999) Vector-Related Case-Control Study of Severe Malaria in Kilifi District, Kenya. Am J Trop Med Hyg. 60(5): 781–785.
30. Dar FK, Bayoumi R, AlKarmi T, Shalabi A, Beidas F, Hussein MM (1993) Status of imported malaria in a control zone of the United Arab Emirates bordering an area of unstable malaria. Trans Royal Soc Trop Med Hyg. 87(6): 617–619.
31. Forootani MR (2007) Malaria infestation in foreign immigrants residing Larestan township in 2003–2004. Hormozgan Medical J. 11(3): 229–236.
32. Nejati J, Ansari Moghadam AR, Keyhani A, Tabatabai SM (2011) Effects of immigration on malaria incidence and its foci classification. Hormozgan Medical J. 16(4): 283–291.
33. Wiwanitkit V (2007) Rate of malarial infection among foreigners in a tertiary hospital of Thailand: change of epidemiology and importance of travel medi-cine (1996–2005). J Vector Borne Dis. 44(3): 219–222.
34. Matteelli A, Volonterio A, Gulletta M, Galimberti L, Maroccolo S, Gaiera G, Giani G, Rossi M, Dorigoni N, Bellina L, Orlando G, Bisoffi Z, Castelli F (2001) Malaria in illegal Chinese immigrants, Italy. Emerging Infect Dis. 7(6): 1055–1058.
35. Salvadó E, Pinazo MJ, Munoz J, Alonso D,
Naniche D, Mayor A, Quintó L, Gascón J (2008) Clinical presentation and complications of Plasmodium falciparum malaria in two populations: travelers and immigrants. Enferm Infecc Microbiol Clin. 26(5): 282–284.
2. World Health Organization (2012) World Malaria Report. World Health Organization, Geneva, Switzerland. Available at: http://www.who.int/gho/malaria/epidemic/cases/en/ (accessed on 27 September 2014).
3. Holakouie Naieni K, Nadim A, Moradi G, Teimori S, Rashidian H, Kandi Kaleh M (2012) Malaria Epidemiology in Iran from 1941 to 2006. SJSPH. 10(1): 77–90.
4. Halimi M, Farajzadeh M, Delavari M, Bagheri H (2014) Climatic Survey of Malaria Incidence in Iran during 1971–2005. SJSPH. 12(1): 1–11.
5. Halimi M, Delavari M, Jafarymadrak M (2013) Modeling the spatial spread of malaria in Baluchistan province by geographically weighted regression model. JSP. 17(3): 85–108.
6. Raeisi A, Nikpoor F, Ranjbar Kahkha M, Faraji L (2009) The trend of Malaria in Iran from 2002 to 2007. Hakim Res J. 12(1): 35–41.
7. Ministry of Health and Medical Education (2010) Malaria Elimination, in Islamic Republic of Iran (Horizon 1404). Ministry of Health and Medical Education, Tehran, Iran.
8. Dial NJ, Ceesay SJ, Gosling RD, Alessandro U, Baltzell KA (2014) A qualitative study to assess community barriers to malaria mass drug administration trials in the Gambia. Malaria J. 13(1): 47–55.
9. Newell I, Wiskin C, Anthoney J, Meza G, de Wildt G (2018) Preventing malaria in the Peruvian Amazon: a qualitative study in Iquitos, Peru. Malar J. 17(1): 31–41.
10. Pilkington H, Mayombo J, Aubouy N, Deloron P (2004) Malaria, from natural to supernatural: a qualitative study of mothers’ reactions to fever (Dienga, Gabon). J Epidemiol Commun Health. 58 (10): 826–830.
11. Yavari P (2013) Epidemiology Textbook of Prevalent Diseases in Iran. Vol. 1. Gap Publishers, Tehran, Iran.
12. Azizi F, Janghorbani M, Hatami H (2011) Epidemiology and Control of Commom Diseases in Iran, Vol. 1. Khosravy Publications, Tehran.
13. Nejati J, Sakeni M, Tabatabai SM, Kiani M, Daneshmand Naroey N (2012) The General Principles of Malaria with an Approch to its Elimination in Sistan and Baluchistan Province. Vol. 1. Nehzat Poya Publishers, Tehran.
14. Sedaghat MM, Nadim A, Goudarzi A, Holakouie Naieni K, Nateghpour M, Ladonni H, Khamis-Abadi K (2013) Entomological research and its specific course in Iran from 1935 to 2008. SJSPH. 11(1): 99–112.
15. Krefis AC, Schwarz NG, Nkrumah B, Acquah S, Loag W, Sarpong N, Adu-Sarkodie Y, Ranft U, May J (2010) Principal component analysis of socioeconomic factors and their association with malaria in children from the Ashanti Region, Ghana. Malaria J. 9(1): 201–207.
16. Koram KA, Bennett S, Adiamah JH, Greenwood BM (1995) Socio-economic risk factors for malaria in a periurban area of The Gambia. Trans R Soc Trop Med Hyg. 89(2): 146–150.
17. Masoumi Asl H, Motabar M, Zamani G, Naserinejad D, Vatandoost H (2003) A case-control study of determinative factors on malaria morbidity in Minab, Jask and Roodan Counties, in Hormozgan Province, southern Iran, 2001. Iran J Publ Health. 32(3): 14–18.
18. Sartipi M, Khosravi A, Khalaji K, Shamsipour M, Kazemi Galougahi MH, Sakeni M, Holakouie Naieni K (2014) Examining the risk factors of Malaria: A matched case-control study. Journal of Nurse and Physician within War. 25: 10–16.
19. Hanafi-Bojd AA, Vatandoost H, Oshaghi MA, Eshraghian MR, Haghdoost AA, Abedi F, Zamani G, Sedaghat MM, Rashidian A, Madani AH, Raeisi A (2011) Knowledge, attitudes and practices regarding malaria control in an endemic area of southern Iran. Southeast Asian J Trop Med Public Health. 42(3):
491–501.
20. Jadgal KM, Zareban I, Rakhshani F, Shahrakipour M, Sepehrvand B, Alizadeh Sivaki H (2012) The effect of health education according to the theory of planned behavior on malaria preventive behavior in rural men of Chabahar. J Research Health. 2(2): 236–245.
21. Fekri S, Vatandoost H, Daryanavard A, Shahi M, Safari R, Raeisi A, Omar AS, Sharif M, Azizi A, Ali AA, Nasser A, Hasaballah I, Hanafi-Bojd AA (2014) Malaria Situation in an Endemic Area, Southeastern Iran. J Arthropod Borne Dis. 8(1): 82–90.
22. Baseri HR, Holakoei Naeini K, Raeisi A, Shahandeh K, Akbarzadeh K, Ranjbar M, Parvin A (2008) Comparison of knowledge, Attitude and Practice (KAP) Regarding Malaria Transmission and Protection between Afghan Refugees and Iranian Residents in Iranshahr, 2005–2006. Iran J Epidemiol. 3(4): 7–13.
23. Poudat A, Ladoni H, Raissi A (2006) Probable effective factors on malaria situa¬tion and morbidity in Bandar. Hormozgan Medical J. 10(2): 101–110.
24. Vatandoost H, Hanafi-Bojd AA (2012) Indication of pyrethroid resistance in the main malaria vector, Anopheles stephensi from Iran. Asian Pacific J Trop Med. 5(9): 722–726.
25. Hanafi-Bojd AA, Vatandoost H, Oshaghi MA, Haghdoost AA, Shahi M, Sedaghat MM, Abedi F, Yeryan M, Pakari A (2012) Entomological and epidemiological attributes for malaria transmission and implementation of vector control in southern Iran. Acta Trop. 121(2): 85–92.
26. Gorouhi MA, Vatandoost H, Oshaghi MA, Raeisi A, Enayati AA, Mirhendi H, Hanafi-Bojd AA, Abai MR, Salim-Abadi Y, Rafi F (2016) Current Susceptibility Status of Anopheles stephensi (Diptera: Culicidae) to Different Imagicides in a Malarious Area, Southeastern of Iran. J
Arthropod Borne Dis. 10(4): 493–500.
27. Edrissian G (2006) Malaria in Iran, Past and Present Situation. Iranian J Parasitol. 1(1): 1–14.
28. Oloo AJ, Mudegu JV, Ngare DK, Ogutu RO, Ondijo SO, Odada PS, Adungo NI, Githeko AK, Ekisa WS, Mahadevan S (1993) The effect of permethrin impregnated sisal curtains on vector density and malaria incidence: a pilot study. East African Medical Journal. 70(8): 475–477.
29. Mbogo CN, Kabiru EW, Glass GE, Forster D, Snow RW, Khamala CP , Ouma JH, Githure JI, Marsh K, Beier JC (1999) Vector-Related Case-Control Study of Severe Malaria in Kilifi District, Kenya. Am J Trop Med Hyg. 60(5): 781–785.
30. Dar FK, Bayoumi R, AlKarmi T, Shalabi A, Beidas F, Hussein MM (1993) Status of imported malaria in a control zone of the United Arab Emirates bordering an area of unstable malaria. Trans Royal Soc Trop Med Hyg. 87(6): 617–619.
31. Forootani MR (2007) Malaria infestation in foreign immigrants residing Larestan township in 2003–2004. Hormozgan Medical J. 11(3): 229–236.
32. Nejati J, Ansari Moghadam AR, Keyhani A, Tabatabai SM (2011) Effects of immigration on malaria incidence and its foci classification. Hormozgan Medical J. 16(4): 283–291.
33. Wiwanitkit V (2007) Rate of malarial infection among foreigners in a tertiary hospital of Thailand: change of epidemiology and importance of travel medi-cine (1996–2005). J Vector Borne Dis. 44(3): 219–222.
34. Matteelli A, Volonterio A, Gulletta M, Galimberti L, Maroccolo S, Gaiera G, Giani G, Rossi M, Dorigoni N, Bellina L, Orlando G, Bisoffi Z, Castelli F (2001) Malaria in illegal Chinese immigrants, Italy. Emerging Infect Dis. 7(6): 1055–1058.
35. Salvadó E, Pinazo MJ, Munoz J, Alonso D,
Naniche D, Mayor A, Quintó L, Gascón J (2008) Clinical presentation and complications of Plasmodium falciparum malaria in two populations: travelers and immigrants. Enferm Infecc Microbiol Clin. 26(5): 282–284.
| Files | ||
| Issue | Vol 13 No 1 (2019) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/jad.v13i1.936 | |
| Keywords | ||
| Malaria Elimination Challenge Iran | ||
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How to Cite
1.
Soofi K, Khanjani N, Kamiabi F. The Challenges of the Malaria Elimination Program in the South East of Iran, a Qualitative Study. J Arthropod Borne Dis. 2018;13(1):94.
