title: Malaria Four-year Epidemiological Trends in Sistan and Baluchistan Province, Iran.
abstract: BACKGROUND
  Malaria is one of the foremost public health concerns in Iran, where more than 90% of malaria cases are reported in the southern and south-eastern areas of the country. The aim of this study was to assess the epidemiological trends of malaria over a four-year period in in the Sistan and Baluchistan province in south east of Iran.
  
  
  METHODS
  This descriptive epidemiological study examined malaria trends in Sistan and Baluchistan province from 2011 to 2014. The study used data collected in accordance with the Iranian Ministry of Health's malaria control and elimination protocol. This protocol has digitized the data reporting system for malaria, and all information were sent online to the Center of Disease Control in the Ministry of Health. In this manner, information on malaria cases in Sistan and Baluchistan were made available for the researchers to analyze. Descriptive and comparative analyses were conducted using the SPSS version 13.
  
  
  RESULTS
  Annual incidence rates reported in 2011, 2012, 2013, and 2014 showed the prevalence of 89.9, 43.9, 38.3 and 36.6 (per 100,000 persons), respectively. Across all 4 years, the highest numbers of cases were found in persons 16-25 years old and among males. Most of the infected individuals were villagers and workers. In total, 64.8% of patients were Iranian and 29.5% were Pakistani. The highest number of cases was diagnosed in the cities of Sarbaz and Chabahar, with 1,742 and 1,707 cases, respectively. The results showed that over the last 4 years, 50.8% of cases have entered into Iran from foreign countries. The majority of cases involved parasites in the trophozoite stage of the life cycle. In terms of surveillance, passive care was reported in the majority of cases, and vivax malaria had the highest prevalence in comparison with other types.
  
  
  CONCLUSIONS
  The findings are showing that the care, control and treatment system applied to Sistan and Baluchistan province has had a positive effect on decreasing the prevalence rate of Malaria disease. Meanwhile, it is recommended to policy makers to provide more health controls for border entries, stop irregular immigration and apply more precise case searches in order to have a complete and on time treatment in a way that the chain of transmission of the disease would be cut. Health education and knowledge-ability promotion programs are better to be set in order to develop self-protection and environment improvement among people.
authors.affiliation: Faculty Member, MSN, BSc, School of Nursing and Midwifery, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Faezeh
authors.initials: F
authors.lastname: Norouzinezhad
authors.affiliation: Assistant Professor in Nursing, Ramsar Nursing Care Research Center, Babol University of Medical Sciences, Mazandaran, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ghaffari
authors.affiliation: Associate Professor of Epidemiology, National Program Manager for Malaria Control, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Raeisi
authors.affiliation: Deputy for Administrative Affairs of the Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Norouzinejad
authors.affiliation: Data Manager and Disease Control Expert in the Center for Communicable Disease Control, Tehran, Iran.
authors.forename: Farzad
authors.initials: F
authors.lastname: Kaveh
keywords: Epidemiology; Iran; Malaria; Sistan and Baluchistan