Academic journal article Iranian Journal of Public Health

Conflict in Neighboring Countries, a Great Risk for Malaria Elimination in Southwestern Iran: Narrative Review Article

Academic journal article Iranian Journal of Public Health

Conflict in Neighboring Countries, a Great Risk for Malaria Elimination in Southwestern Iran: Narrative Review Article

Article excerpt


Movement of malaria parasites by human migration to a potential country are likely to make epidemic the disease. Migration or population movement is one of the most important forces in modem-day malaria transmission and distribution in large measure due to global socio situation and transportation (1, 2). Some malarious countries, such as those in West Africa and central Asia are much more strongly connected to infection movement while some others such as Ethiopia and Myanmar display significantly greater isolation in terms of likely infection movements in and out (2, 3)·

Moreover, many wars take place in countries with a high incidence of malaria. For instance the Afghan civil war takes place in a country where the incidence of malaria is high, and has generated six millions of refugees that, in principles, are at a very high risk of being infected (4, 5). However, the distribution and incidence of malaria, as for often-communicable diseases, can be affected by dispersal of refugees from one country to another in various ways. Refugees may transport malaria parasites from an endemic area to the host country or they may be more vulnerable when coming from a non-endemic area to an endemic area where they may lack natural immunity to local strains. Epidemic conditions may arise when nonimmune immigrants are settled onto sites capable of supporting mosquito breeding (6-8). The 23year conflict in Afghanistan caused one third of the Afghan population (about 6.2 million) fled the war to Pakistan and Iran (9).

Illegal cross border of Afghan refugees became an obsession of health authority regarding to eliminate malaria from Iran (10). Malaria control programs affected by mass movement of Afghani refugees into Pakistan after social conflict occurred in Afghanistan (9, 11, 12).

Since the global malaria eradication campaign ended in 1969, several countries have earmarked on programs aimed at elimination, and some have succeeded in achieving or nearing that goal (13). More recently, a growing number of countries have adopted malaria elimination as a goal and Iran has been listed in these countries to achieve this goal (13-15). Elimination entails reducing to zero the incidence of locally acquired malaria infection in a specific geographic area because of deliberate efforts, with continued measures in place to prevent re-establishment of transmission. Although Iran has been earmarked for elimination of malaria, illegal immigration from east neighbor countries threaten the elimination program. The most of them are immigrant job seekers, which they cause malaria, scatter in the country (16-18). The present study focuses on malaria prevalence in Dezful district, where has been earmarked for malaria elimination but during 2 decades, malaria situation has been changed by occurring military conflicts in the neighboring countries in east and west. Khuzestan Province, located in southeast of Iran, is classified in strata II where the imported cases are found and the potential risk of malaria transmission exists (19).

Dezful district is situated in west of Khuzestan Province. The area is fertile with large scale of agricultural activities and water source. This district with numerous springs and pounds around Dez River and higher temperatures is expected to have greater malaria prevalence, as these conditions favor breeding of many Anopheline species as well as parasite reproduction within the mosquitoes. Dezful is still threatened by imported malaria, therefore assessment of malaria satiation in Dezful district may be used as a model for zones, which challenge with malaria elimination and straggling against the importation of malaria.

In the present study, we consider civil wars and social conflict as one of the basic reasons behind the observed increase in the incidence of malaria either directly (displacement of native inhabitants) or indirectly (influx of migrants from neighboring countries).

Materials & Methods

Study area

Dezful district is located in southwestern Iran, Khuzestan Province border to Iraq (following map). …

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