Iron supplementation during malaria infection in pregnancy and childhood:A review

Malaria presents a significant global public health challenge,with severe malarial anaemia being a primary manifestation of the disease.The understanding of anaemia caused by malaria remains incomplete,making the treatment more complex.Iron is a crucial micronutrient essential for haemoglobin synthesis,oxygen delivery,and other vital metabolic functions in the body.It is indispensable for the growth of human beings,as well as bacteria,protozoa,and viruses in vitro and in vivo.Iron deficiency is among the most common nutritional deficiencies and can have detrimental effects during developmental stages of life.Malaria-induced iron deficiency occurs due to the hemolysis of erythrocytes and the suppression of erythropoiesis,leading to anaemia.Meeting iron requirements is particularly critical during pivotal life stages such as pregnancy,infancy,and childhood.Dietary intake alone may not suffice to meet adequate iron requirements,thus highlighting the vital role of iron supplementation.While iron supplementation can alleviate iron deficiency,it can exacerbate malaria infection by providing additional iron for the parasites.However,in the context of pregnancy and childhood,iron supplementation combined with malaria prevention and treatment has been shown to be beneficial in improving birth outcomes and ensuring proper growth and development,respectively.This review aims to identify the role and impact of iron supplementation in malaria infection during the life stages of pregnancy and childhood.

Assessment of the Drafting Quality of Request Forms Submitted to the Malaria and Parasitology Units at the Institut Pasteur de Cote d’Ivoire

Biological tests provide information on the medical analysis requested by both the patient and the prescriber. It is a communication link between the prescriber and the laboratory staff. The lack of some information on request forms not only affects the drafting quality of the test and patient care, but could also make thousands of data produced by healthcare centers unusable. The aim of this study was to assess the drafting quality of request forms submitted to the Malaria and Parasitology Units at the Institut Pasteur de Côte d’Ivoire. Methods: It was a descriptive cross-sectional study to assess the drafting quality of request forms of various prescribers received at the Institut Pasteur de Côte d’Ivoire. This study was conducted at the Malaria and Parasitology Units, department of Parasitology and Mycology (Institut Pasteur de Côte d’Ivoire), from 6th December 2020 to 6th December 2021. The information on each request forms was recorded on a data collection form designed for this purpose. Each data collection form corresponds to a request forms and each test to a patient. Results: Out of a total of 1990 request forms received, the patient’s age and sex were missing on 18% and 26.8% of the tests respectively. More than half (51.80%) of request forms did not indicate the patient’s place of residence. Clinical information was not provided on 45.90% of the tests. Prescribers omitting their signatures were 51%, stamps were 50.3% and contacts were 71.2%. Only 5.4% of request forms were of good drafting quality. Providing all the required information on the forms could facilitate the use and analysis of data and samples.

Coverage and Factors Associated with Acceptance and Satisfaction of Seasonal Malaria Chemoprevention in Six Health Zones in Benin

Introduction: Seasonal malaria chemoprevention (SMC) was adopted in 2019 in two health zones in Benin where malaria transmission is very high. Positive results led to the extension of the intervention to other zones with additional financial support. Annual SMC campaigns from 2021 to 2023 were carried out in all six health zones in the Atacora and Alibori departments. In five years of implementation, various approaches have been developed on the basis of a communication plan facilitating buy-in and acceptance by all stakeholders. The aim of this study was to assess the effective coverage and acceptance of the SMC by their beneficiary populations in 2023. Methods: It was a cross-sectional study with an analytical focus. Data collection took place from November 30 to December 13, 2023. The study population consisted of children under 5 years of age residing in the departments of Atacora and Alibori in northern Benin. A total of 3573 children under 5 years of age were included in the study, and their parents or guardians were interviewed. Results: During the 2023 campaign, 87.7% of targets were reached by SMC administration and 100.00% of children had received at least one dose of SMC by the fourth visit. Effective therapeutic coverage of SMC was 70.55%, with 99.60% in BNK, 69.40% in KGS, 16.20% in MK, 56.10% in 2KP, 92.40% in NBT and 89.60% in TMC. This coverage was statistically related to child and respondent ages (p Conclusion: SMC is a strategy accepted by the population, and the main reasons for non-participation in SMC were dominated by the absence of mothers or babysitters when the agents visited.

Availability of Antimalarial Medicines in Community Pharmacies of Lusaka District, Zambia: Implications on Compliance to Malaria Treatment Guidelines

Background: Malaria remains a major cause of morbidity and mortality in Zambia, affecting all levels of society, with children under the age of five and pregnant women being most at risk of serious illness. The availability of antimalarial medicines is one of the key interventions of malaria management. This study assessed the availability of antimalarial medicines in community pharmacies in Lusaka district, Zambia. Materials and Methods: This was a cross-sectional study that was conducted among 210 community pharmacies from September to November 2022 using a well-structured checklist in selected areas of Lusaka district. The availability was verified by a physical check of the product. The checklist contained the medicines listed both in the guidelines for diagnosis and treatment of malaria in Zambia as well as in the World Health Organization (WHO) malaria treatment guidelines. Results: This study found that all antimalarials listed in the local treatment guidelines for malaria were available in community pharmacies, though with the varying distribution. Of the 210 community pharmacies, 209 (99.5%) had artemether/lumefantrine in stock. The lowest available antimalarial was quinine/clindamycin, which was only available in 3 (1.4%) of the outlets. Conversely, 3 out of 16 (18.8%) antimalarials that were available in community pharmacies were not listed in the local treatment guidelines of malaria in Zambia, despite being listed in the WHO malaria treatment guidelines. This translated into a compliance level of 81.2% based on the local malaria treatment guidelines. Conclusion: This study concluded that antimalarials were available for all categories of malaria management in community pharmacies, though with a varying distribution. The presence of antimalarials not listed in the Zambian treatment guidelines is of public health concern which may have an impact on antimicrobial resistance in the future.

Malaria slide bank plays a crucial role in achieving and sustaining malaria elimination in India

India's healthcare system continues to place the highest priority on the fight against malaria[1].Malaria elimination program has received considerable attention from both the public and private sectors,resulting in a significant drop in malaria cases[2].In 2022,a total of 176000 million cases of malaria were reported in India,in which Plasmodium(P.)falciparum has contributed 57.0%and 42.3%were P.vivax cases and limited cases of P.malariae and P.ovale.

R21 vaccine:A ray of hope for malaria elimination

The steady decline in malaria cases and deaths in recent years is a step ahead toward elimination;however,an increasing number of reports of antimalarial and insecticide resistance highlight the importance of having newer approaches to achieve the goal in the stipulated time frame.Therefore,having an effective and durable malaria vaccine is extremely crucial,which can complement the tools currently in use.Although the malaria vaccine development efforts initiated in the 1910’s with the first attempts to develop a malaria vaccine involved inoculating humans with live,attenuated strains of the malaria parasite but the efforts have been intensified over the previous decade,resulting in several significant developments.

Evaluation of the Anti-Salivary IgG Response Specific to Anopheles Vectors of Malaria in Children under Five Seen in Health Care Settings in Areas of Low and High Insecticide Resistance in Southern Benin

The widespread use of long-lasting insecticidal nets (LLINs) is a major intervention method for malaria control. While coverage of LLINs has increased, there is a need for information on the operational effectiveness of nets deployed in the field in the context of malaria vector resistance to insecticides used for impregnation. The development of specific anti-malarial biomarkers to assess exposure to mosquito bites is an important development in evaluations. The aim of this study was to characterize the human IgG antibody response to Anopheles gSG6-P1 saliva, a salivary peptide antigen previously shown to be a relevant biomarker of human exposure to Anopheles bites, in order to assess the LLINs under field conditions in areas of low and high vector resistance to insecticides. We analyzed data from 240 randomly selected children ( 0.05). Furthermore, the same finding was observed for antibody expression in children whether or not they used LLINs on the day before the survey (p = 0.7724). Similarly, gender and especially age, major factors of variation in the adaptive immune response, did not have a significant effect on IgG expression.

Pattern of Uncomplicated Malaria Treatment and Antimalarial Prescription Practices among Health Workers in the Littoral Region of Cameroon: An Assessment of Ten Years Post-Malaria Treatment Policy Change

Following highly prevalent Plasmodium resistant strains to antimalarial monotherapies in malaria endemic countries, uncomplicated malaria treatment policy changed to artemisinine-based combination therapies (ACTs). After adoption of this new treatment policy in a country, sufficient care is needed to be taken to prevent occurrence of resistance to the latest drugs. As Cameroon shifted to ACT in 2004, this study aimed to assess knowledge and practices of health workers in government health facilities of the Littoral region regarding mild malaria management in health facilities as well as according to prescription qualities of ACTs in leaflets received in pharmacies. A total of 66 physicians and 16 nurses were questioned in 10 health facilities and 503 medical leaflets with ACTs prescriptions were viewed in 17 pharmacies. All medical workers questioned correctly were defined mild malaria and were aware of the antimalarial policy change in Cameroon. Overall ACTs prescription for mild malaria management in children and adult patients was 72.2% and 87.8% respectively. An important proportion of health workers prescribed antimalarial monotherapies and non recommended antimalarial for uncomplicated malaria treatment. 31.7% of participants did not systematically recommend laboratory diagnostic test before antimalarial prescription. Of leaflets viewed in pharmacies, ACTs were prescribed by physicians, nurses and laboratory technicians. Age was the only criteria for ACTs prescription. Appropriate ACTs quality prescription ranged between 81.2% and 94.4%. Of the ACTs prescribed, blisters had the highest (92.9%) appropriate quality prescription and solutions the lowest (83.3%). According to qualification of prescribers, physicians had the highest score (93.1%) of appropriate quality prescription and laboratory technicians the lowest score (28.1%). For all ACTs containing medical leaflets, concomitant medications were recorded namely antipyretic (73.9%), antibiotic (21.9%), non steroid anti-inflammatory (19.9%) or vitamins (18.1%). Data gathered indicated that although health workers were aware of uncomplicated malaria treatment policy change in Cameroon, mild malaria mismanagement was prevailing in health facilities of the Littoral region and ACTs quality prescription in medical leaflets was not optimal. Therefore, awareness is still needed among prescribers in order to prevent or at least slow the occurrence of Plasmodium resistant strains to ACTs in Cameroon.

A retrospective evaluation of the quality of malaria case management at twelve health facilities in four districts in Zambia

Objective:To establish the appropriateness of malaria case management at health facility level in four districts in Zambia.Methods:This study was a retrospective evaluation of the quality of malaria case management at health facilities in four districts conveniently sampled to represent both urban and rural settings in different epidemiological zones and health facility coverage.The review period was from January to December 2008.The sample included twelve lower level health facilities from four districts.The Pearson Chi-square test was used to identify characteristics which affected the quality of case management.Results:Out of 4891 suspected malaria cases recorded at the 12 health facilities,more than 80%of the patients had a temperature taken to establish their fever status.About 67%(CI_(95)66.1-68.7)were tested for parasitemia by either rapid diagnostic test or microscopy,whereas the remaining22.5%(CI_(95)213.1-23.7)were not subjected to any malaria test.Of the 2247 malaria cases reported(complicated and uncomplicated),71%were parasitologicaily confirmed while 29%were clinically diagnosed(unconfirmed).About 56%.(CI_(95)53.9-58.1)of the malaria cases reported were treated with artemether-lumefantrine(AL),35%(CI_(95)33.1-37.0)with sulphadoxine-pyrimethamine,8%(CI_(95)6.9-9.2)with quinine and 1%did not receive any anti-malarial.Approximately 30%of patients WHO were found negative for malaria parasites were still prescribed an anti-malarial,contrary to the guidelines.There were marked inter-district variations in the proportion of patients in WHOm a diagnostic tool was used,and in the choice of anti-malarials for the treatment of malaria confirmed cases.Association between health worker characteristics and quality of case malaria management showed that nurses performed better than environmental health technicians and clinical officers on the decision whether to use the rapid diagnostic test or not.Gender,in service training on malaria,years of residence in the district and length of service of the health worker at the facility were not associated with diagnostic and treatment choices.Conclusions:Malaria case management was characterised by poor adherence to treatment guidelines.The non-adherence was mainly in leans of:inconsistent use of confirmatory tests(rapid diagnostic test or microscopy)for malaria;prescribing anti-malarials which are not recommended(e.g.sulphadoxine-pyrimethamine)and prescribing anti-malarials to cases testing negative.Innovative approaches are required to improve health worker adherence to diagnosis and treatment guidelines.

Influences of Rainfall and Temperature on Malaria Endemicity in Cameroon: Emphasis on Bonaberi District

Relating the influence of climate on the occurrence of a vector-borne disease like malaria quantitatively is quite challenging. To better understand the disease endemicity, the effects of climate variables on the distribution of malaria in Cameroon are studied over space and time, with emphasis on the Bonaberi district. Meteorological monitoring can lead to proactive control. The government of Cameroon, through the National Control Malaria Program, has put in place strategies to control and stop the spread of the disease. This study is therefore geared towards assessing the yearly parasite ratio of malaria over the ten regions of Cameroon and to work out the influence of rainfall and temperature on disease endemicity with emphasis on a district of Douala. The model used is the VECTRI model, which shows the dynamic link between climatic variables and malaria transmission. The parasite ratio observed and simulated showed a maximum correlation of 0.75 in 2015. A positive relationship between temperature, rainfall and malaria is revealed in this study but Bonaberi has malaria all year round. The West region is the least affected by malaria. We recommend that For the VECTRI model to perform better, the population could be incorporated in the model.

A Cross-Sectional Survey of Knowledge Attitude and Prevention Practice towards Malaria among Basic Schools Pupils Prior to Health Education Campaign

Background: Malaria has historically been a major public health concern in Yemen, noted to be the country with the highest prevalence in the Eastern Mediterranean Region. As more and more children attend school, governments are increasingly recognizing the importance of child health for educational achievement. Aim: The aim is to assess the baseline knowledge, attitude and practice of pupil towards malaria before the health education activities. Methods: We conducted a cross-sectional study, in four randomly selected districts (rural and urban) of Taiz governorate. The study population was 1598 pupils in primary schools. Data was collected using questioner. Results: The pupils who recognized mosquito bite as a route of malaria transmission was 769 (48.1%), while the pupils who recognized fever as the main symptom were 786 (49.2%), 281 (17.58%) of pupils recognized convulsion as a complication of malaria. Regarding protective method 881 (55.31%) were mentioned the cover of the tanks as a protective method, about the BN 293 (18.3%) of pupils known about the BN and 280 (17.5%) mentioned children & pregnancy were the vulnerable groups to malaria. Conclusions and Recommendation: the percentage of knowledge of malaria knowledge and methods of prevention was low (24.5%). Also, the positive attitude and practice toward malaria was 45%. The rate of having bed-nets was very low (10.1%). There were misconceptions of malaria cause and transmission (48.1%). We recommend conducting health education activities that will focus on increasing the knowledge, attitude and practice levels of malaria among school pupils.

Indicators of fatal outcome in severe Plasmodium falciparum malaria:a study in a tertiary-care hospital in Thailand

Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.

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,except 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.

Malaria Transmission Potential in the Three Gorges Reservoir of the Yangtze River, China

Objective To define and evaluate the malaria transmission potential in the Yangtze River, following construction of the Three Gorges Reservoir. Methods Six villages, namely, Kaixian, Fengjie, Wanzhou, Fuling, Yubei, and Zigui were selected for investigating the malaria transmission potential in the reservoir. Transmission potential was estimated by mathematical modeling and evaluation of the local malaria situation. Factors that influenced the transmission potential were analyzed using Poisson regression analysis in combination with Grey Systematic Theory （based on evaluation by the Delphi method）. Results Indirect fluorescent antibody data and the incidence of malaria in the local population were consistent with the malaria transmission potential calculated for the area. Multivariate Poisson regression analysis showed a statistically significant association between the riparian zone and the man‐biting rate. Conclusion The risk of a malaria epidemic can be forecasted using the malaria transmission potential parameters investigated here which was closely correlated with the riparian zone.

Some ecological attributes of malarial vector Anopheles superpictus Grassi in endemic foci in southeastern Iran

Objective:To determine the bionomics and susceptibility status of the malarial vector Anopheles superpictus(An.superpictus)to different insecticides in the Sistan-Baluchestan province which has the highest malarial prevalence in Iran.Methods:Different sampling methods,in addition to scoring abdominal conditions,were used to define the seasonal activity and endo/exophilic behavior of this species.In addition,the standard WHO susceptibility tests were applied on adult field strains.Results:Most adult mosquitoes were collected from outdoor shelters.The peak of seasonal activity of An.superpictus occurred at the end of autumn.Most larvae were collected from natural and permanent breeding places with full sunlight and no vegetation.Blood feeding activities occurred around midnight.Compared with the abdominal conditions of adult mosquitoes collected indoors,the abdominal conditions of adult mosquitoes collected outdoors were gravid and seniigravid.This species was suspected to be resistant to DDT,but was susceptible to other insecticides.Conclusions:An.superpictus was present in almost all outdoor shelters,and the ratios of gravid,semigravid/unfed,and freshly fed confirmed that this species had a higher tendency to rest outdoors than indoors.This behavior can protect An.superpictus from indoor residual spraying in this malarious area.To the best of our knowledge,this is the first report on the susceptibility status of An.superpictus in Southeastern Iran.We do not suggest the use of DDT for indoor residual spraying in southeast Iran.

Effect of Health Education on Knowledge Attitude Practice towards Malaria among Basic Schools Pupils in Taiz

Background: Malaria is one of the main health problems in Yemen. Health education is essential for the control of diseases such as malaria. School-age children represent 25% of Yemen’s population. Schools children can convey the knowledge and skills that they acquire at school to the community, thus increasing general community awareness about malaria. Aim to determine the impact of school-based malaria education intervention on knowledge, attitude and practice of school children towards malaria prevention and control. Methods: We conducted a community-based trial, intervention and non-intervention comparison (exposed & non-exposed), in four randomly selected districts (rural and urban) of Taiz governorate. This study was conducted in four districts of Taiz governorate. The study population was 2130 pupils of grade 6, 7, and 8 in primary schools, chosen from four randomly selected districts;two of them were rural and the others urban. Four schools and their pupils (1065 pupils) were chosen for the study and assigned as an intervention group and four schools with their pupils (1065) were chosen for the study and assigned as a non-intervention (1065 pupils). Data were collected using questioner in intervention and non-intervention schools (three months apart). The major intervention activities included lectures about malaria, distribution of educational materials. χ2 was used to analyze differences. Results: Health education activities in schools were associated with the increased knowledge of malaria symptoms and methods of prevention. The mean knowledge of malaria symptoms is higher in the intervention schools 4.4 ± 1.9, compared with 2.1 ± 1.4 in the non-intervention group. With statistically significant difference (P < 0.001), also the positive attitude and practice toward malaria was higher to be (48%) in the intervention group;compared with (35%) in the non-intervention group the difference was statistically significant. The knowledge of mode of malaria transmission was higher in the intervention schools to be (86.2%) compared with (59.1%) in the non-intervention group, with statistically significant deference (P value <0.001). The knowledge of fever as a main malaria symptom was higher to be (90.4%) in the intervention schools compared with (63.6%) in the non-intervention schools with statistically significant deference. Conclusions and Recommendation: This study concludes that the health education intervention in primary schools in Taize governorate had a positive impact on the knowledge, attitude and practice of pupils. We recommend to conduct similar methods of the health education activities in schools with suitable modifications to reach all schools level.

Demonstration of malaria situation analysis,stratification and planning in Minab District,southern Iran

Objective:To demonstrate malaria situation analysis,stratification and planning for an endemic area in southern Iran.Methods:Data on health system,population,meteorological parameters, malaria cases,anopheline vectors,and control activities during 2005-2007 was obtained from Minab Health Center,Minab Meteorological Station and published documents about malaria elements in the study area.A datasheet was created in excel 2003 for analysis.Results:There were 644 health staff working in Minab District including 99 health staff in malaria control program.The health facilities are distributed as follow:1 hospital with 96 beds,23 health centers including private centers(10 in Minab city and 13 in rural area of Minab District) and 119 health houses in rural areas of Minab District.Anopheles stephensi was the dominant species in Minab District,however,Anopheles dthali,Anopheles superpictus,Anopheles fluviatilis,Anopheles multicolor,Anopheles pulcherrimus and Anopheles turkhudi can also be found in the area. Anopheles stephensi was reported susceptible to malathion,propoxur,primphos-methyl,lambdacyhalothrin permethrin and deltamethrin,and resistant to DDT and dieldrin in the area.During the study period a total of 10 665 positive cases were reported,mainly due to local transmission (99.6%).Plasmodium vivax was the main causative agent followed by Plasmodium falciparum. There were reports about drug resistance of Plasmodium falciparum in the area.Conclusions: Using different parameters,Minab was classified into 3 strata.A plan was designed based on described goal,objectives and targets.The approaches of this plan were categorized into:health education,early detection and correct treatment,and vector control.Main constraints of these approaches are population movement between Iran,Pakistan and Afghanistan;vector control challenges at district,inadequate skilled medical staff in malaria case management and weak inter-sectorial coordination for malaria control,especially in urban areas.

Possible role of PGD_2 in malaria infections

Objective:To preliminarily investigate the possible role of prostaglandin D_2(PGD_2) in malaria infections.Methods:Blood and urinary samples(n=120 each) were collected from Thai patients with Plasmodium falciparum(P.falciparum) with moderate(n=26) and high(n=4) parasitemia,patients with Plasmodium vivax(P.vivax)(n=30),patients with fever associated with other infections(n=30),and healthy subjects(n=30).PGD_2 concentrations in plasma and urinary samples of healthy subjects,patients with fever associated with other infections and patients with malaria were determined using Prostaglandin D2-MOX express EIA kit(Cayman Chemical,USA).Results:The possible association between PGD_2 and malaria infections is clearly demonstrated with PGD_2 concentration in urine.The urinary PGD_2 concentrations were relatively high(about 5-fold) in patients with P.falciparum with moderate parasitemia and P.vivax infections compared with other groups.Furthermore,the concentration in patients with P.falciparum with moderate parasitemia and P.vivax infection were significantly higher than that in healthy subjects and patients with fever associated with other infections.Conclusions:Urinary PGD_2 concentrations may offer a more dependable and useful tool for predicting malaria severity.Confirmation is this preliminary finding is required with a larger sample size.

Epidemiological status of malaria in Iran,2011-2014

Objective:To determine the status and epidemiological aspects of malaria in Iran in favor 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 recendy 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.

Malaria:role of antibodies in protection and pathogenesis:an overview

The research scenario for malaria has improved in the last three decades to understand the epidemiology and host immune responses to plasmodial infection.Due to the augmented episodes of resistance development against the commonly used antimalarials in plasmodium parasites,especially in Plasmodium falciparum,neutralization of infection through effective vaccine(s) remains the feasible alternative in malaria control.In this direction,lot of attention was paid towards the identification of stage specific malaria antigens targeted by host ’s immune system.Preparation of synthetic or recombinant peptides and evaluation of their immunogenecity in naturally occurring antibody response were also given much importance,as these studies could help in finding potential candidates for future malaria vaccine(s).Attention was also paid.on the pathogenic consequences of antibody formation in malaria infection as polyclonal activation of B cells,which is a very prominent feature in malaria infection.Formation of circulating immune complexes in chronic malaria infection was also viewed as pathogenic parameter of severe malaria.The present survey focuses mainly on protective and pathogenic aspects of malaria antibodies(eliciting against various,stage specific antigens),and future research plan in antibodymediated immune response.