History of the successful Struggle against malaria in the Islamic Republic of Iran

This report has been prepared to provide a comprehensive account of the history of malaria and its control in the Islamic Republic of Iran for specialists and lay readers alike. It is based on published and unpublished reports, especially from the Ministry of Health and Medical Education, Tehran, and from the World Health Organization. The main findings are summarized below. Malaria has been a widespread epidemic disease in Iran for at least 3 000 years. The seriousness of its effect is reflected by historical records; for example, about20000 people who had been relocated from Armenia reportedly died from malaria in the Caspian plains in the late 18th century. By the early 20th century, the disease was the most important public health problem in the country. It was particularly severe in the Caspian plains and the southeast, but was prevalent practically everywhere in the country, even in the major cities. Effective large-scale control based on indoor residual spraying was started in the late 1940s and led to major reductions in the Caspian plains and the Central plateau. A national eradication programme was started in 1956, but soon encountered technical and operational problems in the southern plains and the Zagros highlands. However, by combining various interventions and products, the programme succeeded in reducing malaria considerably, even in the southern regions. By 1980, the objectives of the malaria programme changed from eradication to control. Despite limited resources, malaria was greatly reduced in Zagros and the southwestern plains, so that by 1990, the residual problems were concentrated in the three provinces of the southeast. From then on, the strengthening of anti-malaria services was integrated in the overall development plans including improved health services. By 2010, the programme was again re-oriented to national elimination. The number of reported malaria cases in I.R. Iran reached a high of 98 160 in 1991, which was related to the extensive case detection activities. Since then, the burden has been steadily declining. The number of reported cases was as low as 92 in 2016. There is concern that importation may impede progress towards elimination, but with sustained investment and further measures targeting international population movement, there is a good chance that Iran can achieve malaria-free status by 2025 or before.

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