Background: Malaria mortality and morbidity have decreased in recent years. Malaria elimination (ME) and effective efforts to achieve ME is one of the most important priorities for health systems in countries in the elimination phase. In very low transmission areas, the ME programme is faced with serious challenges. This study aimed to assess the trend while getting a better understanding of Health Service Providers' (HSPs) readiness and challenges for ME in a clear area of Iran. Methods: This study was performed in two phases. At first, the malaria trend in East Azerbaijan Province, was surveyed from 2001 to 2018; afterward, it was compared with the national situation for a better understanding of the second phase of the study. Data were collected from the Ministry of Health's protocol and the health centre of the province. In the second phase, malaria control programme experts, health system researchers, and health managers' opinions were collected via in-depth interviews. They were asked regarding HSPs readiness and appropriate Malaria Case Management (MCM) in a clear area and possible challenges. Results: A total of 135 and 154,560 cases were reported in the last 18 years in East Azerbaijan Province and Iran, respectively. The incidence rate decreased in East Azerbaijan Province from 0.4/10,000 in 2001 to zero in 2018. Furthermore, no indigenous transmission was reported for 14 years. Also, for the first time, there was no indigenous transmission in Iran in 2018. The main elicited themes of HSPs readiness through in-depth interviews were: appropriate MCM, holistic and role-playing studies for assessment of HSPs performance, system mobilization, improving identification and diagnosis of suspected cases in the first line. Similarly, the main possible challenges were found to be decreasing health system sensitivity, malaria re-introduction, and withdrawing febrile suspected cases from the surveillance chain. Conclusion: Health systems in eliminating phase should be aware that the absence of malaria cases reported does not necessarily mean that malaria is eliminated; in order to obtain valid data and to determine whether it is

This article is a Letter to the Editor and does not include an Abstract.

Background and aims: Experience transfer and the knowledge utilization of rapid and timely outbreak control can be the key path-finding to health systems (HSs). The aim of this study was to investigate an Entamoeba histolytica diarrhea outbreak through timely control. Methods: A case-control study and an environmental survey were conducted to identify the source of infection and the outbreak etiological agent. Sixty-two confirmed cases in Idahluye Bozorg village, Iran, and 62 group-matched controls (in terms of age and sex) were selected from the healthy neighbors of the same village during the same period. Then, multiple logistic regression was applied to calculate the adjusted odds ratio for diarrhea risk. Results: Totally, 250 cases were identified by a continuous common source epidemic from January 19th to 31st, 2018. Out of the total 36 stool samples, E. histolytica was detected as the common organism. In addition, the final analysis indicated that network drinking water (NDW) increased the odds of diarrhea (16.56, 95% CI=4.14-64.87), whereas well water and boiling water had protective effects and decreased the odds of diarrhea by 81% and 66%, respectively. Conclusion: Overall, the source of infection was detected due to the contamination of underground NDW by pipe sewage erosion. Therefore, additional monitoring of water systems is necessary, especially during the summer and regarding full readiness for outbreak control.

The aim of this study was to provide the natural history and epidemiology of cleft lip and cleft palate in the northwest region of Iran between 2000 and 2019. Since 2000, infants born with birth defects have been registered in the Tabriz Registry of Congenital Anomalies (TRoCA). For this study, the information and data were collected using the TRoCA registry system. Prevalence of cleft lip and cleft palate was 1.48 (95% CI 1.34; 1.62) per 1000 live births over the past two decades in the region. The occurrence of cleft lip and cleft palate was more common in males than females. The fetal death ratio was 5 percent of live born children. The proportion of infants with cleft lip and cleft palate surviving to the second week was 54 percent. The results may have a role in planning and evaluating the strategies for primary prevention of cleft lip and cleft palate, particularly in high-risk populations.