Background: This systematic review was conducted to highlights key challenges, and outlines important next steps to maximize the potential to contribute to the broader malaria elimination interventions. Methods: This systematic review on malaria elimination intervention and challenges was undertaken searching six databases, between 1995 and 2018. Inclusion and exclusion criteria were set. The references were collated and categorized according to type of study, intervention, population, and health outcome. Articles selection based on title and abstract, retrieval of full text and additions of articles from reference lists and recommendations from experts. Disagreement in data extraction was solved by consultation of third reviewer. Results: Overall, 4039 records were examined related to malaria elimination that initially identified by our designated electronic databases search. Overall, 35 studies contained 14 experimental studies (40%) and 21 analytic observational studies (60%) met the inclusion criteria for this review. Studies used a wide variety of malaria elimination interventions. Types of interventions either elimination-focused interventions or general interventions on educational, prevention and treatment of malaria are included. This review pointed out the variety of challenges for eliminate malaria among low and high endemic countries. Conclusion: Malaria elimination is facilitated by strong health systems, determined leadership, appropriate incentivization, an effective surveillance system, and regional collaborations. We have identified areas for elimination-specific interventions deserve more attention in the conduct and reporting.

An important variable in determining the vectorial capacity of malaria mosquito species is the degree of mosquito-human contact. This parameter can be affected by community sleeping behavior and the host-feeding habits of vectors. A cross-sectional study of 775 randomly selected inhabitants, including 385 Baluchi residents and 390 Afghani refugees, was conducted in a malarious area in Sabaz District, Sistan-Baluchestan Province, southeastern Iran. In addition, monitoring of human landing periodicity of main malaria vectors was carried out during an entire transmission season. Afghanis and Baluchis showed diversity in sleeping behavior. Most (79.6%) respondents were familiar with symptoms of malaria and also aware of an association between mosquitoes and malaria. Despite this familiarity, 94.6% of Afghan refugees, 74.8% of Baluch residents, and 87.2% of study participants did not use self-protection preventive measures. Overall, only 8.8% of participants reported using bed nets regularly. Surveyed persons used bed nets mainly during second quarter of night. Three major species of malaria vectors (Anopheles culicifacies, An. fluviatilis, and An. stephensi) started biting by sunset and continued throughout the night. The results of present study indicated that synchronization of encounters between inhabitants and mosquito vectors was caused by poor self-protection and sleeping behavior of inhabitants. In addition, diversity in culture and behavior of the two communities may cause the prevalence of malaria to be different between them. Therefore, promoting awareness of self-protection against mosquito bites could promote community participation in malaria elimination program in this malaria-endemic region.

To improve malaria control measures, taking into account local beliefs and practices are essential. In the present study, the PEN-3 culture model as a theoretical framework was employed to examine how health beliefs, behaviors and practices associated with malaria prevention in two communities, Afghani refugees and Bluchi residents in a malaria endemic area located in southeast of Iran. A mixed-methodology was designed by means of two quantitative surveys and qualitative focus groups. Cross-sectional survey using questionnaires combined with focus group discussions carried out by using a pre-coded questionnaire and eight qualitative focus groups were held. In total, 385 participants volunteered to take the cross-sectional survey, with 194 Afghanis, 191 Bluchis completing quantitative surveys and also 46 participated in the qualitative focus groups. Symptoms of malaria were the most frequently mentioned by both groups. A significant association between education level and knowledge on malaria transmission was also observed within both communities. Although the majority of respondents associated the disease transmission with mosquito bites only 16.5% Afghanis as compared to 63.4% Baluchis reported to use mosquito net. Data from focus group emerged three themes includes similarity in perception about malaria, difference in type of treatment and decision making and, finally resemblance to prevention of malaria in both communities. In the study, cultural differences in the recognition and interpretation of prevention and treatment of malaria within two communities were identified. Cultural match of Afghani and Baluchi perspective to malaria interventions and services will improve receptivity to, acceptance of, and salience of these efforts.

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Background:Malaria elimination efforts face with substantial challenges and the role of health workers in address this challenge, particularly advocates and mobilizes communities. The aim of the study was to explore perceptions of health workers in relation to eliminating malaria in order to better understand the level their involvement in malaria elimination efforts. A qualitative approach was adopted based on key informant interviews with 26 health workers who working at community-level in malaria low endemic areas, southern Iran.Methods:Data were collected through key informant interviews. Data were analyzed using thematic content analysis.Results:Findings reveal that the majority of participants concerned with the imported malaria cases, without to address an effective solution to the issue. Health workers had positive perceptions on their basic knowledge and opinions in relation to their field work with emphases to integrate methods. Participants expressed willingness to contribute to malaria elimination effort. They also emphasized on continuous training, resource mobilization, and support. In addition, their perceptions on malaria elimination policy such as sustained financial investment to achieve elimination and integrated management of vector control were rather negative.Conclusions:A mechanism should be considered that allow the health workers to feedback positively on their quality of their practice to health providers.