Early malaria diagnosis in Bushehr through multi-sectoral approach

In the south of the Islamic Republic of Iran, one of the main obstacles to early malaria diagnosis is the population movement of foreign seasonal building workers from endemic neighboring countries. This population movement causes reintroduction of malaria transmission in cleared-up foci where environmental condition is convenient for malaria transmissions, AVA Diplomatic reports.

Building construction rate is growing. In 2015, it was estimated that about 3,000 new apartments in Bushehr port came under construction and foreign workers from malaria endemic countries played a significant role in these projects. Based on District Health network census data, at least 4,471 foreign workers are working in these projects. These workers are residing in temporary residential places and given the nature of their work they move from one construction site to another once the work is completed. This makes it very difficult, time-consuming and costly to provide them with active routine case finding services.

In addition, follow-ups and evaluation of treatment efficacy of detected positive malaria cases are difficult due to frequent change of residence location. Hence the new location of workers needs to be identified through questioning the friends, co-workers and visiting numerous under construction buildings in a vast area.

To address the problem the national health system adopted the multi-sectoral approach where passive case detection services is in place, in collaboration with volunteers among foreign workers as well as owners of under construction buildings.  This approach required the health workers to be trained and organized for visiting the unfinished buildings and screening all suspected people with malaria symptoms in addition to routine active case finding services.

Mr. Saeed Forozani has been a health worker at Bushehr district for 28 years and works in active/passive case finding. Whenever a positive case is detected during screening, he spends more time to investigate the area to find probable more malaria cases. He has established a network in collaboration with volunteers among foreign workers.  Accordingly, in each under construction building a volunteer/and or owner of building will call and inform him of arrival of newcomers or existence of a person with malaria symptoms at any time of the day or night even on public holidays in order to come and screen them.

According to Mr. Forozani, one day in late spring of 2013, he was informed of the arrival of a new person in the area. He immediately went to the residential location to screen that person but he had no malaria symptom. However, while talking with the newcomer, Mr. Forozani discovered that three other new construction workers had arrived from east neighboring endemic countries, one of whom has had cold symptoms but he had already moved near a shrimp pond in Bandar Rig in Genaveh district (about 97 km away from Bushehr port) for work.

Although it was late at night, Mr. Forozani – a dedicated and responsible health worker – immediately used his own car to drive to the mentioned location in search of this person.  Finally, he found this foreign worker near a shrimp pond in a remote area and tested him using a Rapid Diagnostic Test (RDT) kit. RDT result was positive for malaria and thus treatment started right away. The following day the positive case was reported to Genaveh district for completion of treatment.

In 2013 and 2014, over 50% of positive cases in Bushehr province were from Bushehr district and almost all cases were foreign workers. The multi-sectoral approach of the national health system enables identification of all the cases hence prevention through early diagnosis.