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. 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. 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. 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 eliminated, holistic and role-playing studies are required. Increasing system sensitivity and mobilization are deemed important to achieve ME.

中文翻译：

---

伊朗某地区的疟疾状况：一种更好地了解卫生服务提供者在地区内消除疟疾的意愿和挑战的方法

近年来，疟疾的死亡率和发病率有所下降。消除疟疾（ME）和为实现ME而做出的有效努力是各国处于消灭阶段的卫生系统最重要的优先事项之一。在极低的传输区域，ME程序面临着严峻的挑战。这项研究旨在评估趋势，同时更好地了解伊朗明确地区卫生服务提供者（HSP）对ME的准备情况和挑战。这项研究分两个阶段进行。首先，调查了2001年至2018年阿塞拜疆东部省的疟疾趋势；之后，将其与国情进行比较，以更好地了解研究的第二阶段。数据是从卫生部的协议和全省卫生中心收集的。在第二阶段 通过深入访谈收集了疟疾控制计划专家，卫生系统研究人员和卫生经理的意见。他们被询问有关HSP的准备情况以及在明确地区的适当疟疾病例管理（MCM）以及可能面临的挑战。在过去的18年中，东阿塞拜疆省和伊朗分别报告了135例和154,560例。东阿塞拜疆省的发病率从2001年的0.4 / 10,000下降到2018年的零。此外，有报告说14年来没有土著传播。此外，2018年伊朗首次没有本地传播。通过深入访谈，主要提出了HSP准备就绪的主题：适当的MCM，评估HSP绩效的整体和角色扮演研究，系统动员，一线改进对可疑病例的识别和诊断。同样，发现可能的主要挑战是降低卫生系统的敏感性，重新引入疟疾以及从监视链中撤出高热疑似病例。处于消灭阶段的卫生系统应意识到，未报告疟疾病例并不一定意味着消灭了疟疾；为了获得有效数据并确定是否将其消除，需要进行整体和角色扮演研究。提高系统的敏感性和动员能力被认为对实现ME很重要。处于消灭阶段的卫生系统应意识到，未报告疟疾病例并不一定意味着消灭了疟疾；为了获得有效数据并确定是否将其消除，需要进行整体和角色扮演研究。提高系统的敏感性和动员能力被认为对实现ME很重要。处于消灭阶段的卫生系统应意识到，未报告疟疾病例并不一定意味着消灭了疟疾；为了获得有效数据并确定是否将其消除，需要进行整体和角色扮演研究。提高系统的敏感性和动员能力被认为对实现ME很重要。