Malaria prevention among Afghani refugees in a malarious area, southeastern Iran

Each year, 24-36% of malaria cases in Beluchestan (area) occur among Afghani refugees. Knowledge about malaria transmission and protection are important for these refugees to enable local Health Services to manage malaria control in the area. Our objective was to explore and investigate knowledge, attitude and practices of Afghan refugees and Iranian residents with respect to malaria transmission and protection. A cross-sectional study was performed and 10% of target groups were selected by systematic random sampling and then interviewed. In this study, 385 Iranian and 390 Afghani refugees participated in the survey. Respondents answered questions about demographic characters, cause and transmission of malaria, belief about severity and complications of malaria, malaria mobility and health care-seeking behavior, perceived control of malaria prevention, beliefs about utility of bed nets, perceived susceptibility to malaria, and whether they use window-screens and bed nets. The majority of Iranians (76.6%) and Afghanis (60.1%) were familiar with typical symptoms of the malaria disease, but about 50% of each group did not know malaria transmission occurs by mosquito bites. About 90% of Afghanis stated they do not use personal protection against mosquito bites over night, while 60% of Iranians used bed net. Only one third of Afghani refugees use local Health Center services.

The cross-border traffic of Afghanis is an important factor for persistence of malaria in Baluchestan but based on our data, life style and protective behavior of refugees with regard to malaria protection are also important factors, particularly because they do not use local Health Services. Therefore, it is important to implement prevention education programs specifics to target Afghani refugees and to employ Afghani public health professionals to asset with elimination and treatment.