Challenges and strategies in malaria control: A case series from East Azerbaijan Province, 2023-2024

This retrospective case series describes nine malaria cases identified in the malaria‑free northwest region of Iran to inform surveillance and public health measures in elimination settings. Patient data were collected from treatment follow‑up records at local health centers, and clinical information from hospital records for eight hospitalized patients. All patients had a history of travel to malaria‑endemic areas, including southern Iran or countries such as Pakistan, Kenya, and Sierra Leone. Three cases were infected with Plasmodium falciparum and six with Plasmodium vivax. Diagnosis was confirmed using rapid diagnostic tests and microscopic examination of peripheral blood smears. East Azerbaijan Province was malaria‑endemic about two decades ago. Its northern regions, adjacent to the Aras River, together with rice‑growing districts, provide potential breeding habitats for malaria vectors. Thus, the influx of infected individuals, particularly during the peak mosquito season, may create conditions for local transmission and localized outbreaks. These observations underscore the need to strengthen healthcare personnel training for rapid malaria diagnosis and to pay particular attention to high‑risk transit occupations involving travel to endemic areas within Iran and abroad. In the context of Iran's malaria elimination phase, effective surveillance and timely management of imported cases are essential to sustain progress toward elimination.