# Epidemiological and clinical profile of malaria patients in Isfahan Province, Iran: a retrospective analysis from 2009 to 2025

## TL;DR

This study examines the decline and current challenges of malaria in Isfahan Province, Iran, focusing on imported cases and the need for targeted interventions.

## Contribution

The study provides a detailed retrospective analysis of malaria trends and risk factors in Isfahan Province from 2009 to 2025.

## Key findings

- Malaria incidence declined sharply after 2009 but fluctuated, with a resurgence in 2024.
- Imported cases, especially among Afghan nationals, dominate the malaria burden.
- Plasmodium falciparum is strongly associated with severe disease compared to Plasmodium vivax.

## Abstract

Malaria remains a significant global health challenge despite remarkable declines in incidence, in Isfahan Province, Iran, historically considered an endemic area. Although national elimination programmes have reduced transmission, imported cases continue to sustain malaria risk. This study aimed to assess the epidemiological and clinical characteristics of malaria in Isfahan Province from 2009 to 2025.

A retrospective observational analysis was conducted using surveillance data from the Isfahan Center for Disease Control. All microscopically confirmed malaria cases reported between January 2009 and January 2025 were included. Demographic, epidemiological, and clinical data were extracted via a standardized checklist. Descriptive statistics and multivariable logistic regression were applied to identify trends and risk factors for severe malaria.

A total of 569 cases were reported during the study period, with incidence declining sharply after 2009, but fluctuating during subsequent years, including a resurgence in 2024. Most cases occurred in males (96.1%) and individuals aged 15–24 years (53.6%), with Afghan nationals comprising 80.8% of infections. Imported cases represented 80.8% of the total burden, underscoring migration-related risks. Plasmodium vivax accounted for 88.0% of cases, while Plasmodium falciparum (4.6%) was strongly associated with severe disease (adjusted odds ratio 22.6; 95% CI 1.24–410.8; p = 0.035). Seasonal peaks were observed in spring and summer, and per capita incidence was higher in rural counties despite absolute urban predominance.

Malaria incidence in Isfahan Province has markedly declined over the past 16 years; however, imported cases, predominantly among migrant workers, remain the central challenge to elimination. The dominance of P. vivax alongside the clinical severity of P. falciparum highlights the need for species-specific strategies. Strengthened cross-border collaboration, targeted interventions for migrant populations, and enhanced surveillance in high-risk rural areas are essential to sustain elimination efforts.