Gender characteristics, social determinants, and seasonal patterns of malaria incidence, relapse, and mortality in Sistan and Baluchistan province and other province of Iran: A systematic review and meta-analysis

Abstract

Introduction Malaria is a climate-dependent disease influenced by gender, social determination, seasonal patterns, and relapse incidence This study reviews these characteristics of malaria in the Sistan and Baluchistan (S&B) province and another province of Iran.

Methods This systematic review and meta-analysis was conducted through systematic and manual searches in electronic databases such as PubMed, Web of Science, Scopus, Science Direct, Google Scholar, and the Scientific Information Database. Studies from the S&B province, published from 1990 to 2024, written in Farsi and English, and reporting incidence, relapse, or death were included in this study. The quality of the studies was evaluated using the Newcastle–Ottawa Scale.

Results Out of 1941 studies initially identified, 43 were included in the systematic review, with 12 studies on relapse and 43 on incidence included in the meta-analysis. The combined results of the 43 primary studies using the random effect model showed that the frequency of malaria among infected women is 32% in S&B, 22% in other parts of Iran and 24% in the whole of Iran. This is 68%, 77% and 75% in men respectively. Among the primary studies, 8 deaths were reported in two studies, all of which were men. The incidence rate of malaria relapse varied from 0.30% to 46%. Based on the random effect model, the malaria relapse rate in Iran was estimated at 9%. The highest incidence of malaria in Iran was between spring and summer, and the lowest incidence was winter and spring. Most studies showed a downward trend in malaria incidence of malaria between 1986 to 2019. In term of socio-demographic status, malaria was more common in rural areas (82%). Although 28% were employed, and in term of age, young and old individuals (15 to 50 years) had the highest rate of infection.

Conclusion This systematic review and meta-analysis revealed a lower incidence of malaria in women compared to men. The findings highlight the need for health care and the importance of targeted malaria control interventions, especially for men, rural areas, hot weather conditions, and young to middle-aged age groups, particularly in the S&B province.