INTRODUCTION: Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked 
genetic disorder with a relatively high frequency in malaria-endemic regions. It 
is an obstacle to malaria elimination, as primaquine administered in the 
treatment of malaria can cause hemolysis in G6PD-deficient individuals. This 
study presents information on the prevalence of G6PD deficiency in Sistan and 
Balouchetsan province, which hosts more than 90% of Plasmodium vivax malaria 
cases in Iran. This type of information is needed for a successful malaria 
elimination program.
METHODOLOGY: A total of 526 students were randomly recruited through schools 
located in southeast Iran. Information was collected by interviewing the 
students using a structured questionnaire. Blood samples taken on filter papers 
were examined for G6PD deficiency using the fluorescent spot test.
RESULTS: Overall, 72.8% (383/526) of the subjects showed normal G6PD enzyme 
function. Mild and severe G6PD deficiency was observed in 14.8% (78) and 12.2% 
(64) of subjects, respectively. A total 193/261 males (73.9%) and 190/265 (72%) 
females had normal enzyme activity. Mild G6PD deficiency was observed in 10.8% 
(28) and 18.9% (50) of male and female subjects, respectively. However, in 
comparison with females, a greater proportion of males showed severe enzyme 
deficiency (15.3% versus 9.1%). All these differences were statistically 
significant (p < 0.006).
CONCLUSIONS: G6PD deficiency is highly prevalent in southeast Iran. 
G6PD-deficient individuals are susceptible to potentially severe and 
life-threatening hemolytic reactions after primaquine treatment. In order to 
achieve malaria elimination goals in the province, G6PD testing needs to be made 
routinely available within the health system.