|
September 1995 |
The number of malaria cases reported in the Americas increased steadily from 1974 to 1984. Since then close to one million cases have occurred annually, with 1,114,147 in 1994. The largest number of cases were reported from Brazil, which accounted for 50% of the total in 1994, followed by the Andean Countries, which reported 29% of all cases. The highest risk of transmission occurred in the Guyanas, where the annual parasite index was 210 per 1000, 7 times higher than in Brazil. The Guyanas also had the highest rate of falciparum infection, with half of all infections due to Plasmodium falciparum, compared with 1/3 in Brazil and 1/5 in the Andean Countries. Migration into high risk areas and ecological transformation continued to be major factors contributing to sustained malaria transmission. Countries are gradually adopting the global strategy for malaria control, but the process is incomplete.
In 1994 the population of the Region of the Americas was estimated at 763 million, of which 231 million (30.3%) lived in areas where ecological conditions were propitious to the transmission of malaria.
The exposure to the risk of contracting malaria in the Americas yields a different and more accurate picture of the distribution of the disease than one based solely on ecological conditions propitious to transmission. Taking into account that conditions for malaria transmission depend on factors related to population movement, social stability, individual adoption of attitudes and behavior that prevent and protect against human/vector contact, and immediate access to appropriate treatment, the countries of the Americas have redefined their malarious areas on the basis of different levels of risk of exposure to transmission (Graphic 1).
With regard to a more accurate characterization of the risk of malaria in the Region, Table 1 shows an increase in the malaria morbidity rates, on the basis of total population of the Americas as well as the population inhabiting areas that are ecologically propitious to transmission. Table 1 also shows an increase in the diagnostic efficiency of the blood samples taken, which is the result of a better concentration of surveillance in the areas of highest risk. This is also corroborated by the fact that a 2.7% increase in relation to 1993 in epidemiological surveillance of high-risk areas was observed, accompanied by a significant reduction in surveillance in the areas of low and medium risk (27% and 16.2%, respectively) in the same period.
*Areas with ecological risk for malaria transmission.
In the countries of the Americas with active control programs a, (Table 2), 35.6% of the population (146 million) is exposed to the areas of greatest risk of transmission. In 1994 a 13.3% increase in the number of cases diagnosed was reported in relation to the previous year, partially due to a 14.6% increase in P. falciparum
infections, the etiologic agent of malignant tertian malaria, which indicates the high intensity of the malaria transmission in these areas.
Examined Positive Vivax Malariae Belize 210 49,179 9,957 400 9,557 - Bolivia 3,009 128,580 34,749 4,806 29,916 -
In recent years the epidemiological stratification of malaria in the Americas has been accompanied by the integration of case finding, diagnosis, and immediate treatment activities by local health services. This can be appreciated by the fact that surveillance of 1.9 million suspected cases, with diagnostic efficiency by the local health services increased from 10.5% in 1993 to 16.2% in 1994. In addition, active surveillance has declined by 22.7%, which was anticipated due to the low diagnostic efficiency and high operational cost of this activity. The 42.7% reduction in the number of slides taken from febrile individuals by volunteer collaborators could reflect the implementation of the "clinical disease management" component of the new "Global Malaria Control Strategy" adopted by the countries of the Region in 1992. Nevertheless, this greater availability of treatments by the volunteer collaborators is not reflected in the overall quantity of treatment provided which was maintained at the same level as in 1993, probably indicating a change in the distribution of resources within the different services in the countries.
Table 3 details the geographic-political divisions as well as the demographic location of exposure to high risk, its causes, and the measures used for their control are presented. From the characterization of the factors that determine the persistence of the transmission, various control measures are identified and stand out the need for intersectoral coordination in order to ensure the sustainability of these measures over time.
The control programs, however, are undergoing a drastic reduction in budgetary funding and therefore are obtaining more of their financing each year through loans and grants from outside the health sector. Table 4 reflects a 1% reduction in the regular budget as compared to 1993, and a 75% increase in loans and grants. Moreover, an important increase is seen in investment in research
on malaria in endemic countries of the Region. In Brazil, Colombia, Mexico, and Venezuela US$ 6.5 million were invested for research in 1994--a 58% increase over the previous year.
Haiti
Fr. Guyana
Brazil
Bolivia
Argentina
...
...
9,411,764,706
...
...
...
...
8,705,882,353
103,070
...
...
...
92.50
...
...
50,000
...
12,117,647
619,430
3,000,000
...
...
0.13
-
...
...
-
24,400,000
20,000
-
Source: This article was extracted from "Current Status and Trends of Malaria in the Americas". Prepared by Division of Disease Prevention and Control, Communicable Diseases Program, HCP/HCT,
PAHO.
Population
(thousands)
Blood Slides
Morbidity per
100,000 Popultion
YearCountry
TotalMalarious
Areas*
Examined
Positive
PercentageTotal
AmericasMalarious
Areas
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
505,819
513,544
524,774
535,109
544,865
555,676
565,249
576,942
587,704
600,263
610,021
627,375
635,954
639,212
659,535
665,777
662,983
672,941
703,370
715,994
698,741
721,256
725,564
739,561
763,305
181,257
185,492
190,448
195,528
200,755
205,872
211,086
215,550
220,153
226,361
231,366
239,260
245,307
249,327
257,276
259,838
263,371
268,217
280,758
285,394
278,600
281,124
289,948
289,584
231,323
9,925,162
10,134,212
9,695,953
9,400,682
8,997,318
9276,878
9,352,775
9,274,480
9,493,751
8,630,653
8,943,369
9,100,529
8,826,418
9,113,611
9,422,827
9,485,203
10,070,388
9,764,285
10,092,472
9,638,847
9,459,912
9,732,930
9,373,323
9,633,125
8,261,090
344,170
388,416
284,813
280,276
269,003
356,692
379,364
398,925
468,923
515,271
602,836
629,629
715,177
830,700
931,356
910,917
950,570
1,018,864
1,120,040
1,113,764
1,045,808
1,230,671
1,187,316
983,536
1,114,147
3.47
3.34
2.94
2.98
2.99
3.84
4.06
4.30
4.94
5.97
6.74
6.92
8.10
9.11
9.88
9.60
9.44
10.43
11.10
11.55
11.06
12.64
12.67
10.21
13.49
68.04
65.90
54.27
52.38
49.37
64.19
67.11
69.14
79.79
84.47
98.82
100.36
112.46
129.96
141.21
136.82
143.38
151.40
159.24
155.55
149.67
170.63
163.64
132.99
145.96
189.88
182.44
149.55
143.34
134.00
173.26
179.72
185.07
213.00
227.63
260.56
263.16
291.54
333.18
362.01
350.57
360.92
379.87
398.93
390.25
375.38
437.77
409.49
339.64
481.64
Information from some countries is incomplete
Blood Slides
Parasites Species
Countries by
Geographic
SubregionsPopulation of
Malarious
Areas*
Falciparum
and Mixed
Mexico
Costa Rica
El Salvador
Guatemala
Honduras
Nicaragua
Panama
45,248
1,015
4,951
3,222
2,319
4,264
313
1,923,575
143,721
139,587
133,611
315,893
355,661
220,062
12,864
4,445
2,803
22,057
52,110
41,490
684
63
3
5
423
568
1,427
18
12,801
4,442
2,798
21,634
52,110
40,063
666
-
-
-
-
-
-
-
Sub-total
16,294
1,357,714
133,546
2,844
131,270
0
Haiti
Dominican Republic
5,628
7,376
54,973
316,182
23,140
1,670
23,140
1,664
-
5
-
1
Sub-total
13,004
371,155
24,810
24,804
5
1
French Guyana
Guyana
Suriname
55
132
42
48,242
168,127
29,148
4,241
39,566
4,704
3,809
22,503
4,389
415
16,985
240
17
-
75
Sub-total
229
245,517
48,511
30,701
17,640
92
Brazil
Colombia
Ecuador
Peru
Venezuela
20,600
24,620
6,095
11,171
746
2,671,953
572,924
301,546
295,824
123,953
564,406
127,218
30,006
122,039
13,727
197,009
34,070
10,241
21,203
3,416
367,251
93,108
19,765
100,801
10,294
146
40
-
35
17
Sub-total
45,641
1,422,827
327,739
73,736
253,884
92
Argentina
Paraguay
5,366
1,270
14,070
96,885
948
583
1
12
947
571
-
-
Sub-total
6,636
110,955
1,531
13
1,518
0
Total
147,652
8,103,696
1,113,407
329,170
784,369
331
Countries
Population
Reported
cases
Control measures applied
in different areas
Principal
vectors
Causes producing the
persistance of transmission
Mexico:
Campeche
Chiapas
Guerrero
Michoacan
Oaxaca
Quintana Roo
Sinaloa
Tabasco
Sub-total
Belize:
Corozal
Orange Walk
Belice
Cayo
Stann Creek
Toledo
Sub-total
Costa Rica:
Canton Los Chiles
Canton Limon
Canton Talamanca
Canton Matina
Sub-total
El Salvador:
Costa Pacifica
area hiperendem.
Guatemala:
El Peten
Huehuetenango
Quiche
Alta Verapaz
Escuintla
Sub-total
Honduras:
Region Sanitaria I
Region Sanitaria II
Region Sanitaria III
Region Sanitaria IV
Region Sanitaria VII
Sub-total
Nicaragua:
Rio San Juan
Chinandega
Leon
Jinotega
Matagalpa
Nueva Segovia
R.A.A.N.
R.A.A.S.
Managua
Sub-total
Panama:
Bocas del Toro
Changuinola
Chiriqui Grande
Chepigana
Sub-total
Haiti:
Dominican Republic:
Comendador
Banica
El Llano
Pedernales
Dejabon
Partido
Sub-total
French Guyana:
Guayana:
Región I
Región VII
Región VIII
Región IX
Sub-total
Brazil:
Acre
Amapa
Amazonas
Maranaho
Mato Grosso
Para
Rondonia
Roraima
Sub-total
Peru:
Piura
Sullana
Tumbes
Loreto
Jaen
Lambayeque
San Martin
Ucayali
Madre de Dios
Sub-total
Venezuela:
Amazonas
Bolivar
Delat Amacuro
Tachira
Apure
Sub-total
Argentina:
Fase de ataque
Sector I - Tartagal
Sectro II - Oran
Paraguay:
Caaguazu
Alto Parana
Sub-total
Bolivia:
Depart.: BENI
Provincias
Vaca Diez
Depart: PANDO
Provincias
Fco. Roman
Manuripi
Abuna
Nicolas Suarez
Depart.: TARIJA
Provincias
Gran Chaco
O'Connor
Deprt.: Chuquisaca
Provincias
1, 4, 5, 10
Oropeza
Tomina
H. Siles
Luis Calvo
Sub-total
Colombia:
1. Bajo Cauca
2. Orinoquia
3. Pacifico
4. Uraba
5. Amazonia
Sub-total
Ecuador:
Esmeralda
El Oro
Los Rios
Manabi
Canar
Cotopaxi
Loja
Sucumbios
Pastaza
Napo
Sub-total
581,038
3,184,903
2,768,585
2,750,363
2,984,576
600,194
2,345,724
1,667,257
16,892,640
34,993
33,207
62,000
40,800
20,000
19,000
210,000
15,561
69,728
15,956
19,825
121,070
1,233,133
310,838
214,450
262,108
391,300
440,932
1,179,272
247,677
285,033
319,209
99,272
228,081
1,179,272
37,508
357,612
373,250
190,067
403,917
139,888
115,295
72,075
1,193,930
2,883,542
21,888
64,684
14,433
29,488
130,493
25,118
11,632
9,986
19,471
24,407
5,570
96,184
53,497
401,961
94,200
479,073
271,629
439,995
1,271,090
695,757
259,763
3,859,468
727,932
428,682
142,264
588,135
390,561
129,271
211,944
45,762
66,884
2,731,435
58,000
82,162
2,200
23,112
16,694
182,168
24,741
442,725
447,122
889,847
32,286
2,132
33,770
68,188
446,122
567,452
941,530
507,446
481,608
2,944,158
388,853
38,248
168,324
110,892
30,760
23,798
23,476
46,498
12,723
9,554
853,126
262
2,750
386
589
4,510
586
1,795
188
11,066
1,245
1,179
680
3,533
1,210
2,110
9,957
302
849
445
984
2,580
2,254
5,086
1,747
2,476
5,630
1,273
16,212
6,804
5.484
6,908
6,739
8,373
34,308
1,547
7,539
3,916
3,391
4,703
2,456
2,404
735
11,039
37,730
189
258
96
83
626
32
14
2
3
99
4
154
11,415
4,419
8,692
3,506
28,032
25,813
6,539
45,043
8,642
93,550
147,640
127,121
24,467
478,815
26,880
19,845
4,260
14,211
13,605
7,377
7,685
4,975
2,026
100,864
1,379
820
321
52
1,246
3,818
752
308
125
433
3,106
1,459
645
5,210
51,183
34,660
15,880
10,730
8,017
120,470
9,702
728
1,842
1,382
708
293
360
467
219
233
15,934
House, space and antilarval spraying,
individual and massive radical cure treatments,
entomological studies and environmental
management promotion.
Spraying and treatments with drugs
Radical treatment, focal and space spraying.
Spraying, drug treatments, larvicide, small
engineering works, debnet use
Non-coordinated indoor spraying and low coverage
of diagnosis and treatment of the population.
Integrated measures implemented; drug treatment;
different spraying methods for physical and larval
control; and community participation.
Prophylatic treatments for inmigrants drug
treatment barrier, peridomicile fogging indoor
spraying, cleaning of channels, fish rearing,
breeding site treatment with Bti.
Diagnosis
Radical treatment
Integrated control of low converage due to difficult
acess and low stability of the decentralization
process.
Lack of coodination between financial and
administrative policies
Diagnosis and treatment through the general health
services.
Residual spraying, spatial spraying environmental
health.
Spraying and fogging, application of larvicides.
Epidemiologic surveillance and spraying.
Detection and treatment of cases, house spraying.
Case detection and supervised treatments,
chemical control and physical control of breeding
sites with petroleum.
Health education in prevention and control.
Indoor spraying, physical control.
impregnated bed nets, tropical repellents.
Indoor house spraying.
A. albimanus
A. vestitipennis
A. pseudopunct
A. albimanus
A. albimanus
A. albimanus
A. albimanus
A. albimanus
A. darlingi
A. albimanus
A. pseudopunct.
A. albimanus
A. darlingi
A. darlingi
A. pseudopunct.
A. benarrochi
A. darlingi
A. aquasalis
A. nuneztovari
A. pseudopunct.
A. darlingi
A. darlingi
A. pseudopunct
A. albimanus
A. nuneztovari
A. darlingi
A. puntimacula
A. envasae
A. albimanus
Important migratory movements of agricultural
workers arriving from the south.
Precarious housing.
Vectro resistance in some dispersed areas of
limited extension.
Population habit of staying outdoors for several
hours of the afternoon and evening
Population movements.
De-reforestation
Intense rainfall
Border areas with intense population movements
Agricultural development with unstable manpower
and intense de-forestation.
Large flow of susceptible, inopportune control
measures and lack of inter-agency coordination.
Low social participation.
Deficient decentralization process
Precarious housing, unhealthy environment,
migration, low education, poverty, ideal vector
habitat and types of cultivation.
Unstable politics and migration.
Insecticide resistance.
Presence of rice crops.
Increase of at risk population due to creation of
industrial parks and rice cultivation.
Migrant populations.
Presence of large lagoons that are used for cattle
watering.
Descentralization process in development.
Low coverage of the SILAIS.
High unemployment level.
High human mobility.
Urban epidemic.
Nomadic migration of ethnic groups to the south.
Increase of population movements to the north.
Border migration.
Commercial exchange.
Rice growing
Extensive use of migrant manpower for agriculture
and construction.
Forestry and mining areas of Amerindian groups.
Migratory movements for exploitation of gold,
forests and natural reserves.
All the epidemiologic factors that determine
malaria transmission in "ecological areas of the
agricultural frontier", mining areas and internal
migration.
Delays in the implementation of the global malaria
control strategy.
Implememntation process started in 1994.
Mining areas without control, in the rainforest.
Migrant movements in the border areas.
Intense internal and external migration.
Accessibility limited by climatic factors.
Economical and financial factors limit activities.
Increase of the number of breeding sites.
Migrations. Indigenous groups.
Temporary workers.
Lack of complete and clear political decision.
A priority level was only assigned from August
onwards.
Permanent migration with border communities of
Brazil and to the south with Argentina.
Resistance to change and implementation of new
strategies among some malaria officers.
Lack of complete economic support.
Socio-political factors.
Mining. Drug treatments.
Migration. Colonization.
Illicit crops.
Vector behavior.
Low operating coverage by the national
program.
Lack of political wilingness to solve labor
conflicts
within the old centralized structure
Countries by
Geographic
SubregionsHealth
Sector Budget
(total)Public Health
BudgetPercentage
Assigned to
Public HealthMalaria
Program
BudgetPercentage
for Health
SectorMalaria Program
Loans and Grants
Mexico
Belize
Costa Rica
El Salvador
Guatemala
Honduras
Nicaragua
Panama
Dom. Rep.
Guyana
Suriname
Colombia
Ecuador
Peru
Venezuela
Paraguay
13,292,300,000
33,667,667
-
1,095,153,300
...
...
...
343,350,300
...
7,698,858
360,554
1,038,105,568
126,458,939
-
4,950,294,950
230,565,206
1,515,457,000
2,648,610
185,320
100,789,020
...
70,646,659
...
171,657,150
...
1,477,531
50,245
637,814,868
...
-
3,026,720,994
91,179,875
11.40
7.87
-
9.20
...
...
...
49.99
...
...
13.94
61.44
...
-
61.14
39.55
30,297,000
617,462
138,000
1,314,286
...
1,611,927
...
3,633,545
667,171
295,483
5,494
14,614,045
5,253,888
3,062,696
24,233,445
1,030,831
0.23
1,83
-
0.12
...
...
...
1.06
...
3.84
1.52
-
4.15
-
0.49
0.45
-
79,407
393,308
682,571
288,703
576,382
386,004
124,224
...
-
...
-
-
-
25,319,792
-
Total
30,529,720,049
14,324,612,695
46.92
102,562,351
0.336
52,270,391