Overview of Malaria in the Americas

History followed different courses for different peoples because of differences among peoples’ environments, not because of biological differences among peoples themselves.

Diamond, J.M. (2005) Guns, Germs, and Steel: the fates of human societies.

Environments

Ecological

Social

Economic

Political

Technological

Reflections

• November 6th 1880: Laveran • 1898: Ross, Grassi, Bastianelli, Bignami• Cinchona bark: Fever – Quechua Indians Peru• 17th Century “Jesuit bark” - Rome • 19th Century Malaria throughout Americas• 1902 – Malaria health problem – PAHO• II World War – new antimalarials, DDT• Successes – Americas including Caribbean• 1955 – Global Eradication Program

Malaria Strategies and Goals

• Global Malaria Eradication Strategy – Mexico 1955

• Global Malaria Control Strategy – Amsterdam 1992

• Roll Back Malaria Initiative – 1998

• U.N. Millennium Development Goals - 2000

Interventions

• Diagnosis (Microscopy, Rapid Diagnostic Tests)

• Treatment (Distinct parasites, Drug Resistance)

• Reduction Man – Mosquito contact (distinct mosquitoes, Insecticide resistance, Housing, Management breeding sites, Mosquito nets, etc.)

• Epidemiologic analysis, Operational research• Community, other sector involvement• Health systems – transfer of responsibility but

reduced technical capability

1990 1995 2000 2005 2010 2015

Year

0K

200K

400K

600K

800K

1000K

1200K

Number of Malaria Cases

0

100

200

300

400

500

Deaths due to Malaria

709,717

1,056,307

1,183,919

577,059

RBM Initiative

354

153

RBM Initiative

Deaths

Confirmed Cases

RBM/MDG Target

Malaria Cases & Deaths in Americas, 1990-2008

Nicaragua El SalvadorEcuador Paraguay Suriname Guatemala Honduras Argentina

BoliviaMexicoBelize GuyanaBrazilCosta Rica Colombia PanamaPeru*FRG

VenezuelaDOMHaiti

-100%

-50%

0%

50%

100%

Percentage change since 2000 2010 Target

2008 Target

2015 Target

Change in Malaria Incidence in Americas, 2000-2008

DOM- Dominican Republic, FRG- French Guiana*2007 Data for Peru

Total Number of Malaria Cases in Endemic Countries of the Americas, 2000-2008.Country Year

0K 10K 20K 30K 40K 50K 60K 70K 80K 90K 100K 110K 120K 130K 140K 150K 160K

Total Number of Malaria Cases

Argentina 20002008

Belize 20002008

Bolivia 20002008

Colombia 20002008

Costa Rica 20002008

Dominican .. 20002008

Ecuador 20002008

El Salvador 20002008

French Guia.. 20002008

Guatemala 20002008

Guyana 20002008

Haiti 20002008

Honduras 20002008

Mexico 20002008

Nicaragua 20002008

Panama 20002008

Paraguay 20002008

Peru 20002008

Suriname 20002008

Venezuela 20002008

130440

5381,486

9,74831,469

79,230144,432

9661,879

1,8401,233

4,891104,528

33745

3,2643,708

7,19853,311

11,81524,018

36,77416,897

8,22535,125

2,3577,390

76423,878

7441,036

3416,853

56,53868,321

2,08613,132

32,03729,736

2007 Value used for Peru.This graph does not include Brazil.

Funding of Malaria Control in Americas

72.493.9

155.5132.0 135.4

169.8

15.1

10.1 11.1

24.8

173.6

6.2

2.7

9.6

0.0

50.0

100.0

150.0

200.0

2002 2003 2004 2005 2006 2007 2008

Fund

s (m

illion

US$

)

External contributions

Govt. budget

Source: Annual Country Reports to PAHO

Challenges• Change structure health institutions and systems;• Accessibility, availability health services• Orientation articulation / integration primary health care • Recruitment, training, continuity technical personnel• Sustainability - surveillance, epidemiologic assessments,

operational research • Use scientific evidence to adapt interventions and policies • Multiple sector participation, particularly civil society and

communities• Migration within and between countries• Burden reduction – “call to arms” – elimination