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Malaria in the Americas: We Have Not Won the Fight Just Yet
Read part 2 here
While malaria caused by P. falciparum often receives more attention due to its high mortality rates in Sub Saharan Africa, malaria caused by P. vivax deserves equal attention. It is highly prevalent throughout the world, particularly in the Americas. Regional Challenges Some communities have reported a disproportionate incidence of malaria. In 2008, the municipality of Anajas in Brazil reported 452 cases per 1,000 inhabitants. Additionally, municipalities in Bolivia, Brazil, Colombia, Honduras, Peru, Suriname, and Venezuela reported incidences equal to or greater than 100 per 1,000 inhabitants. Communities with alarming disease incidences generally share the following attributes: • limited access to healthcare In some areas of Colombia, for example, malaria is related to illegal crop cultivation and the forced displacement of people. In 2008, the United States and Canada, which are considered non endemic countries, reported 1,321 malaria cases with nearly all cases originating abroad. Hispaniola is the Caribbean’s only malaria-endemic area with cases on the rise in Haiti. In 2008, Haiti reported a 57 percent increase in malaria cases from 2007, making it the country with the fourth highest disease burden in the Americas. Meanwhile, the Dominican Republic reported a 32 percent decrease; however, most cases remain centralized near areas bordering Haiti.
In 1969, the WHO publically recognized that the campaign was not adequately equipped to fully carry out its objectives. While vector resistance to DDT contributed to incidence re-emergence in some areas, the main issue affecting the program was that individual countries did not have ample resources to sustain malaria control The method of eradication relied on a “one-size fits all” approach and did not take into account varying social and epidemiological characteristics of each country. The use of a standardized approach thus made program implementation difficult on the community level as implementation was the responsibility of individual countries. This led to inconsistent DDT use and subsequently resulted in vector resistance. This coupled with the fact that many countries experienced a rapid decrease in incidence levels also led to a decline in political and financial commitment once malaria control in some targeted areas had begun to take effect. Eventually, funding for the campaign decreased and malaria eradication remained a low priority for many years, allowing it to reemerge and spread unchecked. Shortly following the end of the eradication campaign, DDT use came under global scrutiny. Rachel Carson’s Silent Spring, widely credited with launching the environmental movement, outlined its potential environmental harm. The DDT scare prompted a ban of the insecticide. Initially, it was prohibited for use in agriculture; however in 1972 the U.S. led a global ban of DDT for all uses. The ban subsequently influenced malaria reduction initiatives, which in recent years leading up to current global efforts relied mainly on diagnosis and treatment rather than vector control and prevention. Although other insecticides have been used, none have proven to be as effective and are more costly. In 2006 the WHO reversed its 30-year policy to fully endorse the worldwide use of DDT for malaria control, prompting other donor agencies to follow suit. Today’s malaria campaigns have adopted a more targeted and comprehensive approach by addressing the varying determinants of malaria transmission. At such a time of great interest in malaria eradication, current national and international campaigns have great potential for success and continued commitment. Malaria Champions of the Americas Read part 2 here Sources: 1. http://news.bbc.co.uk/2/hi/science/nature/5350068.stm |
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Lessons Learned