Malaria Remains Formidable Challenge In The Americas

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Malaria

Malaria remains a formidable challenge for the countries of the Americas and more action is needed to improve national control programs to reduce the burden of the disease.

Although recent data show a decrease in cases in 15 of the 21 Pan American Health Organization Member States where the disease is endemic, with eight of these countries achieving a target of at least 50 percent case reduction and seven registering decreases below 50 percent, increases in malaria cases were reported in six other countries where the disease is endemic. The number of malaria cases reported in the Americas in 2006 was 902,373, representing a 22 percent reduction in malaria morbidity from the year 2000.

These figures were reported at the Pan American Sanitary Conference by Dr. Keith Carter, PAHO Regional Advisor on Malaria, who noted that the region "continues to confront a number of formidable challenges and situations that contribute to current constraints in the progress of work against malaria." These include increased migration of people within and among countries, which has made epidemiologic surveillance and monitoring ever more challenging and increased the susceptibility of countries, both endemic and non-endemic, to malaria outbreaks and epidemics, he said.

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Changes in the organization of institutions and health systems in countries have created new conditions that require coordination among programs, and decentralization of vertical programs resulted in the transfer of responsibilities to the local level which, in many instances, lack managerial capacities, according to a document presented to the health ministers. Loss of trained personnel as malaria posts are suspended, and lack of active participation of many sectors, particularly civil society and communities, hampers progress, the report noted.

"Urban infrastructure development is deemed to have a concrete connection to the spread of malaria and other communicable diseases, particularly as a consequence of waste management problems, pollution of water reservoirs, and inadequate housing," the document said, and malaria programs in many countries "continue to be primarily vertical in approach and orientation and are minimally articulated/integrated with the primary health care system, thus undermining the potential gains in integrated and holistic health care for the affected populations."

The health ministers agreed to urge Member States to upgrade health surveillance, monitoring, and evaluation systems and to "reaffirm their commitment to establish and implement national policies and operational plans to ensure accessibility of prevention and control interventions for those at risk or affected by malaria in order to achieve a reduction of the malaria burden by at least 50% by 2010 and 75% by 2015."

The document also urged "Improving the communication process and extension of advocacy work to all stakeholders and target audiences," noting that this "highlights the importance of commemorating the World Malaria Day/Malaria Day in the Americas, proposed by Guyana for 6 November."

Dr. Carter noted that in the Americas, approximately 74 percent of infections are caused by Plasmodium vivax, with Plasmodium falciparum accounting for almost 26 percent of cases.

"The latest regional data on malaria-associated mortality from country reports in 2005 reflect a 69 percent decrease relative to the 2000 baseline figures. It is expected that these mortality figures further decreased in 2006."

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