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Memorias del Instituto de Investigaciones en Ciencias de la Salud

versão On-line ISSN 1812-9528

Mem. Inst. Investig. Cienc. Salud vol.15 no.2 Asunción ago. 2017

https://doi.org/10.18004/mem.iics/1812-9528/2017.015(02)03-005 

Articles

The road to malaria elimination in Paraguay

Mara Muñoz


Malaria is a disease caused by protozoan parasites of the genus Plasmodium that are transmitted by the bite of the infected female mosquito of the genus Anopheles. The genus Plasmodium comprises four species that infect humans: P. falciparum, P. vivax, P. malariae and P. ovale1. While P. falciparum is responsible for most of the deaths, P. vivax predominates outside sub-Saharan Africa and produces about half of the cases of malaria and predominates in countries that are optimal candidates for the elimination of the disease being responsible for more than 70% of the cases that occur in countries with less than 5,000 annual cases2. Unlike P. falciparum, which does not cause chronic liver infection, P. vivax can remain latent in the liver for many months or even years after inoculation and cause repeated relapses. For this reason, the elimination of malaria caused by P. vivax is particularly difficult and in some settings may require new tools and strategies3.

Malaria is present in 21 countries in the Americas and 145 million people are at risk of contracting it in the region. Cases fell by 60% and deaths by 72% between 2000 and 2012. Argentina, Belize, Costa Rica, Ecuador, El Salvador, Mexico and Paraguay are on the way to eliminating it1.

The World Health Organization Global Malaria Program (WHO-GMP) identified the need to accelerate progress in reducing the burden of malaria and thus developed the Global Technical Strategy against Malaria 2016-2030 with two major goals: to eliminate the disease in 35 countries and reduce global incidence and mortality rates by 90%2,4.

In our country, the last major epidemic occurred in 1999 with 9,946 confirmed cases involving 9 departments, located in the central-eastern and northeastern part of the country. After several interventions by the National Malaria Elimination Service (SENEPA), the cases were restricted to the rural areas of the departments of Alto Paraná, Caaguazú and Canindeyú5. The lake of the river Iguazu is in this area, and is characterized by fluctuations of its water level. In a study that was carried out with data from 2002 to 2006, it was observed that when the water level is below the critical threshold malaria cases increased. This observation can be explained from the biological point of view as low water levels favor the formation of vegetation suitable for the proliferation of anopheline mosquitoes6. As of 2006, there was an increase in cases imported from other countries in the Americas and other continents5. The last outbreaks of P. vivax malaria in Paraguay were in 2007 and 2009, in Canindeyú and Alto Paraná(7, 8), then the cases were gradually declining until 2011 when the last autochthonous case of malaria was recorded9.

With this epidemiologic situation Paraguay is one of the candidate countries for the elimination of malaria, since it no longer reports autochthonous cases in its territory, therefore to reach this goal the country must focus on three pillars and two elements of support proposed by the WHO10 which are: achieve universal access to prevention, diagnosis and treatment of malaria, accelerate efforts to achieve elimination and malaria free status, and transform malaria surveillance into a basic intervention. All these based on research and the improvement of the environment conducive to transmission.

The Ministry of Public Health and Social Welfare of Paraguay, along with several of its dependencies, is on the arduous task of achieving a malaria-free country that must be certified by WHO/PAHO, and where the health system guarantees prevention, diagnosis, treatment and epidemiological surveillance. We are close to achieving this and in that sense we must all be an active part and involve ourselves from the area we are or task we have to perform within the country's health system, to walk together towards a malaria-free Paraguay.

Referencias Bibliográficas

1. Organización Panamericana de la Salud/Organización Mundial de la Salud. Diez enfermedades transmitidas por vectores que ponen en riesgo a la población de las Américas. 2014. Disponible: http://www.paho.org/hq/index.php?option=com_content&view=article&id=9438%3A2014-10-vector-borne-diseases-that-put-population-americas-at-risk&catid=1443%3Aweb-bulletins&Itemid=135&lang=esLinks ]

2. Organización Mundial de la Salud. Control y eliminación del paludismo por Plasmodium vivax. Informe técnico. Ginebra: OMS; 2015. ISBN 978 92 4 350924 2. Disponible: http://apps.who.int/iris/bitstream/10665/204494/1/9789243509242_spa.pdf. [ Links ]

3. World Health Organization. Testing for G6PD deficiency for safe use of primaquine in radical cure of P. vivax and P. ovale malaria - Policy brief. Ginebra: WHO; 2016. Disponible: (http://apps.who.int/iris/bitstream/10665/250297/1/WHO-HTM-GMP-2016.9-eng.pdf. [ Links ]

4. World Health Organization. World Malaria Report 2016. Geneva: WHO; 2016. Licence: CC BY-NC-SA 3.0 IGO. Disponible en: http://apps.who.int/iris/bitstream/10665/252038/1/ 9789241511711-eng.pdf?ua=1Links ]

5. Dirección General de Vigilancia de la Salud. Guía Nacional de Vigilancia y Control de Enfermedades, Sistema Nacional de Vigilancia Epidemiológica. Asunción: MSPyBS; 2015. Disponible: http://www.vigisalud.gov.py/documentos/Guia-Vigilancia-2015.pdfLinks ]

6. Muñoz M, Villarroel J, Scavuzzo M, Lanfri M, Cousiño B, Russomando G. Spatial-Temporal Analysis of Malaria in Endemic Areas of Paraguay, 2002-2006. Acta Biológica Venezuelica. 2011; 31(2). Disponible: http://saber.ucv.ve/ojs/index.php/revista_abvLinks ]

7. Muñoz M, Espínola B, Cousiño B, Barreto P, Viveros C. Brote de Malaria en la Localidad de Pirá Verá, Canindeyú-Paraguay, entre las semanas epidemiológicas 4 y 13 del año 2007. Revista Paraguaya de Epidemiología. 2010; 1(1). Disponible: http://www.ins.gov.py/revistas/index.php/epidemiologia/article/view/265Links ]

8. Muñoz M, Espínola B, Viveros C, Villalba A. Brote de Malaria en la Localidad Primer Gobernador, Alto Paraná-Paraguay, entre las semanas epidemiológicas 11 y 23 del año 2009. Presentada y Publicada en el Resumen de Temas Libres de la 1° Muestra Nacional de Epidemiologia.Revista Paraguaya de Epidemiologia. 2010; 1(1). Disponible: http://www.vigisalud.gov.py/documentos/revista/vol1%20nro1%20nov2010%20RPE%20temas%20libres/3.INDICE.pdfLinks ]

9. ABC Color. Dos años sin malaria autóctona en Paraguay. 2013. Disponible: http://www.abc.com.py/nacionales/hace-dos-anos-que-paraguay-no-tiene-malaria-auctoctona-565063.htmlLinks ]

10. Organización Mundial de la Salud. Acción e Inversión para vencer a la Malaria 2016-2030: por un mundo libre de malaria. ISBN 978 92 4 350897 9. Ginebra: OMS; 2015. Disponible: http://www.rollbackmalaria.org/files/files/aim/RBM_AIM_Report_A4_AW_ES-lores.pdfLinks ]

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