Friday, 6 July 2018

In a Rare Success, Paraguay Conquers Malaria

In a Rare Success

Paraguay has eliminated malaria, the primary country within the Americas to try to so in almost 50 years, consistent with the planet Health Organization.

But worldwide, momentum against the disease has stalled. Malaria cases increased by five million between 2015 and 2016, climbing to 216 million from 211 million.

Nine countries within the Americas reported a minimum of a 20 percent increase in malaria cases during that period — greater than in another region.

“This is one among the diseases that hang on tight,” said Luis Alberto Moreno, the president of the Inter-American Development Bank, which finances major anti-malaria efforts in the Americas.

“If you don’t keep the pedal to the metal — stay intensely focused on the difficulty — malaria goes to form its return.”

Malaria, a blood disorder contracted through the bite of an infected mosquito, kills about 445,000 people annually, mostly children, consistent with the W.H.O. Yet cost-effective prevention tools and coverings are documented.

Public health officials at the primary Malaria World Congress in the week attributed Paraguay’s success to the national health system’s ability to quickly detect cases and investigate whether they had been transmitted locally or imported.

W.H.O. officials also expect to certify Argentina as malaria-free later this year, according to Dr. Marcos A. Espinal, director of the communicable diseases department at the Pan American Health Organization.

But throughout the region, other countries are backsliding. Panama, Nicaragua, Peru, and Venezuela reported more malaria infections in 2016 than in 2010. Cases in Colombia doubled from 2015 to 2016.

Officials say the chief hurdle is complacency: In many countries, domestic resources have shifted from anti-malaria efforts to other priorities as case numbers have dwindled.

“Political will is that the single most vital aspect for eliminating malaria,” Dr. Espinal said.
“We have effective tools: bed nets, vector control methods, treatments.

We get to a certain point — we see the top of the tunnel — then we risk losing the commitment.”

The situation is most dire in Venezuela, where President Nicolás Maduro has refused to accept most medical donations amid a depression. Malaria infections, alongside hunger and tuberculosis, have surged since 2008.

As Venezuelans cross borders into Guyana, Colombia, and northern Brazil, they may bring the infection with them.

Breeding conditions for mosquitoes are favorable in those regions, so transmission may increase, consistent with Dr. Alexandre Macedo de Oliveira, a malaria researcher at the Centers for Disease Control and Prevention.

“Until there's a government in Venezuela willing to try to something about it, it’s hard to try to anything but wait,” said Mr. Moreno, who serves on the top Malaria Council, a response coordination team headed by Gates.

“Mosquitoes don’t respect borders,” Mr. Moreno added.

In recent years, the fight against malaria in Central America has grown more complex.

Lingering cases are concentrated in rural areas, where communities lack immediate access to health care and transmission is challenging to detect and disrupt.

Extreme flooding can increase breeding sites for mosquitoes, and therefore the two that are the region’s main sources of malaria — Anopheles darling and Anopheles albitarsis — have begun to point out resistance to the insecticide.

Earlier this year, the Bill and Melinda Gates Foundation, the Inter-American Development Bank and therefore the Carlos Slim Foundation together announced an $83.6 million initiative to eliminate malaria from Central America and therefore the Dominican Republic.

A top priority is controlling the insect itself. Environmental doctors minimize mosquito populations by coating the walls of vulnerable schools and houses with insecticide, a way called indoor residual spraying.

They also drain water during which mosquitoes might breed, like muggy ponds, hollow cinder blocks, and littered bottle caps.

But as long as mosquitoes exist, even countries that eliminate malaria remain in danger for its resurgence.

Paraguay, like all other mosquito-friendly countries, will get to maintain a thorough closed-circuit television.

“It may be a far better economic investment to stop disease than to combat it at full force,” Mr. Moreno said. “The worst thing you'll do is eliminate malaria then have it come.”

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