Sunday , January 17 2021

Malaria, a disease without eradication



Anopheles female mosquitoes with a bite are capable of transmitting the parasite that causes malaria or malaria. The mosquito does not know limits or limits. Their females seek blood to feed their progeny and go hand-in-hand and transmit the disease in a very difficult cycle to eliminate. But not impossible

In Panama, malaria is a stalking disease, and the largest number of cases is denoted in indigenous populations.

The parasites that transmit malaria are five species, according to the Pan American Health Organization (PAHO), but the two most dangerous are Plasmodium vivax and Plasmodium falciparum, which can aggravate the patient's health status and cause death

The epidemiological records of the Ministry of Health (Minsa) show that Plasmodium vivax and Plasmodium falciparum circulate in the country and that when comparing the cases of people who presented the disease until October of this year, which was reported last year the same month, there is an increase 48 cases. In 2017 there were 531, while this year the figure amounts to 579.

This latest report also indicates that the increase in people with malaria is in the expected, due to the fact that Plasmodium vivax outbreaks have occurred in the communities of the Tuira river in the province of Darién, in the Guna Yala region (La Miel, Puerto Obaldía and Playón Chico) and in the region of Ngäbe Buglé and Colón.

The challenge

Against this background, the Memorial Institute for Health Studies of Minsa and Gorgas assumed the challenge of eradicating malaria in 2020 as part of the Malaria Prevention Strategic Plan (PEEM), signed last April between the health authorities and representatives from PAHO, which proposes the necessary actions to achieve the elimination of indigenous cases in the country.

Among the measures that must be taken is the active search of the cases, the integral approach, the orientation towards the community and the spraying intra-domiciliary.

In fact, Epidemiology data show that up to October 549 autochthonous cases and 30 cases of imported malaria were reported. And throughout 2017, there were 599 autochthonous cases and 31 cases imported, that is, a total of 630 people presented the disease.

In this sense, the Department of Epidemiology of Minsa reported that the cases of the disease persist in the indigenous areas because they could not eliminate the malares foci.

In addition, the key problem they have encountered is the linguistic difference between the population of indigenous groups and the health officials who come to these regions with prevention and control programs.

Those responsible for Epidemiology reported that during the workshops with the entities they demonstrated the gaps in the diagnosis, treatment, investigation and response, so PEEM trusted in these aspects.

The Vice Minister of Health, Eric Ulloa, explained that as a country we will not move forward, not only against the fight against the mosquito, the vector; but in the active search of the cases, for which we must work with the community, the promoters, with the associations to actively search for cases and treat them quickly to reduce the transmission.

He added that there are some obstacles, such as the dispersion of endemic localities, the endemic areas on the international borders, the sociocultural characteristics of the indigenous populations, among others.

Suggestions and study

Meanwhile, the scientist Icges Nicanor Obaldía III It recommended a multisectoral approach involving MINSA, the Ministry of Housing, the Vice Minister of Indigenous Affairs, among other entities, to direct efforts towards endemic centers (improve housing and drainage systems, as well as fumigate and eliminate breeding sites mosquitoes).

He argued that they are conducting a study that they hope to be part of the base to propose the establishment of a molecular epidemiological surveillance system for imported or resurgent parasites in Panama and Mesoamerica. [desde la península de Yucatán en México, Centroamérica y Panamá].

The researcher said that this proposal aims to determine genetic diversity and the structure of the population, in order to understand the epidemiology or dynamics of the disease, as well as the biology of its transmission, which are key elements for the implementation of a successful elimination program.

Obaldía III stated that the preliminary results of the research titled Genetic diversity and population structure of human malaria parasites in Panama They indicate that during 2007-2012 the parasite of Plasmodium vivax that circulated in Panama was in a "clonal" phase (highly related genetically or intertwined), which indicates a low diversity and, consequently, a low transmission. These results provide evidence of progress towards elimination.


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