Abstract
Introduction:Malaria still is a public health problem in the Americas. In 2015, Brazil accounted for 37% of all cases in the Americas, and of these cases, 99.5% were located in the Brazilian Amazon. Despite the mobilization of resources from the Brazilian National Plan for Malaria Control, too many municipalities have high transmission levels. The objective of this study is to evaluate the local epidemiological profile of malaria and its trend between 2010 and 2015 in the Brazilian Amazon. This study also aims to recognize the epidemiological differences in the local temporo-spatial dynamics of malaria.Methods:Malaria data were stratified by the annual parasite incidence (API) over the six-year period and by municipality. We used the method of seasonal decomposition by Loess smoothing to capture trend, seasonal and irregular components. A generalized linear model was applied to quantify trends, and the Kruskal-Wallis Rank Sum was applied to test for seasonality significance.Results:The malaria API declined by 61% from 2010 to 2015, and there was a 40% reduction of municipalities with high transmission (determined as an API higher than 50). In 2015, 9.4% of municipalities had high transmission and included 62.8% of the total cases. The time-series analyses showed different incidence patterns by region after 2012; several states have minimized the effect of the seasonality in their incidence rates, thus achieving low rates of incidence. There were 13 municipalities with sustained high transmission that have become the principal focus of malaria control; these municipalities contained 40% of the cases between 2013 and 2015.Discussion:Brazil has achieved advances, but more sustained efforts are necessary to contain malaria resurgence. The use of malaria stratification has been demonstrated as a relevant tool to plan malaria programs more efficiently, and spatiotemporal analysis corroborates the idea that implementing any intervention in malaria should be stratified by time to interpret tendencies and by space to understand the local dynamics of the disease.
Highlights
Malaria still is a public health problem in the Americas
The malaria annual parasite incidence (API) declined by 61% from 2010 to 2015, and there was a 40% reduction of municipalities with high transmission
The study corroborates the approach that implementing any intervention in malaria should be stratified in time to interpret the latest tendencies and in space to understand the local dynamics of the disease
Summary
Malaria still is a public health problem in the Americas. In 2015, Brazil accounted for 37% of all cases in the Americas, and of these cases, 99.5% were located in the Brazilian Amazon. There are disparities between states; for example, Amazonas and Pará are the largest states, and together, they represent 76% of the population and 66% of the municipalities of the area studied Both are the poorest states, with 234 US$ and 209 US$ per capita of monthly income, respectively. In Pará, the municipality with the highest income per capita is Canaã dos Carajás, with 3,000 US$ per month, whereas the poorest, Curralinho, has only 90 US$4 This area is highly heterogeneous with a complex ecology and different socioeconomic characteristics, making the study of internal dynamics extremely important to prevent, control and eliminate local malaria
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