Abstract
BackgroundThe present study provides a countrywide perspective of the malaria situation in Panamá over a long-term framework, with the purpose of identifying historical malaria resurgence events and their potential causes.MethodsA descriptive-ecological study was conducted by analysing demographic and epidemiological annual malaria time series data in Panamá (1884–2019) using several data sources. Malaria intensity indicators were calculated during the study period. The effects of El Niño Southern Oscillation on malaria transmission were also analysed using a retrospective analysis of malaria cases between 1957 and 2019.ResultsSeveral factors were identified responsible for malaria resurgence in Panamá, mostly related with Malaria Control Programme weakening. During the past 20 years (2000–2019) malaria has progressively increased in prevalence within indigenous settlements, with a predominance of male cases and a high proportion (15% of total cases) in children less than 5 years old. During this period, a significant and increasing proportion of the Plasmodium falciparum cases were imported. Retrospective analysis (1957–2019) evidenced that ENSO had a significant impact on malaria transmission dynamics in Panamá.ConclusionsData analysis confirmed that although authorities have been successful in focalizing malaria transmission in the country, there are still neglected issues to be solved and important intercultural barriers that need to be addressed in order to achieve elimination of the disease by 2022. This information will be useful for targeting strategies by the National Malaria Elimination Programme.
Highlights
The present study provides a countrywide perspective of the malaria situation in Panamá over a longterm framework, with the purpose of identifying historical malaria resurgence events and their potential causes
90% of the malaria cases registered in the country during the past 40 years are from poor indigenous regions, and around 1000 annual cases have been reported for the last 15 years, mostly (~ 94%) by Plasmodium vivax [9,10,11,12]; reflecting the neglected status of this disease and marked health inequities associated with ethnicity in Panamá [10, 11]
The general acceptance of the discovery proving that malaria was transmitted by mosquitoes—precisely when US took over the construction of the Panamá Canal in 1904—had profound influence on the incidence and distribution of malaria in Panamá and the rest of the endemic countries [3,4,5,6,7]
Summary
The present study provides a countrywide perspective of the malaria situation in Panamá over a longterm framework, with the purpose of identifying historical malaria resurgence events and their potential causes. Panamá has a long history of tropical diseases control and research since the early twentieth century when arthropod vector-borne pathogens, such as yellow fever and malaria, posed great challenges to the construction of the Panamá Canal by the USA [1,2,3,4,5]. The French effort to construct a Canal through the Panamá isthmus was unsuccessful largely because of the failure to control vector-borne diseases that caused very high morbidity and mortality rates among the French Canal employees on the Isthmus [1, 6, 7]. The degree of socioeconomic inequity in Panamá reaches a value of 49.9 according to the Gini coefficient; one of the highest in Latin America [13]
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