HEALTH-BRAZIL: Malaria Is Not Invincible

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, Oct 3 2001 (IPS) - A programme implemented jointly by national and municipal health authorities in Brazil could serve as a model for fighting malaria, as evidenced by its success in reducing the number of cases reported in the first half of the year by 43 percent with respect to the same period in 2000.

Thanks to the Plan for the Intensification of Malaria Controls in Amazonia (PIACM), which began to be put into effect 15 months ago, the total number of malaria cases dropped from 333,000 between January and June 2000 to 140,000 in the same period this year, reverting the upward tendency reported since 1998.

A full 99.7 percent of all malaria cases in Brazil occur in the Amazon jungle region, which covers more than half of the national territory, according to the National Health Foundation (FUNASA), the Health Ministry body that is implementing the PIACM and other programmes against endemic diseases.

Malaria is endemic in many humid tropical areas in the world, where stagnant water – the breeding-ground of mosquitoes – abounds. The main victims of the disease are the poorest inhabitants of poor countries, who generally lack basic sanitary services.

The illness claims three million lives a year worldwide, and is transmitted by the Anopheles mosquito, which lives in areas up to 3,000 metres above sea level, and which introduces the malaria parasite, the plasmodium, into the bloodstreams of its human victims.

The alert was sounded in Brazil in 1999, when 630,747 cases were reported, 34.21 percent more than in 1998, the turning-point when the incidence of the disease began to increase after several years of decline.

Health authorities expect the number of cases to be cut in half this year, because the government of Fernando Henrique Cardoso has given top priority to the problem, undertaking a series of actions in conjunction with local governments, the coordinator of the PIACM, José Lázaro de Brito Ladislau, told IPS.

The PIACM will involve the training of 20,000 health workers, an increase in technical staff, a nearly 60 percent expansion of the network of disease-diagnosing laboratories, purchases of vehicles and equipment and, especially, the strengthening of municipal health facilities.

Rapid diagnosis and immediate treatment in order to break the chain of contagion are essential to controlling the epidemic, said De Brito Ladislau. For that reason, the number of laboratories operating in Brazil’s Amazon region has increased by 58 percent.

The training of community health workers, who are in close contact with the population, is another important factor in curbing the incidence of malaria, he added.

The symptoms of malaria appear 12 days after the individual is stung by a mosquito that carries the plasmodium parasite. Four days later, if the patient fails to receive proper treatment, they become a carrier of the parasite that causes the disease, said Adonias Correia da Silva, a lab technician.

Da Silva, who has worked in FUNASA for 16 years, is based in Paragominas, one of the most heavily affected municipalities in the northern state of Para, which accounts for 45 percent of all malaria cases in Brazil.

But Paragominas, a city of 70,000, is also one of the municipalities that has made the greatest progress fighting malaria, having cut the number of cases logged in the first half of last year – 8,400 – by two-thirds, said Amiraldo Pinheiro, coordinator of endemic disease control in Para.

In some rural communities just recently created in the jungle, “100 percent of residents” are carriers of the malaria parasite, Da Silva told IPS.

Paragominas’ success in fighting malaria was achieved by increasing the number of laboratories in the city from two to six and setting up the new ones in the hardest-hit areas, while training more than 60 new community health workers, he pointed out.

While in the past, half of the tests came back positive, that proportion has dropped to less than 30 percent – an indication that people are coming in to get tested at the slightest suspicion of malaria, whether they feel “fever or a headache” coming on, which has improved controls, said the lab technician.

An upgraded and expanded structure of municipal services, which was the aim of a policy of decentralisation, has ensured that the PIACM will be an ongoing programme, underlined De Brito Ladislau, a physician who has worked in FUNASA for 23 years.

The history of malaria in Brazil has had ups-and-downs. In the 1940s, the disease attacked one out of seven Brazilians, and an average of six million cases a year were reported. But an intensive prevention campaign reduced the number of patients to around 100,000 a year.

However, the incidence of the disease rose again in the 1970s, as the population of the Amazon jungle region grew when the government provided incentives to those wishing to carve out settlements in the jungle.

Fortunately, the strains of malaria found in Brazil are less lethal than those seen in Africa. FUNASA reported only 187 deaths in 1999, and 132 the following year.

The new focus has left behind the periodic prevention campaigns of the past in favour of putting in place ongoing controls, based on municipal services and a network that continuously monitors the situation in order to allow the central government’s agencies to act swiftly in critical areas, said De Brito Ladislau.

The coordinator of the PIACM noted that malaria spread along with the population, and the 60 percent of cases occurred in new rural settlements set up as part of the agrarian reform process.

The construction of large hydroelectric dams also creates high- risk situations by drawing thousands of workers and their families to areas lacking sanitation services.

Experience has shown that local disease control structures are more effective, which means that as the measures contemplated by the PIACM go fully into effect by the end of next year, the incidence of malaria should fall even more dramatically, De Brito Ladislau concluded.