Malaria in Brazil: achievements, lessons, and assessment of elimination

The title of this paper could also be “How to write about malaria programs and operations”. It is among the most astute, careful descriptions of policy and long-term changes in malaria incidence I have seen. The article deserves broad reading as it contains many lessons on research and control for other countries.

In the past 20 years, Brazil not only reduced reported cases but did so while inverting its falciparum:vivax ratio. While other cases of success have recently been reported, in Equatorial Guinea, The Gambia, Zanzibar, etc relatively short-term changes in small geographies are not as impressive as a sustained decline in a large country with a complex federal structure. In describing this achievement the authors focus on the systems they built (staff, financial, managerial) – and not simply on biomedical tools. They also recognize the danger of success for future efforts:

In summary, the inversion of the P. falciparum/P. vivax cases ratio in Brazil in the last two decades was a major achievement of the National Control Programme, leading to a substantial decrease in the number of deaths. However, this may be troublesome regarding the future perspectives of eliminating malaria in Brazil, since policy-makers are less prone to privilege investments in a disease with low fatality rates and with a massive incidence outside the economic axis area of the country.

With an admirable open and critical tone, they also explicitly address the possibility of elimination from an ecological perspective:

The present difficulties in reducing economic and social risk factors that determine the incidence of malaria in the Amazon Region render impracticable its elimination in the region.

It is a sober but wise assessment which avoids needless platitudes used by so many other leaders.

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1 Response to “Malaria in Brazil: achievements, lessons, and assessment of elimination”



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