A rapid malaria appraisal in the Venezuelan Amazon.

BACKGROUND: While the federal state of Amazonas bears the highest risk for malaria in Venezuela (2007: 68.4 cases/1000 inhabitants), little comprehensive information about the malaria situation is available from this area. The purpose of this rapid malaria appraisal (RMA) was to provide baseline data about malaria and malaria control in Amazonas. METHODS: The RMA methodology corresponds to a rapid health impact assessment (HIA) as described in the 1999 Gothenburg consensus. In conjunction with the actors of the malaria surveillance system, all useful data and information, which were accessible within a limited time-frame of five visits to Amazonas, were collected, analysed and interpreted. RESULTS: Mortality from malaria is low (< 1 in 105) and slide positivity rates have stayed at the same level for the last two decades (15% +/- 6% (SD)). Active case detection accounts for ca. 40% of slides taken. The coverage of the censured population with malaria notification points (NPs) has been achieved in recent years. The main parasite is Plasmodium vivax (84% of cases). The proportion of Plasmodium falciparum is on the decline, possibly driven by the introduction of cost-free artemisinin-based combination therapy (ACT) (1988: 33.4%; 2007: 15.4%). Monitoring and documentation is complete, systematic and consistent, but poorly digitalized. Malaria transmission displayed a visible lag behind rainfall in the capital municipality of Atures, but not in the other municipalities. In comparison to reference microscopy, quality of field microscopy and rapid diagnostic tests (RDTs) is suboptimal (kappa < 0.75). Hot spots of malaria risk were seen in some indigenous ethnic groups. Conflicting strategies in respect of training of community health workers (CHW) and the introduction of new diagnostic tools (RDTs) were observed. CONCLUSION: Malaria control is possible, even in tropical rain forest areas, if the health system is working adequately. Interventions have to be carefully designed and the features of the particular local Latin American context considered.

Ensayo clínico aleatorizado, comparativo de cloroquina y quinina para el tratamiento de la Malaria por Plasmodium falciparum en Amazonas, Venezuela / A comparative randomized clinical assay of chloroquine (CQ) and quinine (QN) for the treatment of plasmodium falciparum malaria in the Amazonas State

Se evaluó la eficacia de la cloroquina (CQ) y quinina (QN) en pacientes con malaria a Plasmodium falciparum en el Municipio Atures, Estado Amazonas, Venezuela. El estudio es un ensayo clínico aleatorizado supervisado, comparativo de CQ y QN, basado en una modificación del protocolo de 28 días de la OMS/OPS (1998). Se observó en un grupo (n=20) tratado con CQ fracaso precoz de tratamiento (FPT), fracaso tardío de tratamiento (FTT) y respuesta clínica adecuada (RCA) en 8 (40 por ciento), en 12 (60 por ciento) y en 0 (0 por ciento) pacientes respectivamente. En un segundo grupo (n=30) tratado con QN se observó FPT en 2 (6,7 por ciento) y FTT en 4 (13,3 por ciento) para un total de 6 (20 por ciento) participantes con fracaso y en 24 (80 por ciento) pacientes se observó RCA. La proporción de RCA al tratamiento con QN fue significativamente alto (p = 0.000) en comparación al tratamiento con CQ. Los resultados en esta investigación demuestran FTT y FPT de la CQ y disminución de la eficacia de QN. Se sugiere hacer cambios respecto al uso de la QN para preservar su potencial