Factores asociados a casos de malaria y plantas medicinales empleadas para su tratamiento en habitantes de Corozal, Colombia / Factors associated with cases of malaria and medicinal plants used for its treatment in inhabitants of Corozal, Colombia

Introducción: La malaria es una de las enfermedades infecciosas más importantes y para tratarla además de medicamentos, la población emplea plantas medicinales. El objetivo fue establecer los factores asociados a malaria y las plantas empleadas para su tratamiento en habitantes de Corozal. Método: Se aplicó una encuesta con preguntas sociodemográficas, de la vivienda, de conocimiento y de actitudes y las plantas medicinales empleadas para tratarla. Resultados: El 48% emplean plantas medicinales solas o con medicamentos, siendo el Gliricidia sepium (matarratón) y el Acmella oppositifolia (yuyo) las plantas más empleadas. En el 48% de las casas ha habido malaria. Por regresión logística se estableció que la malaria se asoció con conocer cómo se adquiere, consultar al médico tradicional y tener más de 15 años en Corozal. Conclusiones: Las plantas que la población de este estudio reportan no muestran evidencia científica como antimalaricos. Es importante una mayor presencia de las autoridades de salud y su trabajo conjunto con el médico tradicional para lograr estrategias más efectivas(AU)

Introduction: Malaria is one of the most important infectious disease and to treat it in addition to medicines the population uses medicinal plants. The objective was to establish the factors associated with malaria and the plants used for its treatment in inhabitants of Corozal. Method: A survey was applied with sociodemographic questions about housing, knowledge and attitudes, in addition to the medicinal plants used to treat it. Results: 48% use medicinal plants alone or with medicines, Gliricidia sepium (rat poisson) and Acmella oppositifolia (Opposite-leaf Spotflower) are the most used. In 48% of the homes there has been malaria. By logistic regression it was established that malaria was associated with knowing how it is acquired, consulting the traditional doctor and living in Corozal for more than 15 years. Conclusions: The plants that the population of this study report usimg do not show scientific evidence antimalarials. A greater presence of health authorities and their joint work with the traditional doctor for more effective strategies is important(AU)

Uso de servicios de salud y enfermedades transmisibles de la población migrante y refugiada venezolana / Use of health services and communicable diseases of the Venezuelan migrant and refugee population

Resumen Introducción: Colombia es el principal país receptor de población migrante venezolana. Esto ha implicado identificar las necesidades en salud de esta población, como la atención y tratamiento de enfermedades infecciosas. Objetivo: Analizar el uso de servicios de salud relacionados con VIH/SIDA, malaria y hepatitis virales en migrantes y refugiados venezolanos en Colombia durante 2018 y 2019. Metodología: Estudio de investigación mixto. Se desarrollaron 12 grupos focales con mujeres y hombres venezolanos y se realizó un análisis del uso de servicios de salud por diagnósticos de VIH/SIDA, malaria y hepatitis virales, durante 2018 y 2019, en seis ciudades con un alto flujo de migración: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta y Riohacha. Resultados: El uso de servicios de salud por enfermedades infecciosas en migrantes venezolanos aumentó de 2018 (n=1,519) a 2019 (n=3,988). Los hombres fueron los que más usaron los servicios de salud por estas enfermedades. Aun así, la situación irregular migratoria, deficiencias en la atención primaria y acceso limitado a protección y detección temprana de enfermedades transmisibles, constituyen las principales barreras para migrantes y refugiados respecto a la atención en salud. Conclusiones: La migración expone a las personas al riesgo de contraer enfermedades infecciosas, así como a desigualdades y exclusión social en el acceso a servicios de salud para el control y tratamiento de estas enfermedades. Por ello, en contextos de migración se debe fortalecer la equidad en los servicios de salud con el fin de asegurar el acceso de las personas a la atención primaria, insumos, pruebas diagnósticas y tratamiento de enfermedades infecciosas.

Abstract Introduction: Colombia is the main receiving country of the Venezuelan migrant population. This has involved identifying the health needs of this population, such as the care and treatment of infectious diseases. Objective: To analyze the use of health services related to HIV/AIDS, malaria and viral hepatitis in Venezuelan migrants and refugees in Colombia during 2018 and 2019. Methodology: Mixed research study. Twelve focus groups were held with Venezuelan women and men and an analysis was made of the use of health services for HIV/AIDS, malaria, and viral hepatitis diagnoses during 2018 and 2019 in six cities with a high migration flow: Barranquilla, Bogotá, Cartagena, Cúcuta, Santa Marta, and Riohacha. Results: The use of health services for infectious diseases among Venezuelan migrants increased from 2018 (n=1.519) to 2019 (n=3.988). Men were the greatest users of health services for these diseases. Even so, irregular migration status, deficiencies in primary care, and limited access to protection and early detection of communicable diseases are the main barriers to health care for migrants and refugees. Conclusions: Migration exposes people to the risk of infectious diseases, as well as to inequalities and social exclusion in access to health services for the control and treatment of these diseases. Therefore, in migration contexts, equity in health services should be strengthened by ensuring people's access to primary care, inputs, diagnostic tests and treatment of infectious diseases.

Guía clínica para la atención integral de personas con malaria / Clinical guide for the comprehensive care of people with malaria

La presente guía clínica contiene el conjunto de recomendaciones e indicaciones necesarias para la estandarización de los procesos de atención en salud, para contribuir a la mejora continua de la calidad de atención. Su proceso de elaboración ha incluido la búsqueda bibliográfica de la información científica, el análisis y la adaptación local de acuerdo a los medicamentos establecidos en el Listado institucional de medicamentos esenciales del MINSAL, asimismo se ha desarrollado el análisis y discusión de los hallazgos, por parte de profesionales de los diferentes niveles involucradas en el proceso de atención a nivel nacional, proporcionando un instrumento útil para la optimización de recursos sanitarios

This clinical guide contains the set of recommendations and indications necessary for the standardization of health care processes, to contribute to the continuous improvement of the quality of care. Its elaboration process has included the bibliographic search of the scientific information, the analysis and the local adaptation according to the drugs established in the Institutional List of Essential Medicines of the MINSAL, as well as the analysis and discussion of the findings, by of professionals of the different levels involved in the care process at the national level, providing a useful instrument for optimizing health resources

Evaluación de la calidad del diagnóstico de malaria en la red local de laboratorios y en los laboratorios intermedios en el contexto de la eliminación de la enfermedad en Ecuador / Quality evaluation of malaria diagnosis in the local laboratories network and in intermediate laboratories in a setting towards the disease elimination in Ecuador

Resumen Introducción. El cumplimiento de la meta de eliminación de la malaria en Ecuador en el 2020 exige contar con la capacidad requerida para el diagnóstico microscópico ajustado a los estándares de calidad de la Organización Mundial de la Salud (OMS) y de la Organización Panamericana de la Salud (OPS) y proveer el tratamiento adecuado a los pacientes. Objetivo. Conocer la idoneidad o competencia de los microscopistas de la red pública local para el diagnóstico parasitológico de la malaria y el desempeño de los laboratorios intermedios de referencia. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal a partir de la información obtenida en los talleres de evaluación de idoneidad en el diagnóstico microscópico de la red de laboratorios en las coordinaciones zonales de salud utilizando un panel de láminas para evaluar la concordancia del diagnóstico. Además, se calificó el desempeño de los laboratorios intermedios en el diagnóstico en el marco del programa de evaluación externa del desempeño. Los resultados se compararon con los obtenidos por el laboratorio supranacional de Perú. Resultados. En los 11 talleres realizados, se evaluó la idoneidad de 191 microscopistas, de los cuales 153 (80,1 %) aprobaron las pruebas. Las medianas de los indicadores fueron las siguientes: concordancia entre la detección y el resultado, 100 % (Q1- Q3: 96-100); concordancia en la especie, 100 % (Q1- Q3: 93-100); concordancia en el estadio, 93,0 % (Q1- Q3: 86-95) y concordancia en el recuento, 77 % (Q1- Q3: 71-82). En el programa de evaluación externa de desempeño, los tres laboratorios intermedios obtuvieron una concordancia del 100 % en el resultado y una del 96 % en la especie. Conclusiones. Los indicadores de competencia de la red local y de desempeño de los laboratorios intermedios alcanzaron altos estándares de calidad acordes con el proceso de entrenamiento implementado en el país.

Abstract Introduction: To reach the goal of malaria elimination in Ecuador for the year 2020, it is necessary to have a laboratory network with the capacity to perform microscopic diagnosis according to the WHO/PAHO quality standards and to provide the adequate treatment of cases. Objective: To determine the level of competence for parasitological diagnosis of the microscopists from the local public network and the performance of intermediate reference laboratories. Materials and methods: We conducted a cross-sectional study based on the information collected in workshops carried out to appraise the competence for microscopic diagnosis of the local laboratory network (zonal health coordinating offices 1 to 8) using a slide panel to evaluate diagnosis agreement, as well as the diagnostic performance of the intermediate laboratories using an external quality assessment program. The results were compared against the reference standards of the supranational laboratory in Perú. Results: We evaluated the competencies of 191 microscopists in 11 workshops and 153 (80.1%) of them were approved. The medians of the indicators were the following: concordance for parasite detection, 100% (Q1- Q3: 96-100), concordance for species identification, 100% (Q1- Q3: 93-100), and concordances for stage identification, 93.0% (Q1- Q3: 86-95) and parasite counting, 77.0% (Q1- Q3: 71-82). In the external quality assessment, the three intermediate laboratories obtained 100% in parasite detection concordance and 96% for species detection concordance. Conclusions: The results for the primary network and the performance indicators for the intermediate laboratories showed the high-quality standards of the training program implemented in the country.

Antiparasitic phytotherapy perspectives, scope and current development / Perspectivas, enfoque y actual desarrollo de la fitoterapia antiparasitaria

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing ineficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identifed potential compounds to treat Chagas' disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

Las enfermedades tropicales por protozoarios son un problema importante de salud pública en todo el mundo y están ligadas fuertemente con la pobreza. Esto lleva a que falte investigación por las empresas farmacéuticas con ánimo de lucro, que sólo se motivan por posibilidades de mercado. Adicionalmente el aumento en resistencia a los tratamientos disponibles, la toxicidad y la necesidad de largos periodos de tratamiento y los costos de muchos de ellos, hacen que exista una urgente necesidad de nuevos medicamentos costo efectivos, seguros y fáciles de administrar y que tengan mecanismos de acción novedosos. Varios extractos crudos de plantas han mostrado propiedades que permiten ser eficaces para tratar la enfermedad de Chagas, la leishmaniasis, la toxoplasmosis, la giardiasis y la malaria. Los compuestos derivados de plantas han mostrado menor toxicidad con mayor especificidad, mostrando un panorama optimista para encontrar nuevos medicamentos. Esto es evidente al analizar las cifras que muestran entre 1.010 nuevas sustancias activas aprobadas para condiciones médicas por las agencias regulatorias en los últimos 25 años, 490 (48,5%) son de origen natural.

Malaria grave en mujeres gestantes hospitalizadas entre el 2010 y el 2014 en el departamento de Antioquia, Colombia / Severe malaria in pregnant women hospitalized between 2010 and 2014 in the Department of Antioquia (Colombia)

Resumen Introducción. La malaria (o paludismo) durante la gestación impacta negativamente la salud de la madre y del neonato, con alto riesgo de complicaciones clínicas y mortalidad. En las regiones de alta endemia se han caracterizado, especialmente, la anemia materna y el bajo peso al nacer, pero es poco conocido el espectro clínico en las zonas de baja endemia. Objetivo. Caracterizar clínica y epidemiológicamente los episodios de malaria en mujeres gestantes hospitalizadas en el departamento de Antioquia entre el 2010 y el 2014. Materiales y métodos. Se hizo un estudio descriptivo, transversal y retrospectivo, con historias clínicas de mujeres gestantes con malaria por Plasmodium falciparum y P. vivax. Se utilizaron los criterios diagnósticos de malaria complicada de la Organización Mundial de la Salud (OMS) y de la Guía para la atención clínica integral del paciente con malaria vigente en Colombia. Resultados. Se analizaron 111 casos; el 13,5 % se clasificó como complicación grave según los criterios de la OMS, porcentaje que ascendió a 23,4 % según los criterios de la guía colombiana. Las complicaciones detectadas fueron disfunción hepática, anemia, acidosis y trombocitopenia grave. No se observó diferencia en la frecuencia de las complicaciones según la especie de plasmodio. El 39,4 % de los casos presentó signos generales de peligro; la palidez y la ictericia fueron los más frecuentes. El 40,5 % presentó signos de peligro para la gestación como la cefalea persistente, el dolor abdominal y el sangrado vaginal. Conclusiones. La malaria grave se presenta con gran frecuencia en las mujeres gestantes, sin diferencia según la especie de plasmodio, y se manifiesta con signos de peligro precozmente reconocibles. Se encontró un subregistro hospitalario del 88 % de los casos graves y falta de exámenes de laboratorio para un diagnóstico más completo. Se requiere un protocolo para el diagnóstico clínico de las mujeres gestantes con malaria.

Abstract Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas. Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014. Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used. Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding. Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.

Environmental and socioeconomic analysis of malaria transmission in the Brazilian Amazon, 2010-2015

ABSTRACT OBJECTIVE To analyze the environmental and socioeconomic risk factors of malaria transmission at municipality level, from 2010 to 2015, in the Brazilian Amazon. METHODS The municipalities were stratified into high, moderate, and low transmission based on the annual parasite incidence. A multinomial logistic regression that compared low with medium transmission and low with high transmission was performed. For each category, three models were analyzed: one only with socioeconomic risk factors (Gini index, illiteracy, number of mines and indigenous areas); a second with the environmental factors (forest coverage and length of the wet season); and a third with all covariates (full model). RESULTS The full model showed the best performance. The most important risks factors for high transmission were Gini index, length of the wet season and illiteracy, OR 2.06 (95%CI 1.19-3.56), 1.73 (95%CI 1.19-2.51) and 1.10 (95%CI 1.03-1.17), respectively. The medium transmission showed a weaker influence of the risk factors, being illiteracy, forest coverage and indigenous areas statistically significant but with marginal influence. CONCLUSIONS As a disease of poverty, the reduction in wealth inequalities and, therefore, health inequalities, could reduce the transmission considerably. Besides, environmental risk factors as length of the wet season should be considered in the planning, prevention and control. Municipality-level and fine-scale analysis should be done together to improve the knowledge of the local dynamics of transmission.

Impacto de diferentes esquemas terapéuticos sobre la malaria en la costa y amazonia peruana, en el marco de una política de medicamentos antimaláricos, 1994-2017 / Impact on the transmission of malaria with different treatment schemes in the peruvian coast and amazon region within the framework of a policy on antimalarial medications, 1994-2017

RESUMEN Al final de los 90 en el Perú, después de determinar la resistencia a antimaláricos, se decidió el cambio de los esquemas terapéuticos antimaláricos, que incluía la terapia combinada para P. falciparum, mefloquina/artesunato en la amazonia y sulfadoxina pirimetamina/artesunato en la costa norte. Luego de dos décadas, con el objetivo de evaluar el impacto en la endemia de malaria de estos esquemas, se revisaron los reportes de malaria en tres departamentos que juntos agrupan más del 70% de los casos reportados en el país. Fue evidente el mayor impacto del esquema sulfadoxinapirimetamina/artesunato en costa norte reduciendo a casi cero los casos de P. falciparum luego de cuatro años de implementar terapia combinada. La monodosis y la capacidad de limitar el desarrollo de esporozoitos fueron importantes para conseguir este objetivo. El esquema mefloquina/artesunato tuvo impacto limitado por la imposibilidad de asegurar tratamiento supervisado en los servicios de salud y la necesidad de tres dosis. Seleccionar un esquema eficaz y de fácil administración es importante al elegir la primera línea de tratamiento para malaria. Esta experiencia es significativa para los objetivos de eliminación de la malaria en el Perú.

ABSTRACT At the end of the 90s in Peru, after determining the resistance to antimalarial drugs, a change in antimalarial treatment schemes was decided; this change included the combined therapy for P. falciparum, mefloquine/artesunate in the Amazon region, and sulfadoxine pyrimethamine/artesunate in the North coast. After two decades, and aimed at assessing the impact of these schemes on the malaria endemic, a review was conducted of malaria reports in three departments accounting for more than 70% of cases reported in the country. The major impact of the sulfadoxine-pyrimethamine/ artesunate scheme in the North coast was evident since it reduced the number of cases of P. falciparum to virtually zero four years after implementation of the combined therapy. The single dose and the ability to limit the development of sporozoites were crucial in order to achieve this goal. The mefloquine/artesunate scheme had a limited impact because it was not possible to ensure supervised treatment in the health service facilities and the need for three doses. It is important to select an effective and easy-to-administer scheme when choosing the first line of treatment for malaria. This experience is significant for the malaria eradication goals in Peru.

Time trends and changes in the distribution of malaria cases in the Brazilian Amazon Region, 2004-2013

Recent efforts to reduce malaria incidence have had some successes. Nevertheless, malaria persists as a significant public health problem in the Brazilian Amazon. The objective of this study was to describe changes in malaria case characteristics and to identify trends in malaria incidence in the Brazilian Amazon. This study used data from the Malaria Epidemiological Surveillance and Case Notification Information System from 2004 to 2013. The annual parasite incidence (API) was calculated and joinpoint regression was used to assess the trends in API over time. There was a sharp increase in API in the state of Acre, followed by two periods of decrease. Pará also presented inconsistent decreases over the study period. Amapá, Amazonas, Rondônia, and Roraima showed statistically significant decreases over the period. The sharpest decrease occurred in Rondônia, with a reduction of 21.7% in the average annual percent change (AAPC) (AAPC: -21.7%; 95% confidence interval: -25.4%, -17.8%; p < 0.05). This panorama of malaria incidence highlights the importance of integrating evidence-based malaria surveillance and control. Malaria is highly preventable, and eliminating its transmission should be a goal in coming decades.

Factors associated with timely treatment of malaria in the Brazilian Amazon: a 10-year population-based study / Factores asociados con el tratamiento oportuno de la malaria en la Amazonia brasileña: estudio de 10 años basado en la población / Fatores associados ao tratamento precoce da malária na Amazônia brasileira: um estudo populacional de 10 anos

ABSTRACT Objective To identify factors associated with timely treatment of malaria in the Brazilian Amazon. Malaria, despite being treatable, has proven difficult to control and continues to be an important public health problem globally. Brazil accounted for almost half of the 427 000 new malaria cases notified in the Americas in 2013. Methods This was a cross-sectional study using secondary data on all notified malaria cases for the period from 2004 - 2013. Timely treatment was considered to be all treatment started within 24 hours of symptoms onset. Multivariate logistic regression was used to identify independent factors associated with timely treatment. Results The proportion of cases starting treatment on a timely basis was 41.1%, tending to increase in more recent years (OR = 1.40; 95%CI: 1.37 - 1.42 in 2013). Furthermore, people starting within < 24 hours were more likely to: reside in the states of Rondônia (OR = 1.50; 95%CI: 1.49 - 1.51) or Acre (OR = 1.53; 95%CI: 1.55 - 1.57); be 0 - 5 years of age (OR = 1.39; 95%CI: 1.34 - 1.44) or 6 - 14 years of age (OR = 1.34; 95%CI: 1.32 - 1.36); be indigenous (OR = 1.41; 95%CI: 1.37 - 1.45); have a low level of schooling (OR = 1.20; 95%CI: 1.19 - 1.22); and be diagnosed by active detection (OR = 1.39; 95%CI: 1.38 - 1.39). Conclusion In the Brazilian Amazon area, individuals were more likely to have timely treatment of malaria if they were young, residing in Acre or Rondônia states, have little schooling, and be identified through active detection. Identifying groups vulnerable to late treatment is important for preventing severe cases and malaria deaths.

RESUMEN Objetivo Determinar los factores asociados con el tratamiento oportuno de la malaria en la Amazonia brasileña. La malaria, a pesar de que es tratable, ha resultado difícil de controlar y sigue siendo un problema importante de salud pública mundial. En Brasil se notificaron casi la mitad de los 427 000 nuevos casos de malaria en la Región de las Américas en el 2013. Métodos Se realizó un estudio transversal que utilizó datos secundarios de todos los casos notificados de malaria en el período 2004-2013. Se entendió como tratamiento oportuno todo tratamiento iniciado en las 24 horas posteriores a la aparición de los síntomas. Para determinar los factores independientes asociados con el tratamiento oportuno, se usó el método de regresión logística multifactorial. Resultados La proporción de casos en los que se inició el tratamiento oportunamente fue de 41,1%, con una tendencia ascendente en los últimos años (razón de posibilidades [OR] = 1,40; IC 95%: 1,37 - 1,42 en el 2013). Además, en las personas que comenzaron el tratamiento menos de 24 horas después de la aparición de los síntomas era mayor la probabilidad de que residieran en los estados de Rondônia (OR = 1,50; IC 95%: 1,49 - 1,51) o Acre (OR = 1,53; IC 95%: 1,55 - 1,57); también era mayor la probabilidad de que tuvieran entre 0 y 5 años (OR = 1,39; IC 95%: 1,34 - 1,44) o entre 6 y 14 años (OR = 1,34; IC 95%: 1,32 - 1,36); fueran indígenas (OR = 1,41; IC 95%: 1,37 - 1,45); tuvieran un nivel bajo de escolarización (OR = 1,20; IC 95%: 1,19 - 1,22) y hubieran sido diagnosticadas por detección activa (OR = 1,39; IC 95%: 1,38 - 1,39). Conclusiones En la zona de la Amazonia brasileña, era más probable que las personas que iniciaban oportunamente el tratamiento contra la malaria fueran jóvenes, residieran en los estados de Acre o Rondônia, tuvieran un nivel bajo de escolarización y fueran detectadas mediante la detección activa. La identificación de los grupos vulnerables al tratamiento tardío es importante para prevenir los casos graves y las muertes por malaria.

RESUMO Objetivo Identificar os fatores associados ao tratamento precoce da malária na Amazônia brasileira. Embora seja tratável, a malária tem sido difícil de controlar e continua a representar um importante problema de saúde pública em escala mundial. Em 2013, o Brasil registrou quase a metade dos 427.000 novos casos de malária notificados nas Américas. Métodos Este foi um estudo transversal que utilizou dados secundários sobre todos os casos de malária notificados no período de 2004 a 2013. O tratamento precoce foi definido como todo tratamento iniciado nas primeiras 24 horas desde o surgimento dos sintomas. Utilizamos a regressão logística multivariada para identificar fatores independentes associados ao tratamento precoce. Resultados A proporção de casos que iniciaram tratamento precoce foi de 41,1%, tendendo a aumentar em anos mais recentes (odds ratio [OR] = 1,40; IC 95%: 1,37 - 1,42 em 2013). Além disso, as pessoas que iniciaram o tratamento em menos de 24 horas tiveram maior probabilidade de: residir nos estados de Rondônia (OR = 1,50; IC 95%: 1,49 - 1,51) ou Acre (OR = 1,53; IC 95%: 1,55 - 1,57); ter entre 0 e 5 anos de idade (OR = 1,39; IC 95%: 1,34 - 1,44) ou entre 6 e 14 anos de idade (OR = 1,34; IC 95%: 1,32 - 1,36); ser indígena (OR = 1,41; IC 95%: 1,37 - 1,45); ter um baixo nível de escolaridade (OR = 1,20; IC 95%: 1,19 - 1,22); e ser diagnosticado por meio da detecção ativa (OR = 1,39; IC 95%: 1,38 - 1,39). Conclusão Na região da Amazônia brasileira, as pessoas têm uma maior probabilidade de receber tratamento precoce para a malária se forem jovens, residirem nos estados do Acre ou de Rondônia, tiverem um baixo nível de escolaridade e forem identificadas através da detecção ativa. A identificação de grupos vulneráveis ao tratamento tardio é importante para prevenir os casos graves e as mortes decorrentes da malária.

Interpretações locais sobre a malária e o discurso sobre os provedores tradicionais de cuidados de saúde no sul de Moçambique / Local interpretations on malaria and the discourse on the traditional health care providers in southern Mozambique

As narrativas sobre o diagnóstico e as causas da malária são diversas e aparentemente ambíguas, sendo baseadas para além do corpo, nas relações sociais estabelecidas entre pares, os seus antepassados e a natureza. Com base num estudo qualitativo e na permanência em Moçambique durante quatro anos, este artigo pretende analisar os discursos dos pacientes e praticantes biomédicos sobre os provedores de cuidados de saúde tradicionais, isto é, tinyanga e pastores ziones, articulando-os com as terminologias locais da malária, num distrito rural no sul de Moçambique. No atual contexto de pluralismo terapêutico e elevada mobilidade, a falta de compaixão e solidariedade atribuída aos tinyanga é fundamentada pela monetarização e comoditização dos seus saberes e rituais medicinais, bem como pela competição com outros provedores na captação de doentes. A implantação das igrejas ziones, de cariz cristão e com práticas terapêuticas semelhantes às dos tinyanga, apresenta-se como uma solução local vantajosa devido à forte ligação comunitária, ao consolo e reciprocidade entre os seus membros e aos resultados terapêuticos a baixo custo. No nível das políticas de saúde e da prática clínica, a invisibilidade dos pastores ziones e o papel subalterno dos tinyanga é gerido à medida dos interesses, das ideias vagas e dos preconceitos que os provedores biomédicos possuem sobre esses provedores terapêuticos. A implementação de políticas de saúde que atendam à diversidade local, às relações de poder existentes e aos conhecimentos e práticas médicas podem fortalecer os cuidados biomédicos prestados e harmonizar as relações entre os provedores e a população.

The narratives on the diagnosis and causes of malaria are diverse and apparently ambiguous, being based beyond the body, on the social relations among peers, their ancestors, and nature. Based on a qualitative study and a four-year stay in Mozambique, this article analyzes the discourses of patients and biomedical practitioners on traditional health care providers, i.e., tinyanga and zion pastors, linking them to local terminology of malaria, in a rural district in southern Mozambique. In the current context of therapeutic pluralism and high mobility, the lack of solidarity and compassion attributed to tinyanga is supported by the monetization and commodification of their medicinal rituals and knowledge, as well as by competition with other providers in attracting patients. The implementation of zion churches, of Christian nature and performing therapeutic practices similar to tinyanga, is presented as a local advantageous solution due to the strong community connection, the comfort and reciprocity among the members, and the therapeutic results at low cost. In terms of health care policies and clinical practice, the invisibility of zion pastors and the subordinate role of healers is managed according to interests, based on vague ideas and prejudices from biomedical providers. The implementation of health policies that address the local diversity, the existing power relations and medical knowledge and practices can strengthen the biomedical care services and harmonize relations between the providers and the population.

EPIDEMIOLOGIA DA MALÁRIA EM ÁREA DE ASSENTAMENTO NA AMAZONIA MATOGROSSENSE / EPIDEMIOLOGY OF MALARIA IN SETTLEMENT AREA IN AMAZON MATOGROSSENSE / EPIDEMIOLOGÍA DE LA MALARIA EN ZONA DE ASENTAMIENTO EN AMAZON MATOGROSSENSE

Objetivo: caracterizar a epidemiologia da malária em área de Assentamento na Amazônia mato-grossense. Método: estudo ecológico, realizado no Assentamento Vale do Amanhecer, no Município de Juruena, Mato Grosso. Foram analisadas 336 fichas. Utilizou-se o software EpiInfo 3.3.2 para a construção dos bancos de dados e software Terraview 3.1.4 e ArcGIS 9.2 para análise espacial, construção do mapa de distribuição de casos e os mapas temáticos de uso e ocupação do solo. Resultados: em 2005, o Assentamento era composto por 718 habitantes, 394 (54,87%) sexo masculino e 324 (45,13.%) sexo feminino. Dos 336 casos de malária, 133 era residente na Estrada 08, 37,60% das notificações. Nas Estradas 13 e 5, foram notificados 124 (35,10%) e 58 (16,40%) casos de malária, respectivamente. A região sul do assentamento apresentou 276 casos e maior número de notificações acima de 10 casos/domicílio. Desses, 102 (30,36%) casos foram causados pelo P. falciparum e 174 (51,79%) por P. vivax. A região norte apresentou 60 casos e notificações abaixo de 10 casos/domicílio. A área de formações florestais apresentou 70 (20,83%) casos. Conclusão: a ocorrência e distribuição de malária no assentamento são influenciadas pelos fatores ambientais e suas alterações.

Objective: to characterize the epidemiology of malaria in settlement area in Mato Grosso Amazon. Method: ecological study conducted in settlement Vale do Amanhecer, in the municipality of Juruena, Mato Grosso. 336 records were analyzed. the software was used EpiInfo 3.3.2 for the construction of databases and Terraview 3.1.4 and ArcGIS 9.2 software for spatial analysis, case distribution map construction and thematic maps of land use and occupation. Results: in 2005, the settlement was composed of 718 inhabitants, 394 (54.87%) male and 324 (45.13%.) Female. Of the 336 cases of malaria, 133 were resident on Highway 08, 37.60% of notifications. Roads in 13:05, were reported 124 (35.10%) and 58 (16.40%) cases of malaria, respectively. South of the settlement region had 276 cases and more up to 10 cases / home notifications. Of these, 102 (30.36%) cases were caused by P. falciparum and 174 (51.79%) by P. vivax. The northern region had 60 cases and 10 cases notifications under / home. The area of forest formations had 70 (20.83%) cases. Conclusion: the occurrence and distribution of malaria in the settlement are influenced by environmental factors, as amended.

Objetivo: caracterizar la epidemiología de la malaria en el área de asentamiento en Mato Grosso del Amazonas. Método: estudio ecológico con datos de asentamiento Vale do Amanhecer, en el municipio de Juruena, Mato Grosso. Se analizaron 336 registros. el software se utilizó EpiInfo 3.3.2 para la construcción de bases de datos y Terraview 3.1.4 y el software ArcGIS 9.2 para el análisis espacial, la construcción caja de mapa de distribución y mapas temáticos de uso y ocupación del suelo. Resultados: en 2005, el asentamiento se compone de 718 habitantes, 394 (54,87%) y 324 hombres (45.13%). Mujer. De los 336 casos de malaria, 133 eran residentes en la autopista 08, 37.60% de las notificaciones. Las carreteras de 13:05, se reportaron casos de malaria 124 (35.10%) y 58 (16,40%), respectivamente. Al sur de la región de asentamiento tenía 276 casos y más casos hasta 10 / notificaciones de origen. De éstos, 102 (30,36%) casos fueron causados por P. falciparum y 174 (51,79%) por P. vivax. La región del norte tenía 60 casos y 10 notificaciones de casos bajo / home. El área de las formaciones forestales contaba con 70 (20,83%) casos. Conclusión: la presencia y la distribución de la malaria en el asentamiento son influenciados por factores ambientales, en su versión modificada.

Associação entre malária e anemia em área urbana de transmissão do Plasmodium: Mâncio Lima, Acre, Brasil / Association between malaria and anemia in an urban area with Plasmodium transmission: Mâncio Lima, Acre State, Brazil / Asociación entre malaria y anemia en un área urbana de transmisión del Plasmodium: Mâncio Lima, Acre, Brasil

Resumo: O objetivo deste trabalho é analisar a prevalência de anemia atribuível à malária na população urbana residente no Município de Mâncio Lima, Acre, Brasil. Trata-se de um estudo de coorte não concorrente com 1.167 pessoas acompanhadas por três meses anteriores à data da entrevista mediante dados do SIVEP-Malária. Foram calculadas as medidas de frequência e a prevalência de anemia em pacientes com e sem histórico de malária recente, conforme as variáveis de interesse. Os resultados mostraram que 50,2% dos indivíduos eram do sexo masculino e 67,96% encontravam-se na faixa etária de 15 anos ou mais. A prevalência geral de anemia foi de 7,1%, sendo maior na faixa etária de 6 meses até 5 anos de idade. Com relação ao histórico de malária recente, verificou-se que 8,3% dos homens que tiveram malária apresentaram anemia. No geral, a prevalência de anemia atribuível à malária foi nulo, exceto para os homens (2,4%) e no bairro Cobal (51,4%). Os resultados demonstram que a prevalência de anemia é baixa e que a contribuição da malária para anemia existe apenas em homens e áreas geográficas específicas.

Abstract: The aim of this study was to analyze the prevalence of malaria-attributable anemia in the urban population of Mâncio Lima, Acre State, Brazil. This was a non-concurrent cohort study of 1,167 persons followed for the three months prior to the interview using data from the SIVEP-Malaria database. Anemia frequency and prevalence rates were calculated in patients with and without a recent history of malaria, according to target variables. 50.2% of the individuals were males, and 67.96% were 15 years or older. Overall anemia prevalence was 7.1%, higher in the 6 months to 5 years age bracket. Some 8.3% of men with a recent history of malaria presented anemia. Overall, prevalence of malaria-attributable anemia was negligible, except in men (2.4%) and the Cobal neighborhood (51.4%). The results showed that anemia prevalence was low and that malaria's contribution to anemia only existed in men and in specific geographic areas.

Resumen: El objetivo de este trabajo es analizar la prevalencia de anemia atribuible a la malaria en una población urbana, residente en el Municipio de Mâncio Lima, Acre, Brasil. Se trata de un estudio de cohorte no-concurrente con 1.167 personas acompañadas por tres meses anteriores a la fecha de la entrevista a través de datos del SIVEP-Malaria. Se calcularon las medidas de frecuencia y la prevalencia de anemia en pacientes con y sin historial de malaria reciente, conforme las variables de interés. Los resultados mostraron que un 50,2% de los individuos eran de sexo masculino y 67,96% se encontraban en la franja de edad de 15 años o más. La prevalencia general de anemia fue de un 7,1%, siendo mayor en la franja de edad de 6 meses hasta 5 años de edad. En relación con el historial de malaria reciente, se verificó que un 8,3% de los hombres que tuvieron malaria presentaron anemia. En general, la prevalencia de anemia atribuible a la malaria fue nula, excepto para los hombres (2,4%) y en el barrio Cobal (51,4%). Los resultados demuestran baja prevalencia de anemia y que la contribución de la malaria a la anemia existe solamente en hombres y áreas geográficas específicas.

Conocimientos, actitudes y prácticas sobre la malaria en la población indígena guna de la comarca de Madungandí, Panamá, 2012 / Knowledge, attitudes and practices regarding malaria in the indigenous Guna population of the Madungandí region, Panamá, 2012

Introducción. Las encuestas sobre comportamientos, actitudes y prácticas permiten determinar el grado de conocimiento de la población sobre la malaria o paludismo, así como las actitudes y prácticas que contribuyen a su transmisión. Objetivo. Identificar los conocimientos, actitudes y prácticas que favorecen la transmisión de la malaria en la población indígena guna de Madungandí. Materiales y métodos. Se hizo un estudio transversal mediante una encuesta a los jefes de familia de una muestra de 40 % de las viviendas en tres comunidades con alta incidencia de malaria. La encuesta se hizo con encuestadores gunas e integrantes del equipo de investigación, y con la ayuda de un traductor. El análisis se hizo en Epi-Info 6.04. Resultados. El rango de edad de los encuestados fluctuaba entre los 20 y los 70 años. Todos los encuestados indicaron pertenecer a la etnia guna y hablar su lengua; 64 % eran del sexo masculino y 30 % eran analfabetas. La mitad de los encuestados (51 %) manifestó haber enfermado de malaria, por lo menos, una vez en los últimos ocho años y 89 % reconoció la enfermedad como un problema de salud. El 63 % manifestó que el médico tradicional "inadule" curaba la malaria, y 78 % practicaba la "fuma de la pipa" y la "quema del cacao" para prevenirla. Conclusión. Dado el limitado conocimiento sobre la malaria y su vector, así como la actitud de colaboración de la población guna, es necesario iniciar programas educativos y de participación comunitaria para mejorar las prácticas de prevención y control en las comunidades, y disminuir así la incidencia de la enfermedad en la comarca de Madungandí.

Introduction: Knowledge, attitudes and practices surveys allow to determine the degree of knowledge on the management of malaria in a given population, as well as the attitudes and practices that contribute or not to its transmission. Objective: To identify the knowledge, attitudes and practices that favor or not the transmission of malaria in the indigenous Guna population of Madungandí. Materials and methods: A cross-sectional study was conducted by applying a survey to the heads of the families in a sample of 40% of households in three communities with high malaria incidence. Local Guna residents and translators were part of the research team that applied the questionnaires. The statistical analysis was performed in Epi-Info 6.04. Results: The age range of those surveyed was between 20 and 70 years. All responders indicated that they belonged to and spoke the language of the Guna ethnic group, 64% were male and 30% were illiterate. Half (51%) of the responders declared they had suffered malaria at least once in the last eight years, and 89% accepted that malaria was a health problem. Sixty-three per cent responded that their traditional doctors, “inadule”, cured malaria and 7.0 % practiced the “pipe smoking” and “cocoa burn” rituals to prevent the disease. Conclusion: Considering the limited knowledge about malaria and its vector, as well as the willingness to collaborate shown by the Guna population, it is essential to initiate educational and participative programs to improve control and prevention activities in the communities aimed at achieving a reduction in malaria incidence in the Madungandí indigenous region.

Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon

ABSTRACTINTRODUCTION:This study aimed to evaluate basic sanitation and socioeconomic indicators, reported cases of malaria, and risk of contracting malaria in the Ananindeua municipality, State of Pará.METHODS:Data on basic sanitation and socioeconomic dimensions were taken from the Brazilian Institute of Geography and Statistics [ Instituto Brasileiro de Geografia e Estatística (IBGE)] 2010 census. Epidemiological malaria information was taken from the Epidemiological Malaria Surveillance Information System [ Sistema de Informação de Vigilância Epidemiológica de Malária (SIVEP/Malaria)], between 2003 and 2013 of the Ministry of Health and from the SIVEP/Malaria forms of the municipality's Endemic Diseases Unit for 2,013 cases.RESULTS:Our data do not confirm the correlation among indicators of basic sanitation, socioeconomic conditions, and water supply with malaria cases. Of the 1,557 cases evaluated, most were caused by Plasmodium vivax , with rare cases of Plasmodium falciparum and mixed infections. There were 756 notifications in 2003. The number of reported cases was sharply reduced between 2006 and 2012, but a 142-case outbreak occurred in 2013. Ananindeua municipality's Annual Parasite Index indicated low risk in 2003 and no risk in other years, and the 2,013 cases were predominantly male individuals aged ≥40 years.CONCLUSIONS:Our data confirm the non-endemicity of malaria in the Ananindeua municipality, as the Annual Parasite Indices described for the years 2004-2013 classify it as a risk-free area. However, the 2013 outbreak indicates the need to strengthen prevention, surveillance, and control activities to reduce the risk of new outbreaks and consequent economic and social impacts on the population.

Structure-based drug design studies of the interactions of ent-kaurane diterpenes derived from Wedelia paludosa with the Plasmodium falciparum sarco/endoplasmic reticulum Ca2+-ATPase PfATP6

Malaria is responsible for more deaths around the world than any other parasitic disease. Due to the emergence of strains that are resistant to the current chemotherapeutic antimalarial arsenal, the search for new antimalarial drugs remains urgent though hampered by a lack of knowledge regarding the molecular mechanisms of artemisinin resistance. Semisynthetic compounds derived from diterpenes from the medicinal plant Wedelia paludosa were tested in silico against the Plasmodium falciparum Ca2+-ATPase, PfATP6. This protein was constructed by comparative modelling using the three-dimensional structure of a homologous protein, 1IWO, as a scaffold. Compound 21 showed the best docking scores, indicating a better interaction with PfATP6 than that of thapsigargin, the natural inhibitor. Inhibition of PfATP6 by diterpene compounds could promote a change in calcium homeostasis, leading to parasite death. These data suggest PfATP6 as a potential target for the antimalarial ent-kaurane diterpenes.

Descripción de un brote epidémico de malaria en una comunidad indígena asentada en la zona urbana de Armenia, Colombia, 2012 / Outbreak of malaria in an indigenous population living in an urban area of Armenia, Colombia, 2012

Introducción. La malaria o paludismo es la enfermedad parasitaria transmitida por mosquitos vectores más frecuente en las regiones tropicales. Debido a diversos factores, incluido el cambio climático, la enfermedad puede aparecer o reaparecer en diferentes lugares del mundo. Objetivo. Describir un brote autóctono de malaria urbana en la ciudad de Armenia, Colombia. Materiales y métodos. Después de la consulta en un hospital de segundo nivel del sur de Armenia de dos niños con síntomas de malaria, cuyo diagnóstico mediante gota gruesa confirmó la presencia de trofozoítos de Plasmodium vivax, se visitó el sector donde residían para la búsqueda activa de casos. Se describieron las condiciones ambientales y socioculturales del sector y se recolectaron e identificaron entomológicamente larvas, pupas y adultos de mosquitos. Igualmente, se implementaron medidas de control y se evaluó su efectividad. Resultados. La búsqueda activa en la comunidad permitió la identificación de 11 casos probables de malaria, de los cuales se confirmaron por microscopía tres casos de malaria por P. vivax en niños. El análisis entomológico de las larvas y pupas de mosquitos mostró la presencia de Anopheles spp ., Anopheles punctimacula y Anopheles argyritarsis. Conclusiones. Se reportó el primer brote autóctono de malaria por P.vivax en Armenia, asociado con un asentamiento subnormal en una comunidad indígena y se constató cómo en los márgenes del río Quindío se presentan las condiciones eco-epidemiológicas que permiten el ciclo de reproducción del mosquito vector de la malaria.

Introduction: Malaria is the most frequent mosquito-borne parasitic infection in the tropical regions of the world. Due to different factors, including climate change, this disease can emerge or reemerge in different areas in the planet. Objective: To describe an autochthonous outbreak of urban malaria in Armenia, Colombia. Materials and methods: After two children consulted a second level hospital located in the south of Armenia with malaria symptoms and their diagnosis was confirmed through the presence of Plasmodium vivax trophozoites detected by a positive thick blood smear, a visit was conducted to the residence of the children. An active search for cases was carried out, the environmental and sociocultural conditions were described and mosquito larvae and pupae were collected and identified. Control measures were implemented and their effectiveness was evaluated as well. Results: The active search in the community allowed the identification of 11 probable cases, three of which were P. vivax malaria cases in children confirmed by blood microscopy. The entomological analysis of mosquito larvae and pupae showed Anopheles spp., Anopheles punctimacula and Anopheles argyritarsis. Conclusion: This is the first report of an autochthonous malaria outbreak by P. vivax in the city of Armenia, associated with the subnormal settlement of an indigenous community. The banks of the Quindío river offer the eco-epidemiological conditions that allow the establishment of the reproductive cycle of the malaria mosquito vector.

The Juscelino Kubitschek government and the Brazilian Malaria Control and Eradication Working Group: collaboration and conflicts in Brazilian and international health agenda, 1958-1961 / O governo JK e o Grupo de Trabalho de Controle e Erradicação da Malária no Brasil: encontros e desencontros nas agendas brasileira e internacional de saúde, 1958-1961

Malaria, a disease which was under control in the beginning of Juscelino Kubitschek government, became the most important endemic disease in 1958, when Brazil made a commitment with the World Health Organization to convert its control programs into eradication programs. For this purpose a Malaria Control and Eradication Group was set up under the leadership of the malaria specialist Mário Pinotti. Malaria would become an important bargaining chip in the context of the development policies of Kubitschek. This article focuses on path of the Malaria Control and Eradication Working Group in Brazil, in its varying relationships with the arguments and guidelines established at international level.

A malária, doença que estava controlada no início do governo de Juscelino Kubitschek, torna-se a mais importante endemia em 1958, quando o Brasil assumiu o compromisso com a Organização Mundial da Saúde de converter seus programas de controle em programas de erradicação. Para isso foi instalado um Grupo de Controle e Erradicação da Malária sob a direção do malariologista Mário Pinotti. A malária seria uma importante moeda de negociação no contexto da política de desenvolvimento de Kubitschek. Este artigo tem como foco a trajetória do Grupo de Trabalho de Controle e Erradicação da Malária no Brasil, em suas diferentes relações com as discussões e normativas travadas e estabelecidas em âmbito internacional.

Variabilidade genética de receptores plaquetários e componentes do inflamossoma: contribuição para a morbidade induzida por Plasmodium vivax / Genetic variability of platelet receptors and inflamossoma components: contribution to the morbidity induced by Plasmodium vivax

Plasmodium vivax tem sido reconhecido por sua capacidade de causar malária grave, oque torna prioritário os estudos acerca dos mecanismos patogênicos associados a essa espécie.Dado o caráter inflamatório exibido pela malária vivax, faz-se relevante estudar os fatoresgenéticos do hospedeiro vertebrado que podem influenciar o curso da doença. Nesse sentido,o presente trabalho investigou a influência da variabilidade genética de componentesplaquetários e do inflamossoma sobre a morbidade na infecção por P. vivax. Maisespecificamente, a primeira hipótese avaliada foi a de que alterações clínicas e hematológicasna malária vivax estão envolvidas com polimorfismos em genes de receptores plaquetários,relacionados ao aumento da adesão e/ou agregação das plaquetas: integrina α2 (C807T),integrina β3 (T1565C) e glicoproteína GPIbα (T-5C). A partir do estudo de aproximadamente200 indivíduos sintomáticos infectados por P. vivax, foi possível confirmar que ospolimorfismos do receptor para colágeno (α2) e do receptor para fator de von Willebrand(GPIbα) estão associados a duas das complicações mais frequentes na malária:trombocitopenia grave e anemia. A segunda hipótese investigada foi a de que polimorfismosem genes de componentes do inflamossoma – plataforma molecular capaz de desencadear aprodução de citocinas inflamatórias – estão associados à morbidade em pacientes infectadospor P. vivax. Nossos achados confirmaram essa hipótese e sugeriram que polimorfismos nosgenes de NLRP1, NLRP3 e CARD8 podem contribuir para as alterações clínicas ehematológicas observadas nos indivíduos estudados. Em conjunto, os dados aqui apresentadosconstituem a primeira demonstração de que a variabilidade genética de receptoresplaquetários e componentes do inflamossoma pode influenciar na patogenia da maláriacausada por P. vivax. Estudos futuros visando esclarecer o papel da cascata de coagulação inflamaçãona morbidade dessa doença fazem-se necessários...

Spatial dependence of malaria epidemics in municipalities of the Brazilian Amazon / Dependência espacial das epidemias de malária em municípios da Amazônia Brasileira

Introduction: In 2010, there were 305 (37.8%) municipalities with malaria epidemics in the Brazilian Amazon. The epidemics spread can be explained by the spatial distribution pattern. Objective: To analyze the spatial dependence, autocorrelation, of the malaria epidemics in the municipalities of this region. Methods: An automated algorithm was used for the detection of epidemic municipalities in 2003, 2007 and 2010. Spatial dependence was analyzed by applying the global and local Moran index on the epidemic months proportion variable. The epidemic municipalities clusters were identified using the TerraView software. Results: The global Moran index values were 0.4 in 2003; 0.6 in 2007; and 0.5 in 2010 (p = 0.01), confirming the spatial dependence among the epidemic municipalities. Box Map and Moran Map identified inter-municipal, interstate and borders clusters with spatial autocorrelation (p < 0.05). There were 10 epidemic municipalities clusters in 2003; 9 in 2007 and 8 in 2010. Discussion: The epidemic municipalities clusters may be linked to the health facilities difficulties on acting together. The structural limitations of the health services can be overcome by territorial integration to support planning and control activities, strengthening the interventions. Conclusion: The routine analysis of the epidemic municipalities clusters with spatial and temporal persistence may provide a new indicator of planning and integrated control prioritization, contributing to malaria epidemics reducing in inter-municipal, interstate and borders areas. .

Introdução: Em 2010, foram observados 305 (37,8%) municípios com epidemias de malária na Amazônia brasileira. A propagação dos eventos epidêmicos pode ser explicada pelo padrão da distribuição espacial. Objetivo: Analisar a dependência espacial, autocorrelação, das epidemias de malária nos municípios dessa região. Métodos: Foi utilizado algoritmo automatizado para detecção dos municípios epidêmicos nos anos de 2003, 2007 e 2010. A dependência espacial foi analisada por meio da variável proporção de meses epidêmicos, aplicando-se os índices de Moran global e local. Foram identificados os agrupamentos de municípios epidêmicos com o programa TerraView. Resultados: Os valores do índice global de Moran foram 0,4 em 2003; 0,6 em 2007; e 0,5 em 2010 (p = 0,01), confirmando a existência de dependência espacial entre os municípios epidêmicos. O Box Map e o Moran Map identificaram agrupamentos intermunicipais, interestaduais e fronteiriços com autocorrelação espacial estaticamente significante, sendo 10 clusters em 2003; 9 em 2007; e 8 em 2010 (p < 0,05). Discussão: Agrupamentos de municípios epidêmicos podem estar vinculados às dificuldades dos serviços de saúde em atuar articuladamente. Limitações estruturais podem ser superadas buscando a integração territorial para sustentação do planejamento e ações de controle, potencializando as intervenções no contexto espacial abrangente. Conclusão: A análise rotineira da autocorrelação espacial entre municípios epidêmicos, identificando os agrupamentos com persistência espaço-temporal, poderá fornecer novo indicador de grande utilidade para o planejamento e priorização ...