Malaria South of the Border
In a public health triumph, naturally acquired polio was recently eradicated from the Western Hemisphere. Unfortunately, many other infectious diseases are booming, in part because of neglect.
At the end of 1996, the Pan American Health Organization published a sobering report on the state of malaria in the Region of the Americas.1 In 1995, 248 million people, or almost one-third of the population of this region, lived in areas where "ecological conditions were propitious for the transmission of malaria." Of these, 78 million live in areas of medium or high risk.
In 1995, 1.3 million cases of malaria were reported, a 14.6% increase from 1994. Infection rates within areas of potential risk increased from 481.6 to 523.3 cases per 100, 000. The largest number of cases were reported in Brazil, which accounted for 44.2% of the total, while the Andean Area was second with 35.9%. The area of greatest risk of transmission, however, was the subregion which includes Guyana, French Guiana, and Suriname. The increase in incidence of malaria in the Americas was associated with a decrease in expenditures for control measures from $0.68 per person residing in potentially malarious areas in 1994 to $0.47 in 1995.
This decrease in expenditures for malaria control may also account for the continuing problem with dengue in the Americas. There were 190,527 cases of this arboviral infection reported in the first 10 months of 1996 (Epidemiological Bulletin of the Pan American Health Organization 1996;17:12-14). Almost 20,000 cases were reported in the first 48 weeks of 1996 by Mexico.
The means of eradicating malaria are known and available. Unfortunately, the amount of money spent on this endeavor is remarkably low and decreasing. This is occurring at a time when many of the countries at risk, with Brazil perhaps being the most outstanding example, are improving their economic status. As always with important public health issues, the decisive factor is political will.scd
1. Malaria in the Americas. Epidemiological Bulletin of the Pan American Health Organization 1996;17:1-11.