A new working group to support malaria elimination in the Amazon region

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Malaria Elimination Working Group, Iquitos-Peru, February 2014

Malaria Elimination Working Group, Iquitos-Peru, February 2014

In February 2014, the Malaria Elimination Working Group (MEWoG), in partnership with the Peruvian Ministry of Health (MoH), hosted its first international conference on malaria elimination in Iquitos, Peru. The two-day meeting gathered 85 malaria experts, including 18 international panelists, 23 stakeholders from different malaria endemic regions of Peru, and 11 MoH authorities.

Several key conclusions and points of consensus arose from this meeting. The most important one is that malaria elimination in the Peruvian Amazon is an achievable and nationally and internationally important goal. It will be important to develop a Comprehensive Regional Strategic Plan, which must satisfy several key characteristics. It was strongly recommended to first, pilot such strategy in suitable sites in the region to establish efficacy and acceptability. As such strategy is implemented, it will be important to monitor and evaluate progress through a variety of metrics and to set intermediate goals on the path to regional elimination. Targeted parasite elimination strategies that are appropriate to the region must be used, stressing active case detection using sufficiently sensitive and effective RDTs and species-specific treatment of the asymptomatic reservoir. This is particularly important in the case P. falciparum malaria, which must be treated with ACT and primaquine to interrupt transmission. The strategy must include and facilitate communication between key stakeholders from the region and political support at all levels of government, and the program should be incorporated into established health systems to improve acceptability and sustainability. The progression of such strategy should be flexible to allow new knowledge of the social determinants of malaria, the cultural acceptability of key interventions, and novel tests and treatments to be incorporated throughout the effort. With this conference, an agreement on the relevance of pursuing malaria elimination as goal has been reached, and the necessary components characteristics of this effort described. Moving forward, further detail should be elaborated as commitments from numerous key stakeholders are obtained

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6 Responses to “A new working group to support malaria elimination in the Amazon region”

  1. Malaria Matters » Blog Archive » A new working group to support malaria elimination in the Amazon region Says:

    […] Antonio Quispe of our Social and Behavioral Foundations of Primary Health Care has posted the following on the course blog […]

  2. mariaymayo Says:

    Very good and pertinent subject. Are there Brazilian and Colombian stakeholders involved on the project implementation? In my opinion there is a need to have the tri-border amazon region converge into an agreement to eradicate malaria.

  3. nimae15 Says:

    Great topic! Malaria elimination is certainly achievable and with the strategic consensus reached here, there is certainly a commitment to achieving this goals. Very often, sustainability becomes a long term challenge, I wonder what strategies can be implemented to see these gains become sustainable?

  4. drantonioquispe Says:

    Very great points. As you noticed, it will not be easy and such effort definitely would need to participate each of the nine Amazonian countries, not only Peru, Brazil and Colombia. And, of course, it must be planned considering its sustainability, which is critical. There is so much to be done, but after discussing some key issues the overall sense in the group was that first we need to catch up and implement those interventions that can effectively help us to interrupt transmission in the Amazon region. That should it be the start point and while we do that, plan how to facilitate the process of adopting new effective and properly adapted strategies and interventions to avoid stay behind again. It is kind embarrassing but in many Amazonian malaria endemic regions subjects at high-risk don´t have access to antimalarials, rapid test, bed nets, or even proper health care… Again, there is so much to be done, that better we start one step at the time…

  5. ariannahutcheson Says:

    This is very similar to my topic, but the state of change is much earlier, which is very interesting. I wonder if Amzaonian countries can look at other countries such as Kenya to see how they have approached fighting malaria. Kenya just got done with it’s pilot community case management for malaria treatment and evaluation and is hopefully on the path to nationalizing CCM. See how this country worked through the stages may be very helpful!

  6. Christian Larsen Says:

    The last mile is always the hardest to jog. When malaria cases are few, and geographically limited, it is often difficult to retain the support of the government, and other stakeholders who may no longer view malaria as a serious issue. It is inspiring to hear about this kind of regional commitment, even in the absence of firm guidelines. Your suggestion for the need for a concrete strategy is spot on. My experience with malaria elimination has been largely in South East Asia, where the push for national mass drug administration (MDA) programs with ART and primaquine is being fueled by the fear of artemisinin resistance. The WHO and the Bill and Melinda Gates foundation have helped develop some partial guidelines, but most regional partners have yet to sign on to a defined regional strategy. It seems the BMG Foundation has a role in this project as well (see the link at the end from a presentation at NAMRU in Lima). They really still seem to be in the investigational stages of regional elimination. Hopefully, there will be effective communication between stakeholders from different regions about best practices and time is not wasted while there is such great support for malaria elimination.

    The amazon region, for all its logistical difficulties, has the benefit of not abutting any densely populated regions. This may make tackling malaria with traditional strategies more feasible. For better or for worse, MDA is not mentioned specifically in the working groups strategy from what I have read. Given the burden of P vivax in the Peruvian amazon, its probably for the best until better G6PD Deficiency diagnostics come round. I look forward to seeing what strategies the working group will use, and if there will be anything novel to come of it.

    NAMRU presentation:
    http://www.paho.org/hq./index.php?option=com_docman&task=doc_view&gid=24829&Itemid=

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