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Malaria in Brazil, 2005 1
Pan AmericanHealthOrganization
..
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Title of the presentation
Author
Title of the presentation
AuthorMALARIA IN BRAZIL: Time Series
Epidemiological Data from 1998 to 2004
MALARIA IN BRAZIL: Time Series
Epidemiological Data from 1998 to 2004
Malaria in Brazil, 2005 2
Pan AmericanHealthOrganization
MALARIA IN BRAZILMALARIA IN BRAZIL
I. The Malaria Burden– Risk of Transmission– Malaria Morbidity– Malaria Mortality– Malariometric Indices (API, AFI, AVI, AMI)
II Trends in Case Detection and Diagnosis– Case Detection: Passive vs. Active
Method– Annual Blood Examination Rate (ABER)– Slide Positivity Rate SPR)
III. TreatmentIV. Resources and Financing
I. The Malaria Burden– Risk of Transmission– Malaria Morbidity– Malaria Mortality– Malariometric Indices (API, AFI, AVI, AMI)
II Trends in Case Detection and Diagnosis– Case Detection: Passive vs. Active
Method– Annual Blood Examination Rate (ABER)– Slide Positivity Rate SPR)
III. TreatmentIV. Resources and Financing
Malaria in Brazil, 2005 3
Pan AmericanHealthOrganization
The Risk of
Transmission
The Risk of
Transmission
Malaria in Brazil, 2005 4
Pan AmericanHealthOrganization
BRAZIL: Population at Risk of Malaria Transmission, 1998–2004 (in thousands)
BRAZIL: Population at Risk of Malaria Transmission, 1998–2004 (in thousands)
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Population at Risk 71,781 73,008 31,597 18,485 20,407 166,087 166,087
Total Population 165,158 167,988 170,406 168,260 174,632 176,876 176,876
1998 1999 2000 2001 2002 2003 20040
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Population at Risk 71,781 73,008 31,597 18,485 20,407 166,087 166,087
Total Population 165,158 167,988 170,406 168,260 174,632 176,876 176,876
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 5
Pan AmericanHealthOrganization
BRAZIL: Population at Ecological Risk of Malaria Transmission According to Level of Transmission Risk ,
1998–2004 (in thousands)
BRAZIL: Population at Ecological Risk of Malaria Transmission According to Level of Transmission Risk ,
1998–2004 (in thousands)
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Low Risk 64,765 65,077 22,741 12,464 13,553 153,532 153,532
Moderate Risk 4,399 4,603 5,404 4,020 4,929 11,099 11,099
High Risk 2,617 3,328 3,452 2,001 1,926 1,456 1,456
1998 1999 2000 2001 2002 2003 20040
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Low Risk 64,765 65,077 22,741 12,464 13,553 153,532 153,532
Moderate Risk 4,399 4,603 5,404 4,020 4,929 11,099 11,099
High Risk 2,617 3,328 3,452 2,001 1,926 1,456 1,456
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 6
Pan AmericanHealthOrganization
Malaria MorbidityMalaria Morbidity
Malaria in Brazil, 2005 7
Pan AmericanHealthOrganization
BRAZIL: Malaria Morbidity, 1998–2004 (number of positive blood slides)
BRAZIL: Malaria Morbidity, 1998–2004 (number of positive blood slides)
0
100000
200000
300000
400000
500000
600000
700000
No. of Cases 469982 635646 613241 388303 348259 408300 463792
1998 1999 2000 2001 2002 2003 20040
100000
200000
300000
400000
500000
600000
700000
No. of Cases 469982 635646 613241 388303 348259 408300 463792
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 8
Pan AmericanHealthOrganization
BRAZIL: Malaria Morbidity According to Level of Transmission Risk, 1998–2004 (number of positive blood slides)
BRAZIL: Malaria Morbidity According to Level of Transmission Risk, 1998–2004 (number of positive blood slides)
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
Low Risk 22,753 23,725 23,770 35,284 31,769 27,343 …
Moderate Risk 103,476 125,630 134,693 117,300 109,253 77,374 …
High Risk 345,526 460,139 452,297 235,996 208,781 274,589 …
Originally Non-Malarious 137 100 118 78 70 34 …
1998 1999 2000 2001 2002 2003 20040
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
Low Risk 22,753 23,725 23,770 35,284 31,769 27,343 …
Moderate Risk 103,476 125,630 134,693 117,300 109,253 77,374 …
High Risk 345,526 460,139 452,297 235,996 208,781 274,589 …
Originally Non-Malarious 137 100 118 78 70 34 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 9
Pan AmericanHealthOrganization
BRAZIL: Malaria Morbidity According to Parasite Species (In All Risk Areas), 1998–2004
BRAZIL: Malaria Morbidity According to Parasite Species (In All Risk Areas), 1998–2004
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
P. falciparum & mixed … … … 81,402 80,437 81,094 …
P. vivax … … … 306,681 268,607 297,962 …
P. malariae … … … 575 829 284 …
1998 1999 2000 2001 2002 2003 20040
50,000
100,000
150,000
200,000
250,000
300,000
350,000
P. falciparum & mixed … … … 81,402 80,437 81,094 …
P. vivax … … … 306,681 268,607 297,962 …
P. malariae … … … 575 829 284 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 10
Pan AmericanHealthOrganization
BRAZIL: Malaria Morbidity According to Parasite Species (In Moderate and High Areas), 1998–2004
BRAZIL: Malaria Morbidity According to Parasite Species (In Moderate and High Areas), 1998–2004
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
P. falciparum & mixed 101721 111,444 131,616 75,701 75,397 75,685 …
P. vivax 345820 473,437 478,212 277,030 241,825 276,021 …
P. malariae 1461 888 932 565 812 257 …
1998 1999 2000 2001 2002 2003 20040
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
P. falciparum & mixed 101721 111,444 131,616 75,701 75,397 75,685 …
P. vivax 345820 473,437 478,212 277,030 241,825 276,021 …
P. malariae 1461 888 932 565 812 257 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 11
Pan AmericanHealthOrganization
Malaria MortalityMalaria Mortality
Malaria in Brazil, 2005 12
Pan AmericanHealthOrganization
BRAZIL: Malaria Mortality, 1998–2004 (number of deaths)
BRAZIL: Malaria Mortality, 1998–2004 (number of deaths)
0
50
100
150
200
250
No. of Deaths 156 193 231 127 77 103 90
1998 1999 2000 2001 2002 2003 20040
50
100
150
200
250
No. of Deaths 156 193 231 127 77 103 90
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 13
Pan AmericanHealthOrganization
Malariometric Indices
(API, AFI, AVI, AMI)
Malariometric Indices
(API, AFI, AVI, AMI)
Malaria in Brazil, 2005 14
Pan AmericanHealthOrganization
BRAZIL: Malariometric Indices (API, AFI, AVI, AMI) in all Risk Areas, 1998–2004
BRAZIL: Malariometric Indices (API, AFI, AVI, AMI) in all Risk Areas, 1998–2004
0
5
10
15
20
25
API … … … 21.03 17.14 2.28 2.77
AFI … … … 4.4 3.94 0.49 …
AVI … … … 16.59 13.16 1.79 …
AMI … … … 0.03 0.04 0.002 …
1998 1999 2000 2001 2002 2003 20040
5
10
15
20
25
API … … … 21.03 17.14 2.28 2.77
AFI … … … 4.4 3.94 0.49 …
AVI … … … 16.59 13.16 1.79 …
AMI … … … 0.03 0.04 0.002 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 15
Pan AmericanHealthOrganization
BRAZIL: Malariometric Indices (API, AFI, AVI, AMI) in Moderate and High Risk Areas, 1998–2004
BRAZIL: Malariometric Indices (API, AFI, AVI, AMI) in Moderate and High Risk Areas, 1998–2004
0
10
20
30
40
50
60
70
80
API 64 73.86 66.28 58.68 46.4 28.03 …
AFI 14.5 14.05 14.86 12.57 11 6.03 …
AVI 49.29 59.69 54 46.01 35.28 21.99 …
AMI 0.21 0.11 0.11 0.09 0.12 0.02 …
1998 1999 2000 2001 2002 2003 20040
10
20
30
40
50
60
70
80
API 64 73.86 66.28 58.68 46.4 28.03 …
AFI 14.5 14.05 14.86 12.57 11 6.03 …
AVI 49.29 59.69 54 46.01 35.28 21.99 …
AMI 0.21 0.11 0.11 0.09 0.12 0.02 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 16
Pan AmericanHealthOrganization
BRAZIL: Annual Parasitic Index (API), 1998–2004BRAZIL: Annual Parasitic Index (API), 1998–2004
0
50
100
150
200
250
300
In All Risk Areas … … … 58.77 47.07 59.67 2.77
Moderate and High Risk Only 99.3 247.18 265.03 285.82 178.59 273.68 …
1998 1999 2000 2001 2002 2003 20040
50
100
150
200
250
300
In All Risk Areas … … … 58.77 47.07 59.67 2.77
Moderate and High Risk Only 99.3 247.18 265.03 285.82 178.59 273.68 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 17
Pan AmericanHealthOrganization
BRAZIL: Annual Index of P. falciparum (AFI), 1998–2004
BRAZIL: Annual Index of P. falciparum (AFI), 1998–2004
0
2
4
6
8
10
12
14
16
In All Risk Areas … … … 4.4 3.94 0.49 …
Moderate and High Risk Only 14.5 14.05 14.86 12.57 11 6.03 …
1998 1999 2000 2001 2002 2003 20040
2
4
6
8
10
12
14
16
In All Risk Areas … … … 4.4 3.94 0.49 …
Moderate and High Risk Only 14.5 14.05 14.86 12.57 11 6.03 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 18
Pan AmericanHealthOrganization
BRAZIL: Annual Index of P. vivax (AVI), 1998–2004BRAZIL: Annual Index of P. vivax (AVI), 1998–2004
0
10
20
30
40
50
60
In All Risk Areas … … … 16.59 13.16 1.79 …
Moderate and High Risk Only 49.29 59.69 54 46.01 35.28 21.99 …
1998 1999 2000 2001 2002 2003 20040
10
20
30
40
50
60
In All Risk Areas … … … 16.59 13.16 1.79 …
Moderate and High Risk Only 49.29 59.69 54 46.01 35.28 21.99 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 19
Pan AmericanHealthOrganization
BRAZIL: Annual Index of P. malariae (AMI), 1998–2004
BRAZIL: Annual Index of P. malariae (AMI), 1998–2004
0
0.05
0.1
0.15
0.2
0.25
In All Risk Areas … … … 0.03 0.04 0.002 …
Moderate and High Risk Only 0.21 0.11 0.11 0.09 0.12 0.02 …
1998 1999 2000 2001 2002 2003 20040
0.05
0.1
0.15
0.2
0.25
In All Risk Areas … … … 0.03 0.04 0.002 …
Moderate and High Risk Only 0.21 0.11 0.11 0.09 0.12 0.02 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 20
Pan AmericanHealthOrganization
Trends in
Case Detection and
Diagnosis
Trends in
Case Detection and
Diagnosis
Malaria in Brazil, 2005 21
Pan AmericanHealthOrganization
BRAZIL: Passive vs. Active Case Detection, 1998–2004 (% of Blood Slides Examined)
BRAZIL: Passive vs. Active Case Detection, 1998–2004 (% of Blood Slides Examined)
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
1998
1999
2000
2001
2002
2003
2004
Passive Active
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
1998
1999
2000
2001
2002
2003
2004
Passive Active
Malaria in Brazil, 2005 22
Pan AmericanHealthOrganization
BRAZIL: Annual Blood Examination Rate (ABER) in Malarious Areas, 1998–2004
BRAZIL: Annual Blood Examination Rate (ABER) in Malarious Areas, 1998–2004
71,781,000
73,008,000
31,597,000
18,485,000
20,407,000
166,087,000
166,087,000
2,089,175
2,364,289
2,562,576
2,275,034
2,118,490
1,774,656
1998
1999
2000
2001
2002
2003
2004
Examined
Population at Risk /In Malarious Areas
71,781,000
73,008,000
31,597,000
18,485,000
20,407,000
166,087,000
166,087,000
2,089,175
2,364,289
2,562,576
2,275,034
2,118,490
1,774,656
1998
1999
2000
2001
2002
2003
2004
Examined
Population at Risk /In Malarious Areas
Malaria in Brazil, 2005 23
Pan AmericanHealthOrganization
BRAZIL: Slide Positivity Rate (SPR), 1998–2004BRAZIL: Slide Positivity Rate (SPR), 1998–2004
471,892
609,594
610,878
388,658
349,873
379,340
459,333
2,089,175
2,364,289
2,562,576
2,275,034
2,118,490
1,774,656
1998
1999
2000
2001
2002
2003
2004Examined
Positive
471,892
609,594
610,878
388,658
349,873
379,340
459,333
2,089,175
2,364,289
2,562,576
2,275,034
2,118,490
1,774,656
1998
1999
2000
2001
2002
2003
2004Examined
Positive
Malaria in Brazil, 2005 24
Pan AmericanHealthOrganization
TreatmentTreatment
Malaria in Brazil, 2005 25
Pan AmericanHealthOrganization
BRAZIL: Antimalarial Drugs Used, 1998–2004BRAZIL: Antimalarial Drugs Used, 1998–2004
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
Chloroquine &/or Amodiaquine @ 150mg 6,840,000 9,351,500 12,782,155 5,197,318 3,880,630 3,679,680 …
Primaquine @ 15mg 7,044,000 7,218,322 15,974,366 8,077,447 6,243,401 5,441,331 …
Sulfa/Pyrimethamine @ 500/25mg … … … … … … …
Mefloquine @250mg 384,000 489,400 483,000 182,308 54,020 160,620 …
Artemisinine Derivatives (# of Tx) 12,075 14,673 130,238 115,000 185,962 3,736 …
Quinine @ 300mg 3,229,500 3,148,091 2,266,277 1,222,390 1,661,520 1,040,297 …
1998 1999 2000 2001 2002 2003 20040
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
Chloroquine &/or Amodiaquine @ 150mg 6,840,000 9,351,500 12,782,155 5,197,318 3,880,630 3,679,680 …
Primaquine @ 15mg 7,044,000 7,218,322 15,974,366 8,077,447 6,243,401 5,441,331 …
Sulfa/Pyrimethamine @ 500/25mg … … … … … … …
Mefloquine @250mg 384,000 489,400 483,000 182,308 54,020 160,620 …
Artemisinine Derivatives (# of Tx) 12,075 14,673 130,238 115,000 185,962 3,736 …
Quinine @ 300mg 3,229,500 3,148,091 2,266,277 1,222,390 1,661,520 1,040,297 …
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 26
Pan AmericanHealthOrganization
Resources and
Financing
Resources and
Financing
Malaria in Brazil, 2005 27
Pan AmericanHealthOrganization
BRAZIL: National Budget and Non-Budgetary Contributions to Malaria Control Programs, 1998–
2004 (in US$)
BRAZIL: National Budget and Non-Budgetary Contributions to Malaria Control Programs, 1998–
2004 (in US$)
1
10
100
1,000
10,000
100,000
1,000,000
10,000,000
100,000,000
ContributedFunds & Loans
National MalariaBudget
Total Budget
Contributed Funds & Loans … … 2,477,870 805,197 1,137,503 523,926 523,926
National Malaria Budget 30,188,891 30,307,650 44,766,876 21,517,299 21,411,765 40,695,955 40,695,955
Total Budget 30,188,891 30,307,650 47,244,746 22,322,496 22,549,268 41,219,881 41,219,881
1998 1999 2000 2001 2002 2003 20041
10
100
1,000
10,000
100,000
1,000,000
10,000,000
100,000,000
ContributedFunds & Loans
National MalariaBudget
Total Budget
Contributed Funds & Loans … … 2,477,870 805,197 1,137,503 523,926 523,926
National Malaria Budget 30,188,891 30,307,650 44,766,876 21,517,299 21,411,765 40,695,955 40,695,955
Total Budget 30,188,891 30,307,650 47,244,746 22,322,496 22,549,268 41,219,881 41,219,881
1998 1999 2000 2001 2002 2003 2004
Malaria in Brazil, 2005 28
Pan AmericanHealthOrganization
BRAZIL: Annual US$ Funds per Person in Malarious Areas, 1998–2004
BRAZIL: Annual US$ Funds per Person in Malarious Areas, 1998–2004
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
US$ Funds per Person inMalarious Areas
0.42 0.42 1.5 1.21 1.1 0.25 0.25
1998 1999 2000 2001 2002 2003 20040
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
US$ Funds per Person inMalarious Areas
0.42 0.42 1.5 1.21 1.1 0.25 0.25
1998 1999 2000 2001 2002 2003 2004