Category Archives: Migration

Malaria in Guyana – Community Dynamics

The Americas have the lowest rates of malaria among the major endemic areas of the world. So when concerns are raised that Guyana may not be able to keep its total cases in 2009 below 10,000, countries like Nigeria, Tanzania and DRC may wonder what the fuss is all about. We must remember therefore, that for malaria eradication to succeed, the disease must be eliminated in EACH endmic country, no matter how few the number of current cases appears to be.

Success in Guyana has been mixed, with great reduction in some target communities, but now “There are areas in the country which did not have a problem now, but are not recording measurable and or moderate levels of malaria.” In the Omai area, “hundreds of small miners have appeared on the scene.” They are not paying attention to environmental control, but instead are responding to the increasing price of gold on the world market.

guyana-regions-and.jpgGuyana has received Global Fund grants from Round 3 and 7 for malaria control. Though the country has around three-quarters of a million people, the proposals focused on the more endemic regions. For example, Regions 7 and 8 are populated mostly by a little over 20,000 Native American peoples. These regions have also been inundated by another 20,000 informal miners and loggers.

The GFATM performance report on case management in the Round 3 grant shows that while appropriate malaria drugs are available in all target communities, actual appropriate treatment of vivax and falciparum malaria hovers around only 60% of cases. (Round 7 was signed only in May 2009 so a detailed progress report is not yet available.)

Community participation indicators also show high marks, but then one needs to consider that the non-indigenous miners and loggers may not really be part of a community.

The 2006 Multiple Indicator Cluster Survey found that sleeping under bednets by children under five years of age increased from 6.5% to 70% between 2000 and 2006. Of course this leaves open the question of whether adult migrant miners are using nets and are harboring the disease. Palmer and colleagues describe one typical mining camp in this region –

The mining camp … was approximately 400 km inland from Georgetown, the capital of Guyana, in the heart of the Amazon region of the country. It was typical of many of the mining camps in the jungle. Men sleep in rows of 20 to 40 hammocks strung underneath a large tarp-like covering. The tarp coverings are not enclosed, but the men usually sleep under mosquito netting, as malaria infection is a constant problem.

If Guyana is to meet its 2012 target of only 8,000 annual cases of malaria some serious thinking is needed about strategies to reach the diverse populations in the endemic regions.  The indigenous peoples have their community structures, and it appears that these have been reached.

The challenge then is to distinguish the other residents of these endemic regions and organize malaria control activities that will be appropriate to their social context, recognizing at the same time that their mining practices may be detrimental to the environment and the elimination of malaria.

When Parasites Travel

Mobile population importation of drug-resistant infections and diseases is a focus of the November 2009 issue of Emerging Infectious Diseases. In that issue, MacPherson and colleagues cite, “Many examples of imported multidrug-resistant (MDR) infectious diseases are associated with migrant populations, e.g., MDR Plasmodium falciparum malaria in immigrants, tourists, and returned foreign-born travelers.”

Parasites travel –

  • According to Monge-Maillo, malaria accounted for nearly 10% “of 2,198 immigrants referred to the Tropical Medicine Unit of Ramón y Cajal Hospital over a 20-year period” in Spain.
  • CDC received reports of 1,324 cases of malaria, including four fatal cases, with an onset of symptoms in 2004 among persons in the United States or one of its territories. This number represents an increase of 3.6% from the 1,278 cases reported for 2003,” as reported in MMWR by Skarbinski and colleagues.
  • In the Netherlands 5043 laboratory cases of imported malaria were confirmed between 2000 and 2003 according to Klein and Bosman.

fly_dscn0185.JPGThe problem is worse when drug-resistant parasites travel. Chan and co-researchers have been examining archival human sera “to explore the origin and evolution of Plasmodium falciparum chloroquine resistance in the Pacific.”

In 2002 Afghan refugees brought malaria into northwestern Pakistan. They experienced a 28% treatment failure rate when chemically substandard locally manufactured sulfadoxine-pyrimethamine was used for routine treatment. This is a potential way of producing drug resistance that could be carried back home by returning refugees

MacPherson and colleagues demand what they call, “Pharmaceutical security systems for standard and quality medicines,” in an effort to combat “commonly substandard or counterfeit” drugs in endemic countries.  Progress in eliminating malaria in Zanzibar, Rwanda and Zambia can easily be threatened if resistant parasites cross their borders. These parasites don’t need passports and visas.