Challenges and opportunities for pursuing malaria elimination in Peru (original) (raw)

Recent history suggests that malaria can be eliminated in low-endemic countries, and there is a growing interest among key stakeholders from Peru to plan accordingly and achieve malaria elimination with a comprehensive programmatic goal. In support of this interest, this dissertation integrates a course of studies to inform and support such goal, by accounting for the two most important malaria transmission patterns that currently characterize Peru, the one affecting the Peruvian north coast and the other affecting the Peruvian Amazon basin. The first study will determine the impact of reactive case detection with focal mass drug administration (RCD/FMDA) as compared to passive case detection on reducing the regional annual parasite incidence in Tumbes, Peru (Paper 1). The second study will determine the impact of the malaria elimination program implemented in Tumbes on interrupting the transmission of malaria beyond the intervention area and along the Peruvian north coast (Paper 2). And the third study will determine whether further understanding the patterns of malaria incidence in Loreto, the main human malaria reservoir in Peru, may offer a variety of strategical targets for the malaria elimination program that was launched in Loreto, influencing as well the nearby regions at the Peruvian Amazon basin in 2017 (Paper 3). It has been observed that the malaria elimination program implemented in Tumbes, which was based on replacing passive case detection with RCD/FMDA strategy, had a significant effect on reducing the regional annual parasite incidence in Tumbes within the intervention areas (2/13 districts) during the first two years of the program (pilot project). When the strategy was scaled up across the entire Tumbes region, malaria transmission was halted with no endogenous cases for the following three years. Additionally, data suggest that the Tumbes intervention indirectly helped to interrupt malaria transmission in the nearby region of Piura. During the intervention in

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