Graduation Year

2019

Document Type

Thesis

Degree

M.S.P.H.

Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Public Health

Major Professor

Ricardo Izurieta, MD, DrPH, MPH

Committee Member

Ismael Hoare, PhD, MPH

Committee Member

Benjamin Jacob, PhD

Keywords

control, elimination, epidemiology, plasmodium

Abstract

The disease of malaria is complex, with clinical presentation that ranges from severe and complicated to mild and uncomplicated or even to asymptomatic malaria. A recent effort made by several world organizations has shown important advances in the effort to control and eradicate malaria. Following the general ordinance established by the trans-border organizations, each country has tried to define, according to their local geopolitical scenario, individual ¨road maps¨ to succeed in reducing the morbidity and mortality caused by malaria. Moreover, it is now accepted universally that these road maps need to be revised and appropriated in order to correct actions that allow fulfillment of the main goal- Control and eventual Eradication of Malaria.

In 2011, the Republic of El Salvador, a small Central American country, in co-ordination with international organizations, The Pan American Health Organization (PAHO) successfully launched and established at the national level, the Plan to Eliminate Malaria (PEM) which was conducted until 2014. According to the statistics El Salvador is positioned to cross into the final steps and get the certification that the disease has been eliminated from its borders. The general strategy of the PEM needs to be evaluated for its effectiveness and if necessary, revised to apply actions in the way of a Reorientation of the Program and this document is a proposal to fulfill this aim.

More than a century has elapsed since Levaran described the plasmodium as micro-organismic species responsible for malaria along with Ross confirming their transmission by the female anopheles’ mosquito. However, malaria still remains a serious parasitic disease in the developing world resulting in high morbidity and mortality. Although the areas where transmission takes place have reduced over time, and they are by now confined to the inter tropical areas, the number of people living at risk has grown to about 3 billion, and is expected to go on increasing. It is reported that there are over 500 million cases every year, and between 1 and 3 million deaths. The disease also carries a huge burden that impairs the economic and social development of large parts of the planet.

Malaria’s impact is felt at various levels, i.e. individual, national and global health care systems, that international organizations and national efforts are directed towards the control, and eventual elimination of the disease. Till, date however, they have been met with varying results. Developed parts of the globe like Europe and North America have succeeded in eliminating malaria from their shores whereas the disease still continues to afflict vast populations in Africa, Asia and South and Central America. These efforts, however, have met with varying degrees of success globally. Developed countries in Europe and North America have succeeded in eliminating malaria from their shores while the disease continues to afflict vast populations in Africa, Asia as well as South and Central America. This shows a regional variation in the success achieved in the fight against malaria dependent on development status and economic strength.

Malaria is believed to have reached the shores of the South America continent just over 500 years ago during the colonization, but it seems to have flourished in the existing favorable environs existing therein. The affected countries are approaching this problem with individual and collaborative efforts with variable success.

Among these nations, the small Central American nation of El Salvador stands out as a frontrunner in efforts to eradicate malaria. As a matter of fact, the nation established the Program to Eliminate Malaria (PEM) spanning a period from 2001 to 2014 and according to the statistics is positioned to cross into the final steps and get the certification that the disease has been eliminated from its borders soon. This document is a retrospective data collection study of the incidence of malaria over two decades from 1994 to 2013 in order to evaluate the efficacy of the malaria control policy of El Salvador.

Materials and Methods

Data pertaining to incidence of malaria in El Salvador was collected for this research project conducted by the University of South Florida, College of Public Health, Department of Global Health in collaboration with the Ministry of Health (El Salvador) and the Pan American Health Organization in El Salvador (PAHO). Primary sources are comprised by the analysis of official documents from the Ministry of Health and Social Wellbeing of El Salvador (MOHS) and the Pan American Health Organization Mission in El Salvador (PAHOS). In addition, the databases at the National Epidemiology Surveillance System of the MOHS were extracted and analyzed. As secondary sources specialized key malaria national and international experts were consulted about the subject.

Results

The collected data was subjected to the most appropriate data analysis. The obtained data was plotted on graphs of various axes and was evaluated for common or recurring themes as well as upward or downward trends. An attempt was made to isolate the factors that contributed towards success of the malaria program in El Salvador.

Discussion

The success story of the Central American Nation of El Salvador has proven itself to be a study model for the region and the world in the mission to eradicate malaria. In the final year included in this study more than half the reported cases were migrants from across the national borders. This according to us is an indication that the so called ¨endgame¨ in the fight against malaria is going to be as laborious and challenging as the pathway towards controlling it.

Conclusion

Thus, we may conclude that El Salvador is a shining example of a success story of fight against malaria that may be considered in its most vital and challenging chapter of transition from control to elimination, which, with the right strategy and execution might be a fairy tale ending that frees the country from malaria “ever after!”.

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