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Malaria in Panama, 1998–2004 1Pan AmericanHealthOrganization

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Title of the presentation

AuthorMALARIA IN PANAMA:

Time Series Epidemiological Data from 1998 to 2004

Malaria in Panama, 1998–2004 2Pan AmericanHealthOrganization

MALARIA IN PANAMAI. 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 Panama, 1998–2004 3Pan AmericanHealthOrganization

The Risk of

Transmission

Malaria in Panama, 1998–2004 4Pan AmericanHealthOrganization

PANAMA: Population at Risk of Malaria Transmission, 1998–2004 (in thousands)

2,400.00

2,500.00

2,600.00

2,700.00

2,800.00

2,900.00

3,000.00

3,100.00

3,200.00

Population at Risk 2,667 2,712 2,757 2,821 2,863 3,016 3,067

Total Population 2,764 2,809 2,839 2,919 2,963 3,121 3,172

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 5Pan AmericanHealthOrganization

PANAMA: Population at Ecological Risk of Malaria Transmission According to Level of Transmission

Risk, 1998–2004 (in thousands)

0

500

1,000

1,500

2,000

2,500

3,000

Low Risk 178 237 0 0 2,428 2,256 2,739Moderate Risk 308 224 2,006 2,430 0 368 221High Risk 0 … 424 391 435 497 107

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 6Pan AmericanHealthOrganization

Malaria Morbidity

Malaria in Panama, 1998–2004 7Pan AmericanHealthOrganization

PANAMA: Malaria Morbidity, 1998–2004 (number of positive blood slides)

0

1,000

2,000

3,000

4,000

5,000

6,000

No. of Cases 1,039 936 1,036 928 2,244 4,500 5,095

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 8Pan AmericanHealthOrganization

PANAMA: Malaria Morbidity According to Level of Transmission Risk, 1998–2004

(number of positive blood slides)

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Low Risk 130 65 … 0 0 321 923

Moderate Risk 909 871 75 102 254 675 1,960

High Risk … … 961 826 1,990 3,504 2,212

Originally Non-Malarious … … … … 0 0 0

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 9Pan AmericanHealthOrganization

PANAMA: Malaria Morbidity According to Parasite Species (in All Risk Areas), 1998–2004

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

P. falciparum & mixed 124 40 45 39 337 627 882

P. vivax 914 896 991 889 1,907 3,873 4,213

P. malariae 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 10Pan AmericanHealthOrganization

PANAMA: Malaria Morbidity According to Parasite Species (In Moderate and High Risk Areas),

1998–2004

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

P. falciparum & mixed 114 29 45 39 337 602 800

P. vivax 795 841 991 889 1,907 3,539 3,372

P. malariae 0 0 … 0 0 0 0

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 11Pan AmericanHealthOrganization

Malaria Mortality

Malaria in Panama, 1998–2004 12Pan AmericanHealthOrganization

PANAMA: Malaria Mortality, 1998–2004 (number of deaths)

0

0.5

1

1.5

2

2.5

3

3.5

4

No. of Deaths 0 0 1 1 2 4 3

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 13Pan AmericanHealthOrganization

Malariometric Indices

(API, AFI, AVI, AMI)

Malaria in Panama, 1998–2004 14Pan AmericanHealthOrganization

PANAMA: Malariometric Indices (API, AFI, AVI, AMI) in All Risk Areas, 1998–2004

00.20.40.60.8

11.21.41.61.8

API 0.4 0.3 0.4 0.33 0.78 1.44 1.66AFI 0 0 0 0.01 0.12 0.2 0.29AVI 0.32 0.33 0.36 0.32 0.67 1.24 1.37AMI 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 15Pan AmericanHealthOrganization

PANAMA: Malariometric Indices (API, AFI, AVI, AMI) in Moderate and High Risk Areas, 1998–2004

0

2

4

6

8

10

12

14

API 2.95 3.89 0.43 0.33 5.16 4.79 12.27AFI 0.37 0.13 0.02 0.01 0.77 0.7 2.44AVI 2.58 3.75 0.41 0.32 4.38 4.09 10.28AMI 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 16Pan AmericanHealthOrganization

PANAMA: Annual Parasitic Index (API), 1998–2004

0

2

4

6

8

10

12

14

In All Risk Areas 0.4 0.3 0.4 0.33 0.78 1.44 1.66Moderate and High Risk Only 2.95 3.89 0.43 0.33 5.16 4.79 12.27

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 17Pan AmericanHealthOrganization

PANAMA: Annual Index of P. falciparum (AFI), 1998–2004

0

0.5

1

1.5

2

2.5

In All Risk Areas 0 0 0 0 0.12 0.2 0.29Moderate and High Risk Only 0.37 0.13 0.02 0.01 0.77 0.7 2.44

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 18Pan AmericanHealthOrganization

PANAMA: Annual Index of P. vivax (AVI), 1998–2004

0

2

4

6

8

10

12

In All Risk Areas 0.34 0.33 0.36 0.32 0.67 1.24 1.37Moderate and High Risk Only 2.58 3.75 0.41 0.32 4.38 4.09 10.28

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 19Pan AmericanHealthOrganization

PANAMA: Annual Index of P. malariae (AMI), 1998–2004

00.10.20.30.40.50.60.70.80.9

1

In All Risk Areas 0 0 0 0 0 0 0Moderate and High Risk Only 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 20Pan AmericanHealthOrganization

Trends in Case Detection

and Diagnosis

Malaria in Panama, 1998–2004 21Pan AmericanHealthOrganization

PANAMA: Passive vs. Active Case Detection, 1998–2004 (% of Blood Slides Examined)

18

18

18

14

16

16

17

82

82

82

86

84

84

83

0 20 40 60 80 100 120

1998

1999

2000

2001

2002

2003

2004

Passive Active

Malaria in Panama, 1998–2004 22Pan AmericanHealthOrganization

PANAMA: Annual Blood Examination Rate (ABER) in Malarious Areas, 1998–2004

486,000

461,000

2,430,000

2,821,000

2,863,000

3,121,000

3,067,000

187,055

161,219

149,702

156,588

166,031

166,811

171,179

1998

1999

2000

2001

2002

2003

2004

Examined

Population at Risk /In Malarious Areas

Malaria in Panama, 1998–2004 23Pan AmericanHealthOrganization

PANAMA: Slide Positivity Rate (SPR), 1998–2004

187,055

161,219

149,702

156,588

166,031

166,811

171,179

1,039

936

1,036

928

2,244

4,500

5,095

1998

1999

2000

2001

2002

2003

2004

Examined

Positive

Malaria in Panama, 1998–2004 24Pan AmericanHealthOrganization

Treatment

Malaria in Panama, 1998–2004 25Pan AmericanHealthOrganization

PANAMA: Antimalarial Drugs Used, 1998–2004

0100,000200,000300,000400,000500,000600,000700,000800,000900,000

Chloroquine &/or Amodiaquine @ 150mg 196,000 191,000 198,000 195,000 266,000 865,052 712,852

Primaquine @ 15mg 197,500 189,000 194,500 182,500 161,000 771,829 554,942

Sulfa/Pyrimethamine @ 500/25mg 2,100 … … 80 221 5,000 6,000

Mefloquine @250mg … … … … … 5,463 8,500

Artemisinine Derivatives (# of Tx) … … … … … … …

Quinine @ 300mg … … … … … … …

1998 1999 2000 2001 2002 2003 2004

Malaria in Panama, 1998–2004 26Pan AmericanHealthOrganization

Resources and

Financing

Malaria in Panama, 1998–2004 27Pan AmericanHealthOrganization

1

10

100

1,000

10,000

100,000

1,000,000

10,000,000

Contributed Funds and Loans

National Malaria Budget

Total Budget

Contributed Funds and Loans … … … … … … 88,417National Malaria Budget 5,171,984 5,161,509 5,066,318 4,680,289 3,986,849 2,751,541 5,024,766Total Budget 5,171,984 5,161,509 5,066,318 4,680,289 3,986,849 2,751,541 5,113,183

1998 1999 2000 2001 2002 2003 2004

PANAMA: National Budget and Non-Budgetary Contributions to Malaria Control Programs,

1998–2004 (in US$)

Malaria in Panama, 1998–2004 28Pan AmericanHealthOrganization

PANAMA: Annual US$ Funds per Person in Malarious Areas, 1998–2004

0

2

4

6

8

10

12

US$ Funds per Person inMalarious Areas

10.64 11.2 2.09 1.66 1.39 0.91 1.67

1998 1999 2000 2001 2002 2003 2004