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Overview of Malaria in the Americas History followed different courses for different peoples because of differences among peoples’ environments, not because of biological differences among peoples themselves. Diamond, J.M. (2005) Guns, Germs, and Steel: the fates of human societies. Environments Ecological Social Economic Political Technological Reflections • • • • • • • • • November 6th 1880: Laveran 1898: Ross, Grassi, Bastianelli, Bignami Cinchona bark: Fever – Quechua Indians Peru 17th Century “Jesuit bark” - Rome 19th Century Malaria throughout Americas 1902 – Malaria health problem – PAHO II World War – new antimalarials, DDT Successes – Americas including Caribbean 1955 – Global Eradication Program Malaria Strategies and Goals • Global Malaria Eradication Strategy – Mexico 1955 • Global Malaria Control Strategy – Amsterdam 1992 • Roll Back Malaria Initiative – 1998 • U.N. Millennium Development Goals - 2000 Interventions • Diagnosis (Microscopy, Rapid Diagnostic Tests) • Treatment (Distinct parasites, Drug Resistance) • Reduction Man – Mosquito contact (distinct mosquitoes, Insecticide resistance, Housing, Management breeding sites, Mosquito nets, etc.) • Epidemiologic analysis, Operational research • Community, other sector involvement • Health systems – transfer of responsibility but reduced technical capability Funding of Malaria Control in Americas External contributions 200.0 24.8 6.2 Funds (million US$) 15.1 150.0 10.1 11.1 9.6 173.6 100.0 2.7 50.0 169.8 155.5 132.0 135.4 2005 2006 93.9 72.4 0.0 2002 2003 2004 Source: Annual Country Reports to PAHO 2007 2008 Govt. budget Challenges • • • • • • • • • Change structure health institutions and systems; Accessibility, availability health services Orientation articulation / integration primary health care Recruitment, training, continuity technical personnel Sustainability - surveillance, epidemiologic assessments, operational research Use scientific evidence to adapt interventions and policies Multiple sector participation, particularly civil society and communities Migration within and between countries Burden reduction – “call to arms” – elimination