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Paraguay Successfully Eliminates Malaria
Paraguay has successfully eliminated malaria, making it the first country in the Americas to accomplish such a feat in nearly 50 years.

Victories Against Malaria

The country’s success has been attributed to its ability to detect malaria cases in a timely manner and discern whether or not the cases had been spread inter or intranationally. Between 1950 and 2011, Paraguay developed and implemented programs and policies meant to both control and eliminate the disease; the country registered its last case of P. Vivax Malaria, the most frequent cause of recurring malaria, in 2011.

After 2011, a five-year program focusing on case management, community engagement and public health education was launched in order to prevent transmission and prepare for official “elimination certification.”

Since the program’s completion in 2016, the Ministry of Health has launched a three-year initiative meant to further train Paraguay’s healthcare workers in regards to malaria. This prioritization will inevitably strengthen the country’s ability to promptly detect, diagnose and treat new malaria cases, as well as address the ongoing threat of “malaria importation.” The country has also prioritized controlling and minimizing mosquito populations within its borders.

New Directions and Prioritizations

The elimination of malaria provides economic leverage for Paraguay’s impoverished population. The significant financial burden of approximately $5 a day per malaria case, according to a study published by the U.S. National Library of Medicine, will no longer plague Paraguayan families. Such relief will help enable them to direct their money towards other essentials, such as food and education.

Poverty affects almost 40 percent of Paraguay’s rural population, as opposed to only 22 percent of its urban population. Peak malaria infection often coincides with harvesting season, severely impacting the amount of food rural families are able to produce.

Malaria cases are typically concentrated in said rural areas, where many lack the resources and public health education to adequately detect or treat the virus. The immediate situation of these rural communities is only impacted by instances of extreme flooding, which act as a breeding ground for mosquitos (potential carriers of the virus).

Points of Impact

Malaria primarily occurs in poor, tropical and sub-tropical regions of the world, most of which don’t have adequate access to primary care facilities – in many of the countries it’s present, malaria is the primary cause of death.

The virus is the result of a parasite carried by mosquitos. The most common symptoms of malaria include chills, fever and other flu-like symptoms. Left untreated, the disease can be fatal.

The groups most vulnerable to high levels of malaria transmission include young children and pregnant women. Malaria caused approximately 216 million clinical cases and over 440,000 deaths in 2016 alone.

Future Goals to Successfully Eliminate Malaria

The success of these programs provides a blueprint for other countries to successfully eliminate malaria themselves. Paraguay’s situation contrasts with those of other countries within the Americas, where the increase in malaria cases is greater than in any other region of the world. In fact, nine different countries reported malaria case increases of at least 20 percent between 2015 and 2016.

As a whole, however, Latin America witnessed over a 60 percent decrease in malaria cases between 2000 and 2015. As treatment and surveillance progress, many other countries will follow Paraguay in eliminating the virus. Argentina is expected to be certified later this year, and other malaria-free Latin American countries include Ecuador, El Salvador and Belize.

Katie Anastas
Photo: Flickr

Health_SaudiArabia MERSAn outbreak of Middle East Respiratory Syndrome (MERS) was reported in Saudi Arabia on March 21, 2016. Mers-CoV is a viral respiratory illness new to humans. The first case was reported in 2012. According to the Centers for Disease Control and Prevention, MERS has a high mortality rate, three to four of every 10 patients who become ill with MERS die.

Caused by a coronavirus and found in camels, the illness has been linked to countries near the Arabian Peninsula. Health organizations such as WHO and the CDC advise against consuming raw camel products like meat and milk that is not pasteurized.

Due to travel, outbreaks have occurred in 26 countries throughout the globe, including cases in the U.S. The largest outbreak outside of the Middle East occurred in the Republic of North Korea in 2015.

A typical case of MERS begins with a cough, fever and shortness of breath. If the virus progresses, an individual can experience pneumonia, kidney failure or septic shock.

“It is not always possible to identify people with MERS-CoV early because the early symptoms are non-specific. For this reason, all health care facilities should have standard infection prevention and control practices in place for infectious diseases,” according to the World Health Organization. “It is also important to investigate the travel history of patients who present with respiratory infection.”

Human-to-human transmission has not been common except in places where there is extremely close contact, such as health care facilities. People with diabetes, renal failure, lung disease and compromised immune systems are especially vulnerable to becoming infected with MERS and should be evaluated immediately after being in close proximity to the disease.

There is not yet a vaccine for MERS or any specific antiviral treatment. Symptoms of the illness can be relieved with medical care. Preventative actions such as hand washing, avoiding those infected and disinfecting frequently touched surfaces. These actions serve as the only forms of protection at this point.

“WHO is working with clinicians and scientists to gather and share scientific evidence to better understand the virus and the disease it causes, and to determine outbreak response priorities, treatment strategies, and clinical management approaches,” WHO said about their response to MERS.

Of the four cases reported this month in Saudi Arabia, one patient died.

Emily Ednoff

Photo: Wikipedia

Zika Virus

The Zika virus has been in Asia and the Pacific for roughly six decades but its symptoms had caused little concern in the area. Yet after the recent outbreak in the Americas, certain countries in the region are now taking preventative measures.

Zika is an emerging mosquito-borne virus that was first identified in Uganda in 1947. The first outbreak in Asia, though, occurred in the 1960s.

“It has appeared in Indonesia, Malaysia, India, Cambodia, Vietnam, Thailand, the Philippines and Pakistan, but no widespread cases have been reported and symptoms have typically been mild and similar to dengue and chikungunya, which may have helped mask its presence,” according to the Associated Press.

Nonetheless, after the World Health Organization (WHO) declared a global emergency a few weeks ago, several countries in the region have started taking special precautions.

According to IRIN, “Tonga has declared an epidemic, and the government of the Cook Islands has advised women to delay becoming pregnant. Japan, South Korea, Nepal and India have issued advisories to pregnant women against traveling to infected countries.”

Nepal is attempting to get rid of standing water where the Zika-carrying Aedes aegypti mosquito might breed, said Dr. Babu Ram Marasini, director of the Department of Health Services.

“South Korea has announced a fine of two million won (about $1,700) on doctors who fail to immediately report suspected cases, while Malaysia has asked travelers to the country to report to health centers if they have symptoms,” added IRIN.

The U.S. Centers for Disease Control and Prevention says that it is unclear how the Zika virus arrived in the Americas. However, it is theorized that it arrived with participants from the Pacific at sporting events in Rio de Janeiro two years ago.

Since then, the Zika virus has been spreading rapidly across the Americas, with 1.5 million cases reported in Brazil alone.

IRIN emphasized that “despite Zika’s relatively benign history in Asia and the Pacific, there is a risk that a stronger form of the virus may have emerged, and that it could spread throughout the region with much more severe consequences than previous outbreaks.”

Additionally, Dr. Shailendra Saexana from the Indian Virological Society said “The strain in Brazil could be new because mutation rates in these viruses are high. Moist tropical climates, population explosion and international travel mean Asia is susceptible to Zika.”

Various Asian countries are currently very vulnerable to an outbreak of Zika, especially due to the increase in migration from rural areas to cities, as well as the lack of sanitation and abundance of stagnant water where mosquitoes can breed. However, with these new preventative measures in place, the risks may be reduced.

Isabella Rolz

Sources: World Health Organization, IRIN, Associated Press
Photo: Flickr

doctors_without_borders_flag
The Myanmar government banned Doctors Without Borders (DWB) from operating in one of its most impoverished states, following rumors of ethnic tension.

Most of the disenfranchised Muslim minority reside in the Rakhine State. The government accused the DWB of favoring this minority over its rival group, the Rakhine Buddhists. This tension led to widespread violence, killing 100 people and displacing nearly 140,000 others. The government regards Muslims as “interlopers” from Bangladesh, as opposed to a legitimate minority. President Thein Sein granted DWB permission to resume its work in other regions, but continued its ban on operations in Rakhine.

Presidential spokesman Ye Htut accused DWB of “not following their core principle of neutrality and impartiality.”

Rakhine State government accused the NGO of intentionally fueling tension between the minorities, according to Htut. The perception of bias led to large-scale protests in the state capital against DWB.

The organization responded to these accusations in a statement, asserting “services are provided based on medical need only, regardless of ethnicity, religion, or any other factor.”

This January, DWB released a statement contradicting the government on an alleged massacre in Rakhine. This reportedly “triggered” the ban on its operations in the region. The United Nations report the death of more than 40 Rohingya Muslims, and DWB confirmed treating 22 victims. Wounds occurred at the hands of state security forces, yet the government denounced these claims, reporting the death of one police officer.

Following the ban, the Ministry of Health plans to provide health services for the “whole community.” Myanmar President Thein Sein also dispatched the emergency response workers and ambulances to the region, replacing the DWB clinics.

These services cannot match those provided by the NGO. The national health services rank “among the most rudimentary in Asia,” according to the New York Times. The government also confines Muslims to their villages, preventing the group from receiving medical care.

Banning DWB deprives nearly 750,000 people of proper healthcare.

The NGO acted as the largest provider in northern Rakhine, a region largely populated with Muslim Rohingya. It managed five permanent clinics as well as 30 mobile units. Within these clinics, workers operated an intensive feeding center for undernourished children. Medical professionals report diagnosing more than 20 percent with acute malnourishment.

The government ban forced these centers to close, following the removal of DWB.

The organization also served those living in displaced camps outside the state capital, Sittwe. Tuberculosis, a disease endemic to Muslim neighborhood Aung Mingla, threatens the health of displaced Muslims. HIV and malaria also threaten resident health. With limited medical attention, the supplies of medicine continue to dwindle.

The government prevents these patients from leaving the area, surrounding the camp with “barbed-wire security posts and police officers.”

As head of the U.N. Office for the Coordination of Humanitarian Affairs in Myanmar, Mark Cutts expresses concern for the present healthcare shortage. Rather than antagonizing the government, though, the U.N. has chosen “quiet diplomacy.”

For the time, the International Committee of the Red Cross and other organizations can provide care. Myanmar deputy health director Dr. Soe Lwin Nyein plans to accept tuberculosis and HIV medication from DWB. These concessions help patients in the region receive more than the minimum government care, yet negotiations over the medicine distribution appear ongoing.

Cutts plans to coordinate with the government and reinstate DWB “as soon as possible,” protecting the minority from disease. As ethnic tension continues to incite violence, the government banned professionals in the best position to serve its people.

Ellery Spahr

Sources: CNN, New York Times
Photo: Richard Roche