# name
Declining malaria transmission in rural Amazon: changing
                epidemiology and challenges to achieve elimination

# metadata.dc.description.abstract[].value
BACKGROUND: In recent years, considerable success in reducing
                its incidence has been achieved in Brazil, leading to a relative
                increase in the proportion of cases caused by Plasmodium vivax,
                considered a harder-to-eliminate parasite. This study aim is to
                describe the transmission dynamics and associated risk factors
                in a rural settlement area in the Western Brazilian Amazon.
                METHODS: A prospective cohort was established in a rural
                settlement area for 3 years. Follow-up included continuous
                passive case detection and monthly active case detection for a
                period of 6 months. Demographic, clinical and transmission
                control practices data were collected. Malaria diagnosis was
                performed through thick blood smear. Univariable and
                multivariable analyses of factors associated with malaria
                incidence were performed using negative binomial regression
                models. Factors associated with recurrence of P. vivax and
                Plasmodium falciparum malaria within 90 days of a previous
                episode were analysed using univariable and multivariable
                Cox-Proportional Hazard models. RESULTS: Malaria prevalence
                decreased from 7 % at the study beginning to 0.6 % at month 24,
                with P. vivax predominating and P. falciparum disappearing after
                1 year of follow-up. Malaria incidence was significantly higher
                in the dry season [IRR (95 % CI) 1.4 (1.1-1.6); p < 0.001)].
                Use of ITN was associated to malaria protection in the
                localities [IRR (95 % CI) 0.7 (0.6-0.8); p = 0.001)]. A
                recurrent P. vivax episode within 90 days was observed in 29.4 %
                of individuals after an initial diagnosis. A previous P. vivax
                [IRR (95 % CI) 2.3 (1.3-4.0); p = 0.006)] or mixed P. vivax + P.
                falciparum [IRR (95 % CI) 2.9 (1.5-5.7); p = 0.002)] infections
                were significantly associated to a vivax malaria episode within
                90 days of follow-up. CONCLUSIONS: In an area of P. falciparum
                and P. vivax co-endemicity, a virtual disappearance of P.
                falciparum was observed with P. vivax increasing its relative
                contribution, with a large proportion of recurring episodes.
                This finding reinforces the perception of P. falciparum being
                more responsive to early diagnosis and treatment and ITN use and
                the contribution of relapsing P. vivax to maintain this species'
                transmission. In areas of P. vivax endemicity, antihypnozoite
                treatment effectiveness assessment in different transmission
                intensity may be a fundamental activity for malaria control and
                elimination.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Declining malaria transmission in rural Amazon: changing
                epidemiology and challenges to achieve elimination