Avaliação das ações de controle da malária em indígenas de São Gabriel da Cachoeira-Amazonas, no período de 2003 a 2007

Abstract

Malaria is a disease, though ancient, still represents a large public health problem in the world nowadays, being one of the main tropical parasitosis and affecting about 500 millions of people every year. According to WHO, every 30 seconds an African child dies as a result of malaria infection and many of those who survive, suffer with brain damage. In Brazil, the region with biggest endemicity is Legal Amazon due to favorable factors to the disease s dissemination, such as: temperature, humidity, altitude and vegetation, besides the dwelling and work conditions of the local population. The indigenous presence in North region is remarkable; it concentrates almost 30% of them in Brazil, especially in extreme Northwestern Amazonas, where the municipal district São Gabriel da Cachoeira is located, the largest indigenous center in the country. Malaria is one of the main illnesses responsible for the high morbidity and mortality of indigenous Brazilians. In view of the very high Annual Parasitical Index (IPA) in Amazonia 18,8 cases/1,000 inhabitants, the Government launched the Intensification of Actions in Malaria Control Plan (PIACM) in 2000 as part of the global strategy against this disease, and the Malaria Prevention and Control National Program (PNCM) in 2003, created as a permanent policy to prevention and control the illness in order to proceed with the advances obtained with PIACM. The objective of this research was to make a retrospective study evaluating the results of the impact of actions regarding malaria control in indigenous population from São Gabriel da Cachoeira County, State of Amazonas, Northern Brazil, in the period from 2003 to 2007, having as source of information data base and archives from both governmental and non-governmental institutions. The health assistance model of the county has its services organized as Special Indigenous Sanitary District of Upper Rio Negro, which divides it in 19 bases. The malariometric indexes indicated an increasing tendency in the number of cases and the mean was 2,989 cases, the biggest numbers occurring in the county s rural area. The same tendency was presented by the IPA with a mean of 174,3 cases/1,000 inhabitants, however the highest IPAs were observed in urban area. The proportion of cases due to Plasmodium falciparum infection presented a progressive decrease along the studied years, going from 18.8% to 1.6%. The hospitalization and mortality rates presented fluctuations during the period and the lethality rate, after an increase of 27% in 2005, showed reduction. All the values were significant statistically (p< 0.05). The study revealed that the actions from the malaria control program showed to be partially effective, according to the malariometric indexes, at the same time it provided a wider ability in detecting the cases and, as consequence, of treatment. Although the county still presents a high risk to malaria transmission, the ongoing Puriannual Plan seems to have a good prognosis concerning the disease control, if it is maintained in a sustainable and permanent manner.