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Purpose of Review Following Paraguay and Argentina, several countries from the Amazon region aim to eliminate malaria. To achieve this, all key affected and vulnerable populations by malaria, including people working on gold mining sites, must be considered. What is the situation of malaria in these particular settings and what are the challenges? This literature review aims to compile knowledge to answer these questions. Recent Findings The contexts in which gold miners operate are very heterogeneous: size and localization of mines, links with crime, administrative status of the mines and of the miners, mobility of the workers or national regulations. The number of malaria cases has been correlated with deforestation (Brazil, Colombia), gold production (Colombia), gold prices (Guyana), or location of the mining region (Peru, Colombia, Venezuela, Guyana). The burden of malaria in gold mines differs between territories: significant in Guyana, French Guiana, or Venezuela; lower in Brazil. Although Plasmodiumvivax causes 75% of malaria cases in the Americas, P. falciparum is predominant in several gold mining regions, especially in the Guiana Shield. Because of the remoteness from health facilities, self-medication with under-the-counter antimalarials is frequent. This constitutes a significant risk for the emergence of new P. falciparum parasites resistant to antimalarial drugs. Summary Because of the workers’ mobility, addressing malaria transmission in gold mines is essential, not only for miners, but also to prevent the (re-)emergence of malaria. Strategies among these populations should be tailored to the context because of the heterogeneity of situations in different territories. The transnational environment favoring malaria transmission also requires transborder and regional cooperation, where innovative solutions should be considered and evaluated.

Background Haiti is one of the Caribbean countries where malaria still persists. Malaria occurs throughout the country at altitudes below 600 meters. More than 99% of the malaria cases are caused by Plasmodium falciparum and the main vector is Anopheles albimanus. This paper aims to describe the epidemiological profile of malaria in Haiti between 2009 and 2018. Methods We analyzed information on malaria cases reported by both the Health Ministry of Haiti (Ministère de la Santé Publique et de la Population-MSPP) and the World Health Organization (WHO) during the study period. Results Between 2009 and 2018, a total of 232,479 malaria cases were reported by the MSPP. There was an increase in the incidence of malaria in the country in 2010 followed by a decrease in 2011. Due to efforts made by Haiti over the past decade to reduce malaria by 2020, malaria incidence has declined from 60,130 cases in 2010 to 8,978 cases in 2018. We verified that the MSPP and the WHO data are conflicting in relation to the number of cases reported. However, the results from both data sets presented the same malaria trend in Haiti from 2009 to 2018. The results also show the endemicity of the disease throughout Haiti, both in rural and urban areas, especially along the coast. Conclusion This work emphasizes the need to promote official data collection and analyses and the application of epidemiological surveillance of malaria for a better knowledge about the real impact of malaria on the Haitian population aiming more appropriate interventions.

The article's objective is to present the results of the study on the evaluability of the Information System on Indigenous Health (SIASI) and its implications for local health administration. The study was performed with the following stages: description of the intervention, description of potential users, and context analysis (internal and external). The following data collection techniques were adopted: document analysis, interviews with key informants, and a workshop. Modeling of the SIASI in the Special Indigenous Health District Upper Solimões River (Amazonas State) and Special Indigenous Health District Eastern Roraima (Roraima State) allowed a schematic view of the system's mode of functioning, considering the peculiarities of the decentralized and centralized information flow. Context analysis pointed to acknowledgment of the SIASI as a tool for organization of the work process in the multidisciplinary indigenous health team (EMSI) and for follow-up of the health situation, despite low utilization of the information in the territories. Persistent challenges include infrastructure problems and fragmentation of information, causing an increase in rework in feeding the data. One key feature is the creation of the Local SIASI Panel, generating dynamic and interactive reports on the health situation. In conclusion, the capacity for use of the SIASI as a tool to support local management can be enhanced by expanding the decentralization of the information flow.O objetivo do artigo é apresentar os resultados do estudo de avaliabilidade do Sistema de Informação da Atenção à Saúde Indígena (SIASI) e suas implicações para a gestão em saúde no nível local. O estudo foi desenvolvido com base nas seguintes etapas: descrição da intervenção, descrição dos usuários potenciais e análise de contexto (interno e externo). Para tanto, adotaram-se as seguintes técnicas de coleta de dados: análise documental, entrevistas com informantes-chave e oficina de trabalho. A modelização do SIASI no Distrito Sanitário Especial Indígena (DSEI) Alto Rio Solimões (Amazonas) e no DSEI Leste Roraima (Roraima) possibilitou a visualização esquemática do modo de funcionamento do sistema, considerando-se as peculiaridades do fluxo de informação descentralizado e centralizado. A análise de contexto aponta para o reconhecimento do SIASI como ferramenta para a organização do processo de trabalho das equipes multidisciplinares de saúde indígena (EMSI) e o acompanhamento da situação de saúde, ainda que ocorra baixa utilização das informações nos territórios. Entre os desafios, persistem os problemas de infraestrutura e a fragmentação das informações, provocando aumento do retrabalho na alimentação dos dados. Como potencialidade, destaca-se a criação do Painel SIASI Local, que gera relatórios dinâmicos e interativos sobre a situação de saúde. Conclui-se que a capacidade de utilização do SIASI como ferramenta de apoio à gestão pelo nível local pode ser potencializada com a ampliação do processo de descentralização do fluxo de informações.El objetivo del artículo es presentar los resultados del estudio de evaluabilidad del Sistema de Información de Atención en Salud al Indígena (SIASI) y sus implicaciones para la gestión sanitaria en el nivel local. El estudio se desarrolló en base a las siguientes etapas: descripción de la intervención, descripción de los usuarios potenciales y análisis de contexto (interno y externo). Para tal fin se adoptaron las siguientes técnicas de recogida de datos: análisis documental, entrevistas con informantes-clave y taller de trabajo. La modelización del SIASI en el Distrito Sanitário Especial Indígena (DSEI) Alto Rio Solimões (Amazonas) y en el DSEI Leste Roraima (Roraima) posibilitó la visualización esquemática del modo de funcionamiento del sistema, considerándose las peculiaridades del flujo de información descentralizado y centralizado. El análisis de contexto apunta al reconocimiento del SIASI como herramienta para la organización del proceso de trabajo de los equipos multidisciplinares de salud indígena (EMSI) y el seguimiento de la situación de salud, aunque exista una baja utilización de la información en los territorios. Entre los desafíos persisten los problemas de infraestructura y fragmentación de la información, provocando un aumento del retrabajo en la alimentación de datos. Como potencialidad se destaca la creación del Panel SIASI Local que genera informes dinámicos e interactivos sobre la situación de salud. Se concluye que la capacidad de utilización del SIASI como herramienta de apoyo a la gestión por parte del nivel local puede potenciarse con la ampliación del proceso de descentralización del flujo de información.

Background: Illegal gold miners are currently a key reservoir for malaria in French Guiana (FG), with a risk of emergence of resistance linked to improper use of artemisinin-based combination therapy (ACT). The remoteness of the mines and regulatory issues hinder their access to health care. Methods: An intervention researched project (Malakit) implemented in FG borders with Brazil and Suriname aimed at determining the effectiveness of distributed kits for self-diagnosis and self-treatment to illegal gold miners, after training, at strategic border staging areas. Evaluation relied on questionnaires at inclusion and follow-up visits, and pre/post intervention surveys. The primary outcome was the proportion of persons reporting a use of certified ACT after a positive malaria diagnosis. The secondary outcomes assessed antimalarial adherence, kit use and impact on malaria epidemiology. Findings: The proportion of patients reporting a use of certified ACT after a positive diagnosis increased after the intervention (OR 1.8, 95%CI [1.1-3.0]). From April 2018 to March 2020, 3,733 persons participated in the intervention. The kit was used correctly by 71.7% [65.8-77.7] of the 223 persons reporting having used a malakit during the follow-up visits. The intervention could have accelerated the decline in malaria incidence in the region by 42.9%. InterpretationThis innovative international project showed that people with low education can correctly self-manage their malaria symptoms. This strategy could be integrated in the malaria control programs of the countries involved and considered in other regions with residual malaria in remote areas. Funding: This project was funded by the European Union, the Global Fund, PAHO, Brazil MoH, Cayenne Hospital and FG Health Regional Agency. Declaration of Interest: Any authors declare to have no conflict of interest. Ethical Approval: Each participant gave a written consent after clear and appropriate information. Ethics approvals were obtained from countries where the project was implemented (Table 1). The project was the subject of a Normal CNIL Declaration on 24 May 2018 (Declaration Number 2188949 v 0) for data analysis according to the General Data Protection Regulation (European Union Regulation 2016/679).

Background In French Guiana, gold miners working illegally represents a major reservoir of malaria. This mobile population, mainly of Brazilian descent, enters the French Guianese forest from neighbouring countries, Suriname and Brazil. A complex and innovative intervention was piloted as a cooperation with the three involved countries involved to control malaria in this specific population. The principle was that health workers called “facilitators” provide the participants with a self-diagnosis and self-treatment kit along with adequate training and material to rapidly manage an episode of malaria symptoms on their own, when they find themselves isolated from health care services. Methods This paper describes the design, development, content of the intervention and players’ organization of this multi-country project, the opportunities and constraints encountered, and the lessons learnt at this stage. Results The choice not to implement the usual “Test and Treat” approach within the community is mainly driven by regulatory reasons. The content of medical messages tends to balance the tension between thoroughness, accuracy and efficacy. The wide range of tools developed through a participatory approach was intended to cope with the challenges of the literacy level of the target population. Despite the difficulties encountered due to language, regulation differences and distance between partners, cooperation was fruitful, due to the complementary of stakeholders, their involvement at all important stages and regular face-to-face meetings. Discussion and conclusion This experience shows the feasibility of an ambitious project of action-research in a border malaria context, involving several countries and with a mobile and undocumented population. It reveals some factors of success which may be transferable in analogous settings.

Resumo O objetivo deste artigo é analisar a influência dos determinantes socioambientais da saúde na incidência de malária por Plasmodium vivax na fronteira franco-brasileira. O estudo foi realizado entre 2011 e 2015, no município de Oiapoque (AP), na Amazônia brasileira. Foram incluídos na amostra 253 indivíduos de ambos os sexos, de 10 a 60 anos de idade. Houve predominância de 63,64% (161/253) de casos de malária em adultos do sexo masculino. A faixa etária mais acometida foi de 20 a 29 anos, com 30% (76/253); 84,6% (214/253) dos pacientes não concluíram o ensino médio, e 29,6% (75/253) não concluíram o ensino primário. No aspecto ambiental, houve correlação negativa entre as precipitações pluviométricas e a incidência da malária por P. vivax (p=0,0026). Em termos de mobilidade, constatou-se considerável proporção de migrantes provenientes dos estados do Pará e do Maranhão (55,73%; 141/253). Por fim, os dados apontaram que 31,23% (79/253) dos casos de malária foram importados da Guiana Francesa. Em síntese, a transmissão da malária na fronteira franco-brasileira envolve fatores ecológico-ambientais, biológicos e sociais que se expressam na elevada vulnerabilidade social da população que vive e circula na zona fronteiriça, favorecendo a ocorrência de surtos e a permanência da enfermidade. Abstract This study analyzes the influence of socio-environmental health determinants on the maintenance of Plasmodium vivax malaria at the borders between French Guiana and Brazil. This study was carried out between 2011 and 2015 in the city of Oiapoque, Amapá, situated in the Brazilian Amazon region. The sample included 253 individuals of both sexes aged between 10 and 60 years. The disease was predominant in 63.64% (161/253) adult males. The most affected age group was 20 to 29 years old, with 30% (76/253). About 84.6% did not complete high school, while 29.6% (75/253) of the cases had not finished the first degree. Concerning the environmental aspect, negative correlation was observed between rainfall and the incidence of P. vivax malaria (p=0.0026). In terms of mobility, there was a considerable influx of migrants from the states of Pará and Maranhão, with 55.73% (141/253). Lastly, the data indicated that 31.23% (79/253) of malaria cases were imported from French Guiana. In summary, the transmission of malaria in these particular borders involved ecological, environmental, biological and social factors, which are expressed in the high social vulnerability of the population living and circulating in the border zone, favoring the occurrence of outbreaks and the maintenance of the disease.

The present study evaluated the diversity of Anopheles Meigen, 1818 belonging to the subgenus Nyssorhynchus Blanchard, 1902 in four areas of Cachoeiras de Macacu municipality, Rio de Janeiro, Brazil. The immature collections were carried out during a rainy period and a post-rainy season. During the two periods, 3,932 specimens of Anopheles (Nyssorhynchus) were collected: 562 in the rainy period (14.29%) and 3,370 in the post-rainy period (85.70%). Among 3,932 specimens collected during both periods, 489 were identified, 50 (8.89%) in the rainy period and 439 (13.02%) in the post-rainy period. Nine Anopheles species were recorded: Anopheles albitarsis Lynch Arribalzaga, 1878 s.l. (76.86%), An. braziliensis (Chagas, 1907) (17%); An. evansae (Brethes, 1926) (8, 48%); An. triannulatus (Neiva & Pinto, 1922) s.l. (8.23%); An. oswaldoi (Peryassu, 1922) (6.43%); An. strodei Root, 1926 (5.40%); An. argyritarsis Robineau-Desvoidy, 1827 (1.54%); An. rangeli Gabaldon et al., 1940 (1.28%); and An. aquasalis Curry, 1932 (0.51%). Among them, An. albitarsis was dominant and abundant in 93.75% of the collection points. Our results show a diverse Anopheles fauna in the municipality of Cachoeiras de Macacu, with a strong association of occurrence between An. rangeli and An. oswaldoi; An. rangeli and An. evansae; An. evansae and An. oswaldoi; and An. albitarsis s.l. and An. braziliensis during the rainy period. However, there was a weak correlation in the post-rainy period, except between An. rangeli and An. oswaldoi and between An. triannulatus and An. aquasalis, which displayed a moderate linear correlation. Our results suggest that following a potential reintroduction of malaria Cachoeiras de Macacu, local transmission of Plasmodium Marchiafava & Celli, 1885 may be enhanced by the presence of nine Nyssorhynchus species (all potential malaria vectors).

Introduction L’emergence de pathogenes a augmente depuis 1940, en particulier d’origine zoonotiques (60 %), issus majoritairement de la faune sauvage (72 %). L’anthropisation et le bouleversement des ecosystemes favorisent le franchissement des barrieres inter-espece, particulierement en zone de grande biodiversite comme en Amazonie. Les personnes pratiquant une activite d’orpaillage, a fortiori non regulee, seraient-elles particulierement touchees par les zoonoses ? Materiels et methodes Capitalisant sur une etude visant a evaluer l’epidemiologie du paludisme sur les sites d’orpaillage clandestins en Amazonie, un examen clinique complet et un prelevement biologique pour mise en collection ont ete effectues en 2019 aupres des personnes majeures et consentantes travaillant sur ces mines. L’examen recensait les signes dermatologiques de leishmaniose avec un ecouvillonnage pour PCR Leishmania en cas de lesion ulceree active, ceux evocateurs de lepre et les antecedents vaccinaux contre la fievre jaune. Au niveau biologique ont ete realises la recherche d’anticorps neutralisant la fievre jaune, d’IgG de phase I et II contre la fievre Q, et des tests MAT (Microscopic Agglutination Test) contre la leptospirose. Resultats Entre octobre et decembre 2019, 380 personnes ont ete inclues dans l’etude. La seroprevalence de la leptospirose etait de 25,5 % (IC95 % = 21,2-30,1). De nombreux mammiferes sauvages sud-americains sont connus pour etre porteurs de leptospires. Cette forte seroprevalence va dans le sens d’un cycle sauvage de leptospirose en Amazonie. La prevalence de la fievre Q etait de 2.9 % (IC95 % = 1,2-4,6). Ceci est plus faible que la prevalence sur le littoral, ce qui affaiblit l’hypothese d’un reservoir de Coxiella burnettii en foret profonde ou tellurique, reservoir toujours inconnu a ce jour dans la region. La majorite des participants declaraient etre vaccines contre la fievre jaune (91.8 %) et 97.9 % avaient des Ac seroneutralisants. Le risque d’epidemie de fievre jaune, comme dans le cas au Bresil en 2016-2019, semble donc peu probable. Dix pourcent (0,7-1,3) des participants avaient des lesions de leishmaniose cutanee, dont trois avaient une lesion active en cette saison seche. Une seule PCR a donne un diagnostic d’espece : L. guyanensis. Concernant la lepre, cinq personnes avaient des lesions typiques, dont trois etaient connues et en cours de traitement, soit une prevalence minimale estimee a 78,9/10 000 pa. Tous venaient de l’Etat bresilien du Maranhao, ou la prevalence en population generale en 2019 etait 17 fois moindre a 4,5/10 000 pa. Cela pose de nombreuses questions, dont celle du role du reservoir animal potentiel qu’est le tatou, sur lequel des travaux sont en cours en Guyane. Conclusion Ces donnees uniques eclairent d’un jour nouveau des cycles de transmission de zoonoses encore mal connus dans la region. A l’heure des problematiques de One Health, une surveillance particuliere doit etre accordee a ces populations vulnerables en contact direct avec l’ecosysteme tropical.

BackgroundIllegal gold miners are currently key hosts for malaria in French Guiana (FG), with a risk of emergence of resistance linked to improper use of artemisinin-based combination therapy (ACT). The remoteness of the mines and regulatory issues hinder their access to health care.MethodsA quasi-experimental researched project (Malakit) implemented in FG borders with Brazil and Suriname aimed at determining the effectiveness of distributed kits for self-diagnosis and self-treatment to illegal gold miners, after training, at strategic border staging areas. Evaluation relied on questionnaires at inclusion and follow-up visits, and pre/post intervention surveys. The primary outcome was the proportion of persons reporting a use of certified ACT after a positive malaria diagnosis. The secondary outcomes assessed antimalarial adherence, kit use and impact on malaria epidemiology.FindingsThe proportion of patients reporting a use of certified ACT after a positive diagnosis increased after the intervention (OR 1.8, 95%CI [1.1-3.0]). From April 2018 to March 2020, 3,733 persons participated in the intervention. The kit was used correctly by 71.7% [65.8-77.7] of the 223 persons reporting having used a malakit during the follow-up visits. No serious adverse events related to the misuse of malakit have been reported. The intervention appears to have accelerated the decline in malaria incidence in the region by 42.9%.InterpretationThis innovative international project showed that people with low education can correctly self-manage their malaria symptoms. This strategy could be integrated in the malaria control programs of the countries involved and considered in other regions with residual malaria in remote areas., ContexteLes chercheurs d'or illégaux sont actuellement un réservoir clé du paludisme en Guyane, avec un risque d'émergence de résistance lié à une mauvaise utilisation des combinaisons thérapeutiques à base d'artémisinine (ACT). L'isolement de ces sites miniers clandestins et des contraintes règlementaires entravent leur accès aux soins.MéthodesUn projet de recherche opérationnelle quasi-expérimental (Malakit) a été mis en œuvre aux frontières de la Guyane avec le Brésil et le Suriname. Il visait à déterminer l'efficacité de la distribution de kits d'autodiagnostic et d'autotraitement à des orpailleurs illégaux, après une formation adaptée, dans des zones stratégiques transfrontalières. L'évaluation s'est appuyée sur des questionnaires lors des visites d'inclusion et de suivi, et sur des enquêtes pré/post intervention. L'indicateur principal était la proportion de personnes déclarant avoir utilisé une ACT certifiée après un diagnostic positif de paludisme. Les indicateurs secondaires reposaient sur l'adhérence aux traitements antipaludiques, l'utilisation des kits et l'impact sur l'épidémiologie du paludisme.RésultatsLa proportion de patients déclarant une utilisation d'ACT certifiée après un diagnostic positif a augmenté après l'intervention (OR 1,8, 95%CI [1,1-3,0]). D'avril 2018 à mars 2020, 3 733 personnes ont participé à l'intervention. Le kit a été utilisé correctement par 71,7% [65,8-77,7] des 223 personnes revues en visites de suivi ayant déclaré avoir utilisé un malakit. Aucun événement indésirable grave lié à une mauvaise utilisation du malakit n'a été signalé. L'intervention semble avoir accéléré la diminution de l'incidence du paludisme dans la région de 42,9%.InterprétationCe projet international innovant a montré que les personnes ayant un faible niveau d'éducation peuvent se prendre en charge par eux-mêmes pour des symptômes de paludisme. Cette stratégie pourrait être intégrée dans les programmes de lutte contre le paludisme des pays impliqués et envisagée dans d'autres régions où du paludisme résiduel persiste dans des zones isolées.

Imported malaria is a malaria infection diagnosed outside the area where it was acquired and is induced by human migration and mobility. This retrospective study was performed based on secondary data from 2007 to 2015. In total, 736 cases of imported malaria (79.7% of 923 cases) were recorded in Rio de Janeiro state. Of the imported cases, 55.3% came from abroad, while 44.7% came from other regions of Brazil. Most cases of imported malaria in Brazil (85.5%) originated in Amazonia Legal, and Burundi (Africa) accounted for 59% of the cases from abroad. Analyses of the determinants of imported malaria in Rio de Janeiro state must be continued to understand the relationship between the origin and destination of cases.

INTRODUCTION: Elimination of malaria in areas of interrupted transmission warrants careful case assessment to avoid the reintroduction of this disease. Occasional malaria cases are reported among visitors of the Atlantic Forest area of Brazil, while data on residents of this area are scarce. METHODS: A sectional study was carried out to examine 324 individuals living in a municipality where autochthonous cases were detected. RESULTS: Asymptomatic Plasmodium infections were detected in 2.8% of the individuals by polymerase chain reaction (PCR), with one case of P. falciparum (0.3%), two cases of P. vivax (0.6%), and six cases of P. malariae (1.9%). The thick blood smears were negative in all individuals. Serological tests performed in 314 subjects were reactive in 11.1%, with 3.5% for P. falciparum and 7.7% for P. vivax. A subsample of 42 reactive individuals for any Plasmodium species showed P. malariae in 30.9% of specimens. Individuals who entered the Atlantic Forest region were 2.7 times more likely to exhibit reactive serology for P. vivax compared with individuals who did not enter this region (p

Introduction A contexte extraordinaire, reponse innovante. Une recherche operationnelle a grande echelle a ete mise en oeuvre dans un contexte transfrontalier en Amazonie, visant a tester une nouvelle strategie de controle du paludisme dans les zones d’orpaillage illegal. Les orpailleurs constituent un reservoir cle de paludisme dans la region, avec un risque d’emergence de resistances lie au mesusage de combinaisons therapeutiques a base d’artemisinine (ACT) provenant du marche informel. Materiels et methodes Notre etude de recherche operationnelle a evalue l’efficacite de la distribution de kits d’autodiagnostic et d’autotraitement pour augmenter la bonne utilisation des ACT: traitement initie apres un test de diagnostic rapide (TDR) positif, et conduit avec une bonne observance. Les orpailleurs consentant recevaient un kit apres une formation dispensee par des mediateurs sur les zones strategiques de passage transfrontalier. L’evaluation s’est basee sur des questionnaires aux participants lors des visites d’inclusion et de suivi, et sur des etudes transversales pre/post intervention. L’indicateur principal etait la modification des comportements rapportes lors des etudes transversales. Etaient egalement evalues la bonne utilisation des kits et l’impact de la strategie par une analyse de series chronologiques interrompues (ITS) basee sur les donnees de surveillance du paludisme des pays frontaliers. Resultats D’avril 2018 a mars 2020, 3 733 personnes ont participe a l’intervention et 1 098 aux etudes d’evaluation. L’utilisation appropriee d’un traitement precedee d’un diagnostic (en utilisant un kit ou en se tournant vers le systeme de sante) a augmente de 54,2 % a 68,2 % (OR = 1,8, IC95 % [1,1-3,0]) apres l’intervention. L’observance au traitement etait plus elevee lorsque le patient recevait des soins dans un centre de sante (91 % [89-94]) ou utilisait un kit (81 % [67-96]) qu’en cas d’automedication non reglementee (65 % [60-70]) (OR = 5,4 [3,7-7,8]). Parmi les 303 participants declarant avoir utilise un kit lors des visites de suivi, 71,7% [65,8-77,7] l’avaient utilise correctement. La prevalence du Plasmodium par PCR dans cette population a diminue entre 2015 et 2020. L’analyse ITS des donnees de surveillance estime a 46 % (IC95 % [7-62]) la majoration de la reduction de l’incidence du paludisme depuis la mise en oeuvre de la strategie. Peu d’evenements indesirables ont ete signales. La circulation des kits hors protocole est apparue limitee. Conclusion Ce projet international innovant montre que des personnes avec un faible niveau d’instruction peuvent etre formees a la prise en charge autonome du paludisme et changer leur comportement. Cette strategie pourrait constituer un nouvel outil de lutte contre le paludisme dans d’autres regions confrontees a une situation similaire.

Background Extra-Amazonian malaria mortality is 60 times higher than the Amazon malaria mortality. Imported cases correspond to approximately 90% of extra-Amazonian cases. Imported malaria could be a major problem if it occurs in areas with receptivity, because it can favor the occurrence of outbreaks or reintroductions of malaria in those areas. This study aimed to model territorial receptivity for malaria to serve as an entomological surveillance tool in the State of Rio de Janeiro, Brazil. Geomorphology, rainfall, temperature, and vegetation layers were used in the AHP process for the receptivity stratification of Rio de Janeiro State territory. Results The model predicted five receptivity classes: very low, low, medium, high and very high. The ‘very high’ class is the most important in the receptivity model, corresponding to areas with optimal environmental and climatological conditions to provide suitable larval habitats for Anopheles (Nyssorhynchus) vectors. This receptivity class covered 497.14 km2 or 1.18% of the state’s area. The ‘high’ class covered the largest area, 17,557.98 km2, or 41.62% of the area of Rio de Janeiro State. Conclusions We used freely available databases for modeling the distribution of receptive areas for malaria transmission in the State of Rio de Janeiro. This was a new and low-cost approach to support entomological surveillance efforts. Health workers in ‘very high’ and ‘high’ receptivity areas should be prepared to diagnose all febrile individuals and determine the cause of the fever, including malaria. Each malaria case must be treated and epidemiological studies must be conducted to prevent the reintroduction of the disease.

Background: In Brazil, 99.7 % of malaria cases occur in the Amazon region. Although the number of cases is decreasing, the country accounted for almost 60 % of cases in the Americas Region, in 2013. Novel approaches for malaria treatment open the possibility of eliminating the disease, but suboptimal dispensing and lack of adherence influence treatment outcomes. The aim of this paper is to show the results on dispensing practices, non-adherence and determinants of non-adherence to treatment of non-complicated malaria. Methods: The study was conducted in six high-risk municipalities with Plasmodium vivax and Plasmodium falciparum transmission in the Brazilian Amazon and based on the theoretical framework of the Mafalda Project, which included investigation of dispensing and adherence. The World Health Organization Rapid Evaluation Method has been used to estimate sample size. Individuals over 15 years of age with malaria were approached at health facilities and invited to participate through informed consent. Data was collected in chart review forms focusing on diagnosis, Plasmodium type, prescribing, and dispensing (kind, quantity, labelling and procedures). Follow-up household interviews complemented data collection at health facility. Non-adherence was measured during the implementation phase, by self-reports and pill-counts. Analysis was descriptive and statistical tests were carried out. Determinants of non-adherence and quality of dispensing were assessed according to the literature. Results: The study involved 165 patients. Dispensing was done according to the national guidelines. Labelling was adequate for P. vivax but inadequate for P. falciparum medicines. Non-adherent patients were 12.1 % according to self-reports and 21.8 % according to pill-counts. Results point to greater non-adherence among all P. falciparum patients and among malaria non-naive patients. More patients informed understanding adverse effects than `how to use' anti-malarials. Conclusions: Non-adherent patients were mostly those with a P. falciparum diagnosis and those in their second or more malaria episode. New taxonomies and concepts on adherence stress the importance of focusing on the individual patient. Interventions targeted to and tailored for malaria patients must be addressed by health policy and implemented by managers and clinicians.

Malaria constitutes one of the main causes of death in the Brazilian Amazon rainforest. There, it presents different behaviors among cities with predominately imported cases. This study describes t...