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Background: Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described. Methods: Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018). Results: An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%. Conclusions: The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk. [ABSTRACT FROM AUTHOR]

Lobster fishery (Panulirus argus) forms an important part of the fishing activities along the Caribbean coast of Central America. The present study provides information regarding the seasonal abundance and distribution of postlarval P. argus in Parque Nacional Cahuita, Costa Rica. During the study period (March 2004-February 2005), a total of 1907 pueruli were obtained from GuSi collectors. Postlarvae were present during all months, with a pronounced peak in January-February 2005 (CPUE of 21.82 and 22.18, pueruli/collector/month, respectively), and minor peaks in May and October 2004. The abundance of postlarval P. argus in the study area was comparable to locations which support important lobster fisheries, e.g. Mexico. A majority of the postlarvae (1027 ind.) was collected during the first quarter moon, the remaining pueruli (880 ind.) during new moon; these results are in general agreement with similar findings for P. argus in the Caribbean area. Based upon our results, we recommend introducing a local or regional monitoring program, studying spiny lobster migration and distribution patterns, and evaluate the introduction of artificial shelters for P. argus. [ABSTRACT FROM AUTHOR]