Loiola Carlos Catão Prates, da Silva C J Mangabeira, Tauil Pedro Luiz
Universidade de Brasília, Faculdade de Medicina.
Rev Panam Salud Publica. 2002 Apr;11(4):235-44. doi: 10.1590/s1020-49892002000400005.
This paper reviews malaria control initiatives in Brazil, from the Malaria Eradication Campaign (Campanha de Erradicação da Malária), which was launched in 1965 and was based on spraying dichlorodiphenyltrichloroethane (DDT) and on administering antimalarial drugs, to the implementation, in 2000, of the Program for Intensification of Malaria Control in the nine-state Legal Amazon region of Brazil (Plano de Intensificação das Ações de Controle da Malária na Amazônia Legal), which was implemented in response to the World Health Organization's Roll Back Malaria effort. Among the Brazilian initiatives discussed are epidemiological stratification, the Impact Operation (Operação Impacto), the Amazon Basin Malaria Control Project (Projeto de Controle da Malária na Bacia Amazônica), and the Integrated Malaria Control Program (Programa de Controle Integrado da Malária). Although there was progress in the control of malaria before the Intensification Program was launched in 2000, the actions carried out were not sustained. From 1998 to 1999 there was even a 34% increase in the number of malaria cases in the Brazilian Amazon. The Intensification Program set a goal, in comparison to 1999, of reducing by 50% the number of malaria cases by the end of 2001 and of cutting by 50% the mortality due to malaria by the end of 2002. Data for 2001 showed an overall 39% decrease in the number of malaria cases in the nine Amazonian states of the Intensification Program. The smallest decrease (15%) was in the state of Amapá, where the plan was not implemented until the second half of 2001. In terms of incidence by species, there was a 35% reduction in cases caused by Plasmodium falciparum and a 41% reduction in cases caused by P. vivax. The only independent variable that explains this reduction is the implementation of the Intensification Program. Although preliminary, these results indicate considerable gains. Decisive to this progress has been the strong mobilization of federal, state, and municipal governments.
本文回顾了巴西的疟疾控制举措，从1965年发起的以喷洒二氯二苯三氯乙烷（滴滴涕）和使用抗疟药物为基础的疟疾根除运动（Campanha de Erradicação da Malária），到2000年在巴西九个州的合法亚马逊地区实施的加强疟疾控制计划（Plano de Intensificação das Ações de Controle da Malária na Amazônia Legal），该计划是为响应世界卫生组织的遏制疟疾行动而实施的。文中讨论的巴西举措包括流行病学分层、影响行动（Operação Impacto）、亚马逊盆地疟疾控制项目（Projeto de Controle da Malária na Bacia Amazônica）以及综合疟疾控制计划（Programa de Controle Integrado da Malária）。尽管在2000年加强计划启动之前疟疾控制取得了进展，但所采取的行动并未持续。从1998年到1999年，巴西亚马逊地区的疟疾病例数量甚至增加了34%。加强计划设定了一个目标，与1999年相比，到2001年底将疟疾病例数量减少50%，到2002年底将疟疾死亡率降低50%。2001年的数据显示，加强计划所涉及的亚马逊九个州的疟疾病例总数总体下降了39%。降幅最小的是阿马帕州（仅15%），该州的计划直到2001年下半年才实施。就按疟原虫种类划分的发病率而言，由恶性疟原虫引起的病例减少了35%，由间日疟原虫引起的病例减少了41%。唯一能够解释这种下降的独立变量就是加强计划的实施。尽管这些结果只是初步的，但表明取得了显著成效。这一进展的决定性因素是联邦、州和市政府的有力动员。
