Long-term Transmission Patterns and Public Health Policies Leading to Malaria Elimination in Panamá
Abstract Background: The present study provides a countrywide perspective of the malaria situation in Panama over a long-term framework, with the purpose of identifying historical malaria resurgence events and their potential causes.Methods: A descriptive-ecological study was conducted by analyzing demographic and epidemiological annual malaria time series data in Panamá (1884 – 2019) using several data sources. Malaria intensity indicators were calculated during the study period. We also analyze the effects of El Niño Southern Oscillation on malaria transmission using a retrospective analysis of malaria cases between 1957 and 2019.Results: Several factors were identified responsible for malaria resurgence in Panama, mostly related with Malaria Control Programme weakening. During the past 20 years (2000 – 2019) malaria has progressively increased its prevalence within indigenous settlements, with a predominance of male cases and a high proportion (15% of total cases) in children less than 5 years old. During this period a significant and increasing proportion of the P. falciparum total cases were imported. Our retrospective analysis (1957 - 2019) evidenced that ENSO has a significant impact on malaria transmission dynamics in Panama.Conclusions: Data analysis confirmed that although authorities have been successful in focalizing malaria transmission in the country, there are still neglected issues to be solved and important intercultural barriers that need to be addressed in order to achieve elimination of the disease by 2022. This information will be useful for targeting strategies by the National Malaria Control Programme.