By: Carla Salazar
Many Latin American countries have shown a reduction in malaria cases and deaths due to anti-malaria strategies. Venezuela is one of the few countries left in the region struggling with this deadly mosquito-borne infection that has re-emerged in the last 20 years. The latest epidemiological data shows a 71% increase in incidence rates in 2017, and mortality rates have been increasing since 2013-2014. Due to the current economic and political situation of the country, which has deteriorated since Nicolas Maduro was first elected in 2013, this disease has dramatically resurged in the population because of the health care collapse, as well as, a halt in public health efforts. There are still many remaining political and economic challenges in Venezuela. But one that needs to be addressed promptly with international aid is the current humanitarian crisis involving food and medicine shortages, power outages, lack of employment, hyperinflation, high levels of violent crime, among others. Furthermore, the country should re-start epidemiological surveillance to contain the spread of infections and to provide updated data for health professionals and researchers.
Keywords: malaria, Venezuela, resurgence, prevalence, crisis
Malaria Resurgence in Venezuela
In 2010, malaria had several more reported cases (214 million) than other deadly infections such as Tuberculosis and HIV/AIDS, which shows the global burden of the disease (Chang & Wei, 2019). Even though Venezuela was one of the first Latin American countries to eradicate malaria in the 1960s, the severe socioeconomic crisis has collapsed the healthcare’s infrastructure and public health’s programs. The country’s economy started degrading under president Hugo Chavez, who was elected in 1999, due to corruption, mismanagement, and high levels of debts. The current president, Nicolas Maduro, was elected in April 2013 after the death of the socialist Hugo Chavez. Since that, the economy in the country continued spiraling downward, fueled by extreme hyperinflation, power cuts, and shortages in food and medicines (BBC, 2020).
There is no independent institution in the country to check on executive power which has led to a series of measures without pretense of independence by the current government. The government has been repressing disagreements with violent crackdowns on street protests, jailing opponents, and prosecuting civilians in military courts (Human Rights Watch, 2018). In fact, the United Nations has accused the government of using fear tactics on its population to remain in power, and urged country’s leaders to end the violation of human rights (BBC, 2019). Lack of investment in infrastructure and sanctions on Venezuela’s oil sector, which provides the most government’s revenue, have worsened the economy (BBC, 2020). Malaria incidence rates in Venezuela have been increasing since the early 2000s, rising 359% by 2015 (Grillet et al., 2019). In 2012, Venezuela had the highest incidence rate in its history with 51,264 cases (Retch et al., 2017).
In 2016, 240,613 total cases of malaria were reported in Venezuela, approximately a 75% increase compared to the previous year, accounting for 34.4% of the cases in the Americas region (Grillet et al., 2019; Retch et al., 2017). A year later, that number increased to 411,586 reported cases, a 71% increase, demonstrating the rapid resurgence of infectious diseases in the country (Grillet et al., 2019). Furthermore, the most prevalent species of malaria are Plasmodium vivax and Plasmodium falciparum, the former being more common in states such as Bolivar and Sucre (Pacheco, Moreno, & Herrera, 2018). During 2016, P. vivax accounted for 179,554 reported cases (71% of total), and P. falciparum accounted for 46,503 reported cases, (20% of total) (Grillet et al., 2019; World Health Organization [WHO], 2018). The most recent data shows that the number of cases is still increasing: by 2017, 316, 041 cases of P. vivax were reported (a 76% increase) and P. falciparum increased to 69,076 cases (Grillet et al., 2019; WHO, 2018). Simultaneously, cases of mixed infections have shown a two-fold increase over the last four years (WHO, 2018). This concerning data does not only describe an immense public health challenge, but also demonstrates the detrimental effect of the current economic, political, and humanitarian crisis on the rising of infectious diseases.
Mortality and Death Rates
By 2017, all regions worldwide showed a decrease in malaria mortality rates, except for the Americas due to the rapid increase of cases in Venezuela; between 2010-2017, this rate increased almost 50% (WHO, 2018). Venezuela experienced one of the worst death rates of malaria between 1990-2000, and it has been estimated that mortality rates will likely increase in the following years (Hotez, Basáñez, Acosta-Serrano, & Grillet, 2017). To be more specific, the case fatality rates in Venezuela due to malaria have increased almost nine fold between 2013 and 2017, with 406 deaths reported in 2017 (Page et al., 2019).
Population at risk
People living in rural tropical areas are vulnerable to contract this disease because they are heavily exposed to mosquito bites and lack access to health care services (CDC, 2019). In Venezuela, 47% of malaria infections are among miners. One of the highest risk areas is the state of Bolivar, Sifontes Municipality because of the illegal gold mining industry, which led to a significant population working outdoors for long hours without proper protection. In addition, the impoverished area has a shortage of adequate housing. (Grillet et al., 2019; Retch et al., 2017). Malaria cases in this state have increased 10 times between 2014 and 2017, and 3 times between 2016 and 2017 (Pacheco, Moreno, & Herrera, 2019). Additionally, in the state of Anzoátegui, the number of malaria cases increased by 1341% in 2016-2017 (Page et al., 2019; Retch et al., 2017). Neighboring countries such as Brazil and Colombia are also affected by Venezuela’s situation, where 78% and 81% cases are estimated to come from Venezuelan refugees and migrants, respectively (Retch et al., 2017).
The alarming malaria incidence rates and mortality rates in Venezuela have rapidly developed a public health emergency in the country that not only affects its habitants, but also neighboring countries in the region. The high number of local and external migration due to the economic crisis worsened the spread and transmission of the infection. The biggest remaining challenge is addressing the current humanitarian crisis, which requires a lot of political will, economic restructuring, and intervention from international organizations. Moving forward, epidemiological surveillance needs to improve: in the last 5-6 years, publication of disease surveillance reports have stopped, making it more difficult for health professionals and researchers to assess the current malaria’s situation (Grillet et al., 2019). In addition, replenishment of health care services to provide anti-malaria protection, treatment, strategies, and education is needed to combat the resurgence of malaria in Venezuela.
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