Malaria: Mining areas pose a challenge to controlling the disease

In the most severe cases of malaria, children may suffer neurological sequelae, such as blindness or speech disorder, which will affect their developmental capacity and education

A public hearing held in mid-March by the Senate’s External Commission, created to monitor actions in the Yanomami Indigenous Land, the largest indigenous territory in the country, portrayed the deep scars that illegal mining has left on the soul and skin of the Yanomami. Indigenous representatives heard that urgent health work needs to be done in these communities to combat malaria, which is out of control in the region. According to the report, the miners’ planes continue to fly over the Indigenous Land. The Minister of Indigenous Peoples, Sônia Guajajara, said in early March that she is concerned about the spread of diseases in Boa Vista (RO) with the departure of illegal miners from the Yanomami Indigenous Land.

In January, the Ministry of Health declared a public health emergency in the Territory due to the serious health crisis, with water contamination by mercury, dozens of cases of malaria, and severe malnutrition, resulting from illegal mining invasions. Mining areas represent a major challenge for malaria control due to intense migratory flow and a favorable environment for disease transmission. To learn more about the subject, the communication team of the Brazilian Society of Tropical Medicine (SBMT) interviewed Dr. André Siqueira, a tropical medicine specialist, malaria expert, SBMT board member, and researcher at the National Institute of Infectious Diseases of the Oswaldo Cruz Foundation (INI/Fiocruz), who, after monitoring the situation of the Yanomami in Roraima, earlier this year, revealed that it was the worst health and humanitarian situation he had ever witnessed.

Read the full interview.

SBMT: In Brazil, despite the constant activities carried out by the endemic control services of government agencies, malaria has increased in recent decades. What is the reason for this and what can be done?

Dr. André Siqueira: Malaria control is very sensitive to the routine maintenance of actions that include timely diagnosis and treatment (ideally within 48 hours of symptom onset), vector control with the use of long-lasting insecticidal nets and indoor residual spraying, and active surveillance. What we see in Brazil is a fluctuation of periods with better and worse control, and this is due to two main reasons. First, the scarcity of resources for health actions in general, which makes the manager have to prioritize actions and when malaria incidence decreases, its position as a priority also decreases. Second, there is a lack of policies to maintain and adapt actions that follow changes in scenarios at different levels of the health system, since strategies that are appropriate for high transmission scenarios are not necessarily the best for when malaria incidence is low. Because there is no adaptation and targeting of strategies for low transmission scenarios and the various contexts in which malaria occurs in the country (urban, rural, riverine, indigenous, etc.), both surveillance and assistance actions suffer from a lack of sustainability and are neglected, missing opportunities to achieve and sustain the elimination of malaria at local and regional levels.

SBMT: Malaria in the Amazon region is concentrated in specific areas with specific characteristics. What is the current situation of the disease in this region?

Dr. André Siqueira: Malaria transmission in Brazil occurs almost exclusively in the Amazon region, but it does not have a unique characteristic. There is a great heterogeneity in the intensity of transmission, environmental and demographic characteristics, and the preparation of local and state health systems. It is not possible to compare malaria transmission situations in Porto Velho, Rondônia, for example, with those in Rorainópolis in Roraima. They are different situations that require adapted strategies to face them. In general, maintaining timely diagnosis and treatment, intensifying appropriate epidemiological analysis and vector control actions are the ways to achieve better malaria control.

SBMT: The movement of gold miners through the forest makes malaria circulate more easily, causing the disease to affect vulnerable populations such as indigenous people. How is the transmission of the disease controlled in mining areas and among these populations?

Dr. André Siqueira: Firstly, since mining is illegal, the enforcement of regulations should be intensified, which has not been happening. From a health standpoint, the Unified Health System (SUS) advocates for universal and comprehensive care, and there should be no restriction on access to care due to engagement in illegal activities. Countries such as Suriname trained individuals associated with mining to carry out malaria diagnosis and treatment, as well as to report cases and distribute mosquito nets, with significant impact, and today the country is on track to achieve the transmission elimination goal ahead of schedule. In Brazil, strategies to encourage testing at entry points to mining areas, as well as health education efforts, could also be implemented to reduce transmission.

SBMT: In severe cases, children can suffer long-term neurological sequelae, such as blindness or speech disorders, affecting their ability to develop and benefit from education. What will be the life of these children like? Will they need rehabilitation? Will they have access?

Dr. André Siqueira: In most cases where malaria is treated promptly (within 48 hours), it progresses without sequelae or problems. However, severe malaria, which can result from any species, can lead to complications and sequelae for adults and children, whose impact will be very specific depending on the individual and the complication. Health services should welcome such complications, as well as all others, promoting rehabilitation when necessary.

SBMT: What is the importance of private sector participation in malaria control, particularly those that develop activities in the Brazilian Amazon region?

Dr. André Siqueira: The private sector has the obligation to participate in malaria control in areas where they develop economic activities that lead to environmental and demographic changes that alter the risk of malaria transmission in order to mitigate the impact on the health of affected populations. In several countries, there are projects and support from the private sector with resources and technical support to leverage the goal of achieving the elimination of malaria transmission, and there could be similar initiatives in Brazil as well.

SBMT: Would you like to add anything?

Dr. André Siqueira: The proposal to eliminate malaria is achievable in Brazil, but it lacks robustness in both the proposal and funding to be achieved. The SUS can be more active in this process, and initiatives to promote the integration of surveillance actions with primary health care, monitoring the effectiveness of antimalarials and insecticides, are very important for advancing malaria control and elimination.

World Malaria Day

On this April 25th, World Malaria Day, SBMT wishes to remind us that more needs to be done to improve the response to malaria at the local, municipal, national, and international levels. May countries intensify efforts to combat the disease, as well as efforts for prevention, diagnosis, and treatment based on data and adapted to local contexts.