Malaria in the colombian regions of Uraba and Bajo Cauca, province of Antioquia: an overwiew to interpret the antimalarial therapeutic failure

Abstract

Problem: in the past 5 years we have studied the treatment response to antimalarials and their combinations in the Antioquia region (Turbo, Zaragoza and El Bagre municipalities). The interpretation and better understanding of the treatment outcome (adequate clinical response, early treatment failure or late treatment failure) require further information since this response depends on host’s and parasite’s factors, independently of the characteristics of the antimalarial administered.

Objectives: to define an adequate reference frame which allows for interpretation of results obtained during antimalarials treatment assessment studies. This would include demography, epidemiology, climatic and social-economic information about Colombia, Antioquia, the regions of Uraba, Bajo Cauca and the municipalities of Turbo and El Bagre.

Methodology: research of secondary information (publications reports and internet resources), and some primary information (taken from Sistema de Vigilancia Epidemiológica de Antioquia (Sivigila) of Dirección Seccional de Salud de Antioquia DSSA). Data about treatment response were primary information (produced by Grupo Malaria, Universidad de Antioquia), or obtained from other authors. With the gathered data, tables and graphs were produced and calculations were carried out using other variables.

Results: the frequency of malaria is presented for Colombia during the period 1960-2002 and the results of the malaria eradication and control programs, and their failure, are described. Similarly, the frequency of malaria in Antioquia during 1959-2003 is discussed and presented in terms of incidence rates and parasite annual indexes (PAI). Non adjusted and adjusted rates and PAI were obtained, therefore adjusted rates are presented by exposed population, which is less of 20%. Adjusted results are 5-6 fold higher that non-adjusted values in Antioquia. However this is not true for the Uraba and Bajo Cauca regions, where 100% of the population is exposed to malaria. Malaria incidence in Antioquia is increasing. The mean PAI for the period 1996-2002 was 54,08‰ in Turbo and 111,20‰ in El Bagre. Malaria is described considering patient’s gender and age, in Antioquia as well as in Turbo and El Bagre. A review of the findings about treatment failure in Plasmodium falciparum malaria is presented and some recommendations about the use of antimalarials are outlined.