In Latin America, approximately 40 percent of the population lives in at-risk areas for malaria transmission. Plasmodium vivax (P. vivax), the least deadly strain, is the one most commonly found in Latin America, although there are high incidence rates and prevalence of the more deadly Plasmodium falciparum (P. falciparum) in rainforest regions. Malaria transmission is a public health problem in the eight South American countries that share the Amazon rainforest: Bolivia, Brazil, Colombia, Ecuador, Guyana, Peru, Suriname and Venezuela (along with French Guiana, which is a department of France). Malaria is also present in Central America, including Mexico and the island of Hispaniola, where Haiti and the Dominican Republic are located. In the Dominican Republic, a serious epidemic was contained with the help of the Global Fund, which also supports the Haitian government in implementing strategies to fight malaria.
One of the countries with a high incidence of P. falciparum is Colombia. Treatment and prevention in malaria-endemic zones have been hampered by violence in the region. In 1996, a malaria epidemic was declared in Ecuador with 11,000 cases; five years later, the number of cases had increased by a factor of nine to a record 106,000. Malaria cases have since diminished through concerted government efforts. In Peru, malaria threatens about 2.5 million people that live in at-risk areas, while in Brazil and Suriname high population movement across borders resulted in an epidemic in 2003.
Several countries employ insecticide-treated bed nets as part of their national malaria control strategy. The Global Fund is supporting efforts to widen net distribution to encompass poor and vulnerable popula- tions living in remote areas. These efforts have met with some success, especially in countries such as Suri- name, where native populations have contributed to the design and treatment of the bed nets.
Vector control by indoor residual spraying and larviciding in focal areas form part of the national malaria control strategy in most countries. Additional strategies include the integration of the national program with local health services to promote community participation in malaria control.
Drug resistance of P. falciparum to chloroquine has been documented in 80 percent of cases, while resistance to several other drugs has also been documented or suspected in 20 percent of cases. In South America, Bolivia, Colombia, Ecuador, Guyana, Peru, Suriname and Venezuela are changing national drug policies and now use artemisinin-based combination therapy (ACT) for the treatment of falciparum malaria.