The changing distribution of malaria in the Brazilian Amazon, 2003-2004 and 2008-2009

Basic sanitation, socioeconomic conditions, and degree of risk for the presence and maintenance of malaria in a low-transmission area in the Brazilian Amazon

“…The predominance of cases of adults and males performing activities considered high risk for contracting the disease corroborates other studies in the Amazon region (16) (20) (22) . However, the urbanization of malaria occurs due to an increase in migratory fl ow, because individuals infected while working bring the pathogen to urban areas, where the high population density and the rural habits of populations with lower QLI, living in environmentally fragile environments, favor the spread of malaria (24) .…”

“…In 2013, 25,401 cases of malaria were recorded across the state, characterizing the disease as endemic to the area (6) . However, different APIs have been observed in analyses by municipality and/or mesoregions, which in fact show that the distribution of malaria in the state is heterogeneous (6) (7) (22) . The municipality of Ananindeua exemplifi es this irregularity because, in spite of being in an endemic malaria state, it is itself not an endemic area and, according to the API, was risk-free for the 10-year study period, except 2003, when it was classifi ed as having a low risk of infection.…”

“…Malaria behaves like an occupational disease because it reaches people who are part of uncontrolled migration and who occupy rural areas, especially those involved in activities related to the mining of gold and other minerals, agricultural settlements, timber exploitation, and agricultural activities (15) (22) . The predominance of cases of adults and males performing activities considered high risk for contracting the disease corroborates other studies in the Amazon region (16) (20) (22) .…”

Time trends and changes in the distribution of malaria cases in the Brazilian Amazon Region, 2004-2013

“…Fish farming was heavily subsidised by the government of the state of Acre in 2005, a possible reason for the explosion in malaria cases in this state, particularly in 2006 (Costa et al 2010, Oliveira-Ferreira et al 2010, Duarte et al 2014) and in 2012, when Acre was one of the three states with the highest rates of deforestation and malaria (Guimarães et al 2016). The complex scenario of malaria surveillance on the border between Brazil, Bolivia and Peru deserve special attention.…”

Using the Lorenz Curve to Characterize Risk Predictiveness and Etiologic Heterogeneity

“…Very few investigators have made use of the Lorenz curve to illustrate public health concepts, though there have been some notable exceptions. For example, Green et al 13 used it to describe regional variations in the incidence of multiple sclerosis, Hickson et al 14 used the tool to characterize the representativeness of African American participants in a study of heart disease, Perini et al 15 used it to characterize the methylphenidale consumption in Brazil, Duarte et al 16 studied the distribution of malaria cases in the Brazilian Amazon, Hashemi et al 17 used it to characterize regional access to cataract surgery, and Gail 18 and Petracci et al 19 have used it in evaluating breast cancer risk.…”