When climate change couples social neglect: malaria dynamics in Panamá

Abstract

A major challenge of infectious disease elimination is the need to interrupt pathogen transmission across all vulnerable populations. Ethnic minorities are among the key vulnerable groups deserving special attention in disease elimination initiatives, especially because their lifestyle might be intrinsically linked to locations with high transmission risk. There has been a renewed interest in malaria elimination, which has ignited a quest to understand factors necessary for sustainable malaria elimination, highlighting the need for diverse approaches to address epidemiological heterogeneity across malaria transmission settings. An analysis of malaria incidence among the Guna Amerindians of Panamá over the last 34 years showed that this ethnic minority was highly vulnerable to changes that were assumed to not impact malaria transmission. Epidemic outbreaks were linked with El Niño Southern Oscillations and were sensitive to political instability and policy changes that did not ensure adequate attention to the malaria control needs of the Gunas. Our results illustrate how the neglect of minorities poses a threat to the sustainable control and eventual elimination of malaria in Central America and other areas where ethnic minorities do not share the benefits of malaria control strategies intended for dominant ethnic groups.

Complex temporal climate signals drive the emergence of human water-borne disease

“…EMD is a technique developed specifically to decompose non-stationary and nonlinear time series and has been successfully applied to a number of climatic and epidemiological datasets. 1,30 The method is an iterative process which builds a number of oscillatory signals called intrinsic mode functions (IMFs), which are repeatedly subtracted from the time series; each iteration results in an IMF with a longer periodic component until just a trend signal is present. For a detailed description of EMD, see Huang et al .…”

Characterization of a recent malaria outbreak in the autonomous indigenous region of Guna Yala, Panama

“…As Panamá experiences one of the largest economic growth in Latin America and engages in a national malaria elimination initiative [1, 2], the country still faces a major challenge in controlling malaria transmission among socially marginalized populations [3]. The worst case is that of the ‘Comarcas’: special administrative regions that serve as reservations for Panamanian citizens of Native American descent [4].…”

“…The worst case is that of the ‘Comarcas’: special administrative regions that serve as reservations for Panamanian citizens of Native American descent [4]. These regions and their inhabitants never benefited from sanitation achievements related to the construction of the Panamá Canal and the subsequent development of Panamá [3]. For example, although only 12 % of the total Panamanian population inhabits these reservations, nearly 90 % of the malaria cases in Panamá were reported in these areas during the past decades [1].…”

“…For example, most communities from this region, where malaria transmission has been reported during the past decade, can be reached only by boats. Other factors, such as languages barriers, a lack of intercultural understanding and political commitment, further complicate any control effort aimed at the Gunas: the main ethnic group in the region, and the one bearing the largest malaria burden in Panamá [3]. All of these factors have resulted in a poor knowledge of the local malaria epidemiology and historical transmission patterns in Guna Yala.…”

Declining Prevalence of Disease Vectors Under Climate Change

“…Dengue transmission is associated in space and time with local climate effects on survival of its vector Aedes aegypti —more rain and higher temperature generates more transmission45. Changes in inter-annual climate variability such as the El Niño Southern Oscillation have been shown to be important drivers for malaria transmission6. Further, vectors also show distributional shifts from low to high altitudes during warm years7.…”