guyana11

Overview of the situation Figures 1-5

Historically, malaria has been a major public health problem for Guyana, as it has for other countries of the Americas. nevertheless, the number of cases reported in Guyana is much lower than in countries such as Brazil, colom-bia, Peru, and Venezuela. APi in the country has declined from 52 per 1,000 inhabitants in 2005, to 28 per 1,000 in 2006, and 15 per 1,000 in 2007 and 2008.

The most important vector of malaria in the interior of Guyana is the Anopheles darlingi mos-quito, whereas the species A. aquasalis is a se-condary and poor vector of malaria transmission on the coastland.

Malaria transmission in Guyana is focalized and endemic, mainly in the gold mining and log-ging areas of the interior in parts of regions 1 and 2, regions 7, 8, and 9, and part of region 10. Ma-laria by Plasmodium falciparum has been rees-tablished in areas where it was previously under control or had been eradicated; transmission by this type predominates in highly mobile popula-tions with little or no immunity.

in 2008, there were 11,815 new cases in Gu-yana (41 imported), of which 5,252 were P. fal-ciparum malaria. Region 7 (cuyuni-Mazaruni) reported 5,190 cases, or 44% of the total number of cases of malaria in the country. This region

also has the largest population movements due to mining activities. Both the geographical clus-tering of cases and the limited access to health services in areas dominated by mining and log-ging pose major difficulties for malaria control.

Morbidity and mortality trendsFigures 4 – 9

in 2005, there was a major peak in malaria in-cidence in Guyana, with 38,984 cases reported. The number of cases subsequently decreased and then stabilized in 2007 and 2008. in 2008, the number of cases of P. falciparum malaria in-creased slightly compared to 2007. in 2006 and 2007, malaria transmission decreased signifi-cantly in regions 1, 8, and 9, but remained the same in 2008.

The decrease in the number of cases was ac-companied by a reduction in mortality. in 2008, Guyana reported only one malaria-related death.

Geographic DistributionFigures 1, 12-19

in 2008, the District of Mazaruni in the west of the country, reported 3,016 new cases, 25.5% of the total number of cases in the country. The districts of cuyuni and Potaro reported 2,113 and 2,175 new cases, respectively. together the-se three mining and logging districts accounted for 61.8% of new cases in the country, which re-

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 81 5 6

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presents a pointed focalization of the problem. Within each district, however, malaria cases are distributed among a large number of localities, making it difficult to control.

The georeferencing of malarious localities in Guyana provides visual confirmation of the fact that, in 2008, 352 localities were reported as a source of cases but of these, 206 reported less than 5 cases each. Only 32 districts registered more than 50 cases in the year and only six loca-lities had more than 250 cases.

in Region 8, the town of Mahdia recorded 983 new cases in 2008, the highest number of cases in the country. The towns of Konawaruk in Region 8, Omai in Region 7 and Mabura Hill in Region 10 constitute a major focus of trans-mission at the confluence of these three regions, close to the center of the country. These are gold mining and logging areas, where about 54% of the cases were P. falciparum malaria, affecting mostly an Afro-Guyanese population.

Malaria in specific populations Figures 25–28

in 2008, Guyana reported 517 cases of malaria in children under 5 years of age, or 4.3% of the total number of malaria cases in the country. Along with costa Rica, Guyana is the country with the lowest proportion of cases in this age group, which might be explained by the fact that mala-ria is mostly endemic in mining areas. in 2008, 81% of total cases were reported in people bet-ween 15 and 49 years of age and, of those, 80% were among males.

in Guyana, the Amerindian population is significantly affected by malaria. in 2008, 34% of the total number of cases reported occurred in this ethnic group, much higher than in other

countries.in the districts of Rupununi West, Region 9,

ireng/upper Potaro, Region 8 and Moruka/Po-meroon, Region 2 the proportion of cases among Amerindians was 86%, 79% and 69%, respecti-vely. Among persons infected with malaria in Region 9, in the south of the country, Amerin-dians were the most affected. Also, the region had higher incidence rates of the disease than the rest of the country.

Pregnant women accounted for 9% of ma-laria cases among all women between 15 and 45 years of age with malaria in 2008. This propor-tion was similar to that observed in Brazil, but higher than other countries, like Bolivia and co-lombia. This may reflect better recordkeeping of malaria during pregnancy than exists in other countries.

Diagnosis and treatmentFigures 20-24, 29–30

As in the rest of the Amazon region, P. falcipa-rum strains in Guyana are resistant to chloroqui-ne and sulfadoxine-pyrimethamine treatment. in 2004, Guyana changed its malaria treatment policy, and introduced the use of Acts as a first line of treatment for uncomplicated P. falciparum malaria.

in 2004, 2,580 artemether + lumefantri-ne treatments were distributed. in 2005, 17,727 Act treatments were distributed and more than 10,000 treatments were distributed in 2006. This can partly be explained by the fact that both P. vivax and P. falciparum malaria rose sharply during 2005, as it did in Brazil and many other countries in the region.

By the end of 2006, the number of cases had fallen significantly. The Malaria control

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 8G u YA nA

Program has continued to use the arthemether + lumefantrine combination as a first line of treatment. two evaluations of therapeutic effica-cy have been conducted.

The slide positivity rate in 2008 was 8.6%, a proportion similar to that of other countries in the region, and lower than that of Brazil and co-lombia. This positivity rate is lower than the an-nual average for the decade, but is slightly higher than the 2007 rate. in 2008, the number of blood slides examined was lower than in 2007, while the number of cases remained relatively stable. This may highlight the need for enhanced mi-croscopy for the early detection of cases.

Guyana’s information system does not re-cord the time span between the onset of symp-toms and diagnosis. However, it is noteworthy that many of the cases that were part of the out-breaks in Regions 7 and 8 in 2008 were diagno-sed in the capital city of Georgetown. in 2008, 2,143 of the 5,190 cases reported in Region 7 (41%) were diagnosed and treated in the capital.

in 2008, the use of rapid diagnostic tests for malaria was not reported.

Populations in mining areas can readily ac-cess medicines that are not recommended by the Ministry of Health. This presents a problem for the malaria treatment policy in Guyana. The in-discriminate use of these drugs to suppress cli-nical symptoms makes it difficult to detect cases and contribute to widespread resistance.

Prevention and vector controlFigures 31-33

The use of long-lasting insecticide impregnated nets (llins) started in Guyana in 2006, with the distribution of 29,577 nets purchased by the go-vernment with financial support from the Glo-bal fund, and Amazon Malaria initiative (AMi) projects. currently, llins are the primary in-tervention for malaria vector control in Guyana. The policy dictates the distribution of two llins per household, and the development of joint in-tervention that includes llin distribution and access to treatment with Act.

The AMi project also provided support for the distribution of mosquito nets, of which 5,813 llins were distributed in 2007 and 4,287 llins were distributed in 2008. Distribution focused on vulnerable groups, such as pregnant women, children under the age of 5 years, and miners and loggers in Regions 1, 7, 8, 9 and 10. in 2008, no indoor residual spraying took place.

Financing of malaria controlFigure 34

Since 2005, Guyana became a beneficiary of a Global fund project for malaria control, which in recent years has supported the intensification of control activities in priority regions. The eu-ropean union and the AMi project, financed by the uSAiD and coordinated by the PAHO, have provided funding for technical cooperation to control malaria. in 2008, approximately half of the funding for control measures was provided by external sources.

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Legend

Number of cases by species

500

P. vivax

P. falciparum

500250

Figure 1. Number of cases by locality, 2008

Suriname

Guyana

Brazil

Venezuela

49%

51%

Plasmodium species

P. vivax

Figure 2. Proportion of cases by species, 2008

P. falciparum and mixed

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 8G u YA nA

ADM1 Total casesP. vivaxP. falciparum + mixed

Figure 3. Number of malaria cases by species by ADM1 level in 2008

ADM1

4,0002,0000 0% 50% 100%

Total number of cases Percentage of total cases

Cuyuni/Mazaruni

Potaro/Siparuni

Barima/Waini

Upper Demerara/Berbice

Upper Takutu/U.Essequibo

Pomeroon/Supenaam

Essequibo I./West D.

Demerara/Mahaica

East Berbice/Corentyne

Mahaica/Berbice 2

6

11

247

393

692

817

2,171

2,175

5,113

1

2

5

138

317

608

355

1,340

1,023

2,105

1

4

6

109

76

84

462

831

1,152

3,008 Cuyuni/Mazaruni

Potaro/Siparuni

Barima/Waini

Upper Demerara/Berbice

Upper Takutu/U.Essequibo

Pomeroon/Supenaam

Essequibo I./West D.

Demerara/Mahaica

East Berbice/Corentyne

Mahaica/Berbice

Plasmodium species

P. falciparum and mixed P. vivax

Figure 4. Number of cases by species, 2000-2008

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

0

10,000

15,000

20,000

Num

ber o

f cas

es

Plasmodium species

P. falciparum and mixed P. vivax

5,000

11,694

14,291

11,296

14,654

16,141

21,255

10,560

6,7125,920

12,324

12,831

10,599

12,970 12,234

16,438

9,818

4,6775,741

24,0

18 27,1

22

21,8

95 27,6

27

28,8

66

38,9

84

21,0

64

11,6

57

11,8

15

Figure 5. Number of malaria cases, 2000-2008

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

30,000

20,000

Num

ber o

f cas

es

40,000

0

10,000

0

10

2020

33

38

NANANANA

Num

ber o

f dea

ths

Figure 6. Number of malaria deaths, 2000-2008

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

40

30

20

10

NA - No Data Available

NA NA NA NA NA NA NA NA

348

Num

ber o

f cas

es

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

0

400

300

200

100

Figure 7. Number of hospitalized malaria cases, 2000 - 2008

NA - No Data Available

1 6 0

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 8 G u YA nA 1 6 1

Year

2000 2001 2002 2003 2004 2005 2006 2007 2008

-5000

-10,000

0

5,000

Plasmodium species

P. falciparum and mixed P. vivax

Diff

eren

ce in

num

ber

of c

ases

-792

-3,848

-10,695

5,114

1,487

3,358

-2,995

2,5971,064

-5,141

-6,620

4,204

-736

2,371

-2,232

507

Figure 8. Annual variations in number of cases

Year

2000 2001 2002 2003 2004 2005 2006 2007 2008

-50%

0%

50%

Per

cent

age

diff

eren

ce

Figure 9. Percentage differencein number of cases compared to 2000

-49%-43%

-10%

82%

38%

25%

-3%

22%

0%

-53%-62%

-20%

33%

-1%

5%

-14%

4%

Plasmodium species

P. falciparum and mixed P. vivax

Num

ber

of c

ases

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

10,000

20,000

40,000

30,000

Figure 10. Number of cases and RBM / MDG targets for 2010 and 2015

Year

Reported cases RBM / MDG Targets

Figure 11. Percentage of hospitalized cases, 2008

3%

97%

Percentage of cases

Oupatients

Hospitalized

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 8G u YA nA

Figure 12. Localities (ADM2) with highest malaria burden and cummulative proportion of total cases in the country, 2008

0 200 400 600 800 1,000

Number of cases

0% 20% 40% 60% 80% 100%

Cummulative proportion (%) of total cases

Mahdia

Omai

Puruni River

Mabura Hill

Arimu Mine

Arakaka

Konawaruk

Issano

Barama River

Port Kaituma

Cuyuni River

Quartzstone Landing

Aranka River

Oko River 238

238

241

258

265

277

319

406

469

514

586

602

667

983

54%

52%

50%

48%

45%

43%

40%

38%

34%

30%

25%

20%

15%

9%

* See Annex A for a complete list.

Figure 13. Localities by numberof malaria cases, 2008

Number of cases

501-1,000

251-500

101-250

51-100

11-50

6-10

1-5

Grand Total

206

42

72

18

12

6

5

3�1

Number of localities

0 50 100 150 200 250 300 350 0 50 100 150 200 250

Number of localities

501-1,000

251-500

101-250

51-100

11-50

6-10

1-5 174

23

39

8

10

4

1

Grand Total 259

Figure 14. Localities by number ofP. falciparum cases, 2008

Number ofP. falciparum

cases

Figure 15. Regions (ADM1) by number of cases, API and percentage of P. falciparum cases, 2008

Number of cases (logarithmic scale)

API0

100200

290.56

25

250

1 2 5 10 20 50 100 200 500 1,000 2,000 5,000 10,0000

10

20

30

40

50

60

Upper Takutu/U.Essequibo

Potaro/Siparuni

Pomeroon/Supenaam

Mahaica/Berbice

Essequibo I./West D.

East Berbice/Corentyne

Demerara/MahaicaCuyuni/Mazaruni

Barima/Waini

Per

cent

age

of P

. fal

cip

arum

cas

es

1 6 2

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 8 G u YA nA 1 6 3

Figure 16. Annual Parasite Index (API) by districts (ADM2), 2008

Legend

Municipal API

0.01

0.1

1

10

100

Suriname

Guyana

Brazil

Venezuela

Figure 17. Population by malariatransmission risk, 2008

High risk (API > 10/1000)

Medium risk (1/1000 < API < 10/1000)

Low risk (API < 1/1000)

Malaria free areas (No indigenous transmission)

20%

15%7%

58%

Population

0

Number of cases

0

API

100 200 3002,000 4,000 6,000 400

0.04

0.04

0.05

2.4

7.98

19.87

35.69

89.43

215.45

290.56

11

2

6

247

393

817

692

2,171

2,175

5,113Cuyuni/Mazaruni

Potaro/Siparuni

Barima/Waini

Upper Takutu/U.Essequibo

Upper Demerara/Berbice

Pomeroon/Supenaam

Essequibo I./West D.

East Berbice/Corentyne

Mahaica/Berbice

Demerara/Mahaica

* See Appendix A to the list.

API (cases/ 1000 people at risk)

0 290.56

Figure 18. Annual Parasite Index (API) and numberof cases by district, 2008

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 8G u YA nA

2000

2001

2002

2003

2004

2005

2006

2007

2008 52,428

52,428

52,428

52,428

115,000

115,000

145,000

149,000

146,000

434,015

638,757

586,000

537,000

511,000

556,000

468,000

511,000

511,000

152,314

41,112

41,000

49,000

45,000

30,000

88,000

45,000

45,000

112,466

71,354

71,000

112,000

93,000

63,000

63,000

59,000

59,000

Figure 19. Population by malaria transmission risk, 2000-08

Year Malaria freeareas (Noindigenoustransmission)

Low risk(API < 1/1000)

Medium risk(1/1000 < API< 10/1000)

High risk(API >10/1000)

Year Number of slidesexamined

Number of slidespositive

Slide PositivityRate (%)

2000

2001

2002

2003

2004

2005

2006

2007

2008

Figure 20. Slides examined and Slide Positivity Rate (SPR),2000-2008

8.61

6.55

10.39

18.53

19

14.86

12.44

12.84

11.48

11,815

11,657

21,064

38,984

28866

27,627

21,895

27,122

24,018

137,247

178,005

202,688

210,429

151,938

185,877

175,966

211,221

209,197

Number of cases Number of cases

200020012002200320042005200620072008 137,247

178,005202,688210,429

151,938185,877

175,966211,221209,197

0 100,000 200,000 0 100,000 200,000

Year

Diagnostic Method

Microscopy RDTs

Figure 21. Cases diagnosed by microscopyand RDTs, 2000-08

NA

NA

NA

NA

Figure 22. Number of cases diagnosedand cases treated, 2000-2008

Year2000

2001

2002

2003

2004

2005

2006

2007

2008

Diagnosed cases

Cases treatedDiagnosed casesCases treated

Diagnosed casesCases treated

Diagnosed cases

Cases treatedDiagnosed cases

Cases treated

Diagnosed casesCases treated

Diagnosed casesCases treated

Diagnosed cases

Cases treatedDiagnosed cases

Cases treatedDiagnosed cases

Cases treated

0 20,000 40,000

Number of cases diagnosed/treated

NA- No Data Available

ADM1 Examined Total cases SPR (%)

Figure 23. Slide Positivity Rate (SPR) by ADM1, 2008

Cuyuni/Mazaruni

Potaro/Siparuni

Barima/Waini

Upper Demerara/Berbice

Upper Takutu/U.Essequibo

Pomeroon/Supenaam

Essequibo I./West D.

Demerara/Mahaica

East Berbice/Corentyne

Mahaica/Berbice

4.63

2.19

26.24

7.15

18.18

38.18

1.8

0.06

9.79

22.76

393

692

817

2,175

2

247

6

11

2,171

5,113

8,482

31,593

3,113

30,427

11

647

333

19,402

22,180

22,463

Figure 24. Time span between onset of symptomsand diagnosis, 2008

No Data Available

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Figure 25. Number and percentageof cases by age group, 2008

Number of cases

<55-1415-49>50 6.1%

81.1%8.4%4.4%

4,000 8,0000

Figure 26. Number and percentageof cases by locality type, 2008

No Data Available

90.9%9.1%

Number of cases

PregnantNot pregnant

Figure 27. Number and percentage of cases in pregnantwomen among women of child bearing age, 2008

0 1000500

Figure 28. Number and percentage of cases, 2008

66.3%33.7%

Number of cases

AmerindianOther

0 4,000 8,000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

100

0

20

40

60

80

Per

cent

age

of P

. fal

cip

arum

cas

es

51.3 47.3 48.4 46.942.4

42.2

46.640.1

48.6

Figure 29. Proportion of P. falciparum cases, 2000-2008

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Figure 30. Number of ACT treatmentsdistributed by year, 2000-08

Num

ber

of A

CT

trea

tmen

ts

20,000

15,000

10,000

5,000

0 0000

5,2524,520

10,426

17,727

2,580

Figure 31. Indoor residual sprayingcoverage by year, 2000-08

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Num

ber

of p

eop

le p

rote

cted

0

6,25

0

1,72

5

0 0 0 0 0 0 0

6,000

4,000

2,000

Figure 32. Number of LLINs distributed by year, 2000-2008

Num

ber

of b

edne

ts

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

0

10,000

20,000

30,000

4,2875,813

29,577

R e P O R t O n t H e S i t uAt i O n O f M A l A R iA i n t H e A M e R i c A S , 2 0 0 8G u YA nA

Figure 33. Number of ITNs distributed by year, 2000-08

Not Distributed

Figure 34. Sources for malaria control funds by year, 2000-08

2000

NA

2001 2002 2003 2004 2005 2006 2007 2008

Year

US

$

0

1M

2M

Financing sources

USAID

UN agencies

Other bilateral funds

Global Fund

Government

NA - Data not available

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