title: Successful malaria elimination in the Ecuador-Peru border region: epidemiology and lessons learned.
abstract: BACKGROUND
  In recent years, malaria (Plasmodium vivax and Plasmodium falciparum) has been successfully controlled in the Ecuador-Peru coastal border region. The aim of this study was to document this control effort and to identify the best practices and lessons learned that are applicable to malaria control and to other vector-borne diseases. A proximal outcome evaluation was conducted of the robust elimination programme in El Oro Province, Ecuador, and the Tumbes Region, Peru. Data collection efforts included a series of workshops with local public health experts who played central roles in the elimination effort, review of epidemiological records from Ministries of Health, and a review of national policy documents. Key programmatic and external factors are identified that determined the success of this eradication effort.
  
  
  METHODS
  From the mid 1980s until the early 2000s, the region experienced a surge in malaria transmission, which experts attributed to a combination of ineffective anti-malarial treatment, social-ecological factors (e.g., El Niño, increasing rice farming, construction of a reservoir), and political factors (e.g., reduction in resources and changes in management). In response to the malaria crisis, local public health practitioners from El Oro and Tumbes joined together in the mid-1990s to forge an unofficial binational collaboration for malaria control. Over the next 20 years, they effectively eradicated malaria in the region, by strengthening surveillance and treatment strategies, sharing of resources, operational research to inform policy, and novel interventions.
  
  
  RESULTS
  The binational collaboration at the operational level was the fundamental component of the successful malaria elimination programme. This unique relationship created a trusting, open environment that allowed for flexibility, rapid response, innovation and resilience in times of crisis, and ultimately a sustainable control programme. Strong community involvement, an extensive microscopy network and ongoing epidemiologic investigations at the local level were also identified as crucial programmatic strategies.
  
  
  CONCLUSIONS
  The results of this study provide key principles of a successful malaria elimination programme that can inform the next generation of public health professionals in the region, and serve as a guide to ongoing and future control efforts of other emerging vector borne diseases globally.
authors.affiliation: Center for Health, Work & Environment, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Lyndsay K
authors.initials: LK
authors.lastname: Krisher
authors.affiliation: Center for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Ave., Syracuse, NY, 13210, USA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Krisher
authors.affiliation: Ministerio de Salud Pública, Machala, El Oro, Ecuador.
authors.forename: Mariano
authors.initials: M
authors.lastname: Ambuludi
authors.affiliation: Ministerio de Salud Pública, Machala, El Oro, Ecuador.
authors.forename: Ana
authors.initials: A
authors.lastname: Arichabala
authors.affiliation: Ministerio de Salud Pública, Machala, El Oro, Ecuador.|Facultad de Medicina, Universidad Técnica de Machala, Machala, El Oro, Ecuador.
authors.forename: Efrain
authors.initials: E
authors.lastname: Beltrán-Ayala
authors.affiliation: Ministerio de Salud Pública, Machala, El Oro, Ecuador.
authors.forename: Patricia
authors.initials: P
authors.lastname: Navarrete
authors.affiliation: Ministerio de Salud Pública, Machala, El Oro, Ecuador.
authors.forename: Tania
authors.initials: T
authors.lastname: Ordoñez
authors.affiliation: Center for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Ave., Syracuse, NY, 13210, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Polhemus
authors.affiliation: Dirección Regional de Salud Tumbes, Ministerio de Salud de Peru, Tumbes, Peru.
authors.forename: Fernando
authors.initials: F
authors.lastname: Quintana
authors.affiliation: Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Rochford
authors.affiliation: Ministerio de Salud Pública, Machala, El Oro, Ecuador.
authors.forename: Mercy
authors.initials: M
authors.lastname: Silva
authors.affiliation: Red Cross/Red Crescent Climate Centre, Lima, Peru.
authors.forename: Juan
authors.initials: J
authors.lastname: Bazo
authors.affiliation: Center for Global Health and Translational Science, State University of New York Upstate Medical University, 505 Irving Ave., Syracuse, NY, 13210, USA. stewarta@upstate.edu.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Stewart-Ibarra
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration*; D060740:Disease Eradication; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000517:prevention & control*; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D055815:Young Adult
keywords: Binational collaboration; Border region; Ecuador; Elimination; Malaria; Peru; Plasmodium falciparum; Plasmodium vivax; Vector control