title: Time trends and changes in the distribution of malaria cases in the Brazilian Amazon Region, 2004-2013.
abstract: Recent efforts to reduce malaria incidence have had some successes. Nevertheless, malaria persists as a significant public health problem in the Brazilian Amazon. The objective of this study was to describe changes in malaria case characteristics and to identify trends in malaria incidence in the Brazilian Amazon. This study used data from the Malaria Epidemiological Surveillance and Case Notification Information System from 2004 to 2013. The annual parasite incidence (API) was calculated and joinpoint regression was used to assess the trends in API over time. There was a sharp increase in API in the state of Acre, followed by two periods of decrease. Pará also presented inconsistent decreases over the study period. Amapá, Amazonas, Rondônia, and Roraima showed statistically significant decreases over the period. The sharpest decrease occurred in Rondônia, with a reduction of 21.7% in the average annual percent change (AAPC) (AAPC: -21.7%; 95% confidence interval: -25.4%, -17.8%; p < 0.05). This panorama of malaria incidence highlights the importance of integrating evidence-based malaria surveillance and control. Malaria is highly preventable, and eliminating its transmission should be a goal in coming decades.
authors.affiliation: Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil.
authors.forename: Isac da Sf
authors.initials: ID
authors.lastname: Lima
authors.affiliation: Organização Pan-Americana da Saúde-Brasil, Brasília, DF, Brasil.
authors.forename: Oscar Mm
authors.initials: OM
authors.lastname: Lapouble
authors.affiliation: Universidade de Brasília, Faculdade de Medicina, Brasília, DF, Brasil.
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: Duarte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000852:Anopheles; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007303:Insect Vectors; D008288:Malaria / Q000453:epidemiology*; D012959:Socioeconomic Factors