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Health policy impacts on malaria transmission in Costa Rica

Published online by Cambridge University Press:  28 April 2020

Luis Fernando Chaves Open the ORCID record for Luis Fernando Chaves [Opens in a new window] ,
Melissa Ramírez Rojas ,
Monica Prado ,
José Luis Garcés ,
Daniel Salas Peraza  and
Rodrigo Marín Rodríguez
Luis Fernando Chaves*
Affiliation:
Vigilancia de la Salud, Ministerio de Salud, San José, Costa Rica
Melissa Ramírez Rojas
Affiliation:
Vigilancia de la Salud, Ministerio de Salud, San José, Costa Rica
Monica Prado
Affiliation:
Centro de Investigación en Enfermedades Tropicales (CIET), Universidad de Costa Rica, San Pedro, Costa Rica
José Luis Garcés
Affiliation:
Vigilancia de la Salud, Ministerio de Salud, San José, Costa Rica
Daniel Salas Peraza
Affiliation:
Ministro de Salud, Despacho del Ministro, Ministerio de Salud, San José, Costa Rica
Rodrigo Marín Rodríguez
Affiliation:
Vigilancia de la Salud, Ministerio de Salud, San José, Costa Rica
*
Author for correspondence: Luis Fernando Chaves, E-mail: [email protected]
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Abstract

Costa Rica is near malaria elimination. This achievement has followed shifts in malaria health policy. Here, we evaluate the impacts that different health policies have had on malaria transmission in Costa Rica from 1913 to 2018. We identified regime shifts and used regression models to measure the impact of different health policies on malaria transmission in Costa Rica using annual case records. We found that vector control and prophylactic treatments were associated with a 50% malaria case reduction in 1929–1931 compared with 1913–1928. DDT introduction in 1946 was associated with an increase in annual malaria case reduction from 7.6% (1942–1946) to 26.4% (1947–1952). The 2006 introduction of 7-day supervised chloroquine and primaquine treatments was the most effective health policy between 1957 and 2018, reducing annual malaria cases by 98% (2009–2018) when compared with 1957–1968. We also found that effective malaria reduction policies have been sensitive to natural catastrophes and extreme climatic events, both of which have increased malaria transmission in Costa Rica. Currently, outbreaks follow malaria importation into vulnerable areas of Costa Rica. This highlights the need to timely diagnose and treat malaria, while improving living standards, in the affected areas.

Keywords

BreakpointsEl Niño Southern Oscillationmass drug administrationmalaria eliminationregime shifts
Type
Research Article
Information
Parasitology , Volume 147 , Issue 9 , August 2020 , pp. 999 - 1007
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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