Pan American Health Organization Malaria in Costa Rica, 1998–20041... Title of the presentation Author Title of the presentation Author MALARIA IN COSTA.

Malaria in Costa Rica, 1998–2004 1

Pan AmericanHealthOrganization

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Title of the presentation

Author

Title of the presentation

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MALARIA IN COSTA RICA:

Time Series Epidemiological Data from 1998 to 2004

MALARIA IN COSTA RICA:

Time Series Epidemiological Data from 1998 to 2004



MALARIA IN COSTA RICAMALARIA IN COSTA RICA

I. The Malaria Burden– Risk of Transmission– Malaria Morbidity– Malaria Mortality– Malariometric Indices (API, AFI, AVI, AMI)

II. Trends in Case Detection and Diagnosis– Case Detection: Passive vs. Active

Method– Annual Blood Examination Rate (ABER)– Slide Positivity Rate SPR)

III. TreatmentIV. Resources and Financing

I. The Malaria Burden– Risk of Transmission– Malaria Morbidity– Malaria Mortality– Malariometric Indices (API, AFI, AVI, AMI)

II. Trends in Case Detection and Diagnosis– Case Detection: Passive vs. Active

Method– Annual Blood Examination Rate (ABER)– Slide Positivity Rate SPR)

III. TreatmentIV. Resources and Financing



The Risk of

Transmission

The Risk of

Transmission



COSTA RICA: Population at Risk of Malaria Transmission, 1998–2004 (in thousands)

COSTA RICA: Population at Risk of Malaria Transmission, 1998–2004 (in thousands)

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Population at Risk 1,280 1,332 1,359 1,288 1,374 1,403 1,424

Total Population 3,650 3,933 4,024 3,810 4,025 4,170 4,249

1998 1999 2000 2001 2002 2003 20040

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

Population at Risk 1,280 1,332 1,359 1,288 1,374 1,403 1,424

Total Population 3,650 3,933 4,024 3,810 4,025 4,170 4,249

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Population at Ecological Risk of Malaria Transmission According to Level of Transmission

Risk , 1998–2004 (in thousands)

COSTA RICA: Population at Ecological Risk of Malaria Transmission According to Level of Transmission

Risk , 1998–2004 (in thousands)

0

200

400

600

800

1,000

1,200

1,400

Low Risk 331 497 841 948 1,057 1,215 1,196

Moderate Risk 864 780 493 307 281 149 187

High Risk 85 55 25 33 36 39 41

1998 1999 2000 2001 2002 2003 20040

200

400

600

800

1,000

1,200

1,400

Low Risk 331 497 841 948 1,057 1,215 1,196

Moderate Risk 864 780 493 307 281 149 187

High Risk 85 55 25 33 36 39 41

1998 1999 2000 2001 2002 2003 2004



Malaria MorbidityMalaria Morbidity



COSTA RICA: Malaria Morbidity, 1998–2004 (number of positive blood slides)

COSTA RICA: Malaria Morbidity, 1998–2004 (number of positive blood slides)

0

1,000

2,000

3,000

4,000

5,000

6,000

No. of Cases 5,148 3,998 1,879 1,363 1,021 718 1,289

1998 1999 2000 2001 2002 2003 20040

1,000

2,000

3,000

4,000

5,000

6,000

No. of Cases 5,148 3,998 1,879 1,363 1,021 718 1,289

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Malaria Morbidity According to Level of Transmission Risk, 1998–2004 (number of positive blood slides)

COSTA RICA: Malaria Morbidity According to Level of Transmission Risk, 1998–2004 (number of positive blood slides)

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Low Risk 69 295 246 210 155 153 144

Moderate Risk 3,162 2,494 1,275 624 478 280 411

High Risk 1,701 1,024 259 499 377 269 699

Originally Non-Malarious 216 185 99 30 11 16 35

1998 1999 2000 2001 2002 2003 20040

500

1,000

1,500

2,000

2,500

3,000

3,500

Low Risk 69 295 246 210 155 153 144

Moderate Risk 3,162 2,494 1,275 624 478 280 411

High Risk 1,701 1,024 259 499 377 269 699

Originally Non-Malarious 216 185 99 30 11 16 35

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Malaria Morbidity According to Parasite Species (in All Risk Areas), 1998–2004

COSTA RICA: Malaria Morbidity According to Parasite Species (in All Risk Areas), 1998–2004

0

200

400

600

800

1,000

1,200

1,400

P. falciparum & mixed … … … 1 2 14 5

P. vivax … … … 1,362 1,008 704 1,284

P. malariae … … … 0 0 0 0

1998 1999 2000 2001 2002 2003 20040

200

400

600

800

1,000

1,200

1,400

P. falciparum & mixed … … … 1 2 14 5

P. vivax … … … 1,362 1,008 704 1,284

P. malariae … … … 0 0 0 0

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Malaria Morbidity According to Parasite Species (In Moderate and High Areas), 1998–2004

COSTA RICA: Malaria Morbidity According to Parasite Species (In Moderate and High Areas), 1998–2004

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

P. falciparum & mixed 11 11 12 1 0 1 0

P. vivax 4,852 3,507 1,867 1,122 855 548 1,110

P. malariae 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 20040

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

P. falciparum & mixed 11 11 12 1 0 1 0

P. vivax 4,852 3,507 1,867 1,122 855 548 1,110

P. malariae 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 2004



Malaria MortalityMalaria Mortality



COSTA RICA: Malaria Mortality, 1998–2004 (number of deaths)

COSTA RICA: Malaria Mortality, 1998–2004 (number of deaths)

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

No. of Deaths 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 20040

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

No. of Deaths 0 0 0 0 0 0 0

1998 1999 2000 2001 2002 2003 2004



Malariometric Indices

(API, AFI, AVI, AMI)

Malariometric Indices

(API, AFI, AVI, AMI)



COSTA RICA: Malariometric Indices (API, AFI, AVI, AMI) in all Risk Areas, 1998–2004

COSTA RICA: Malariometric Indices (API, AFI, AVI, AMI) in all Risk Areas, 1998–2004

0

0.2

0.4

0.6

0.8

1

1.2

API … … … 1.06 0.74 0.51 0.91

AFI … … … 0 0 0.01 0

AVI … … … 1.06 0.73 0.5 0.9

AMI … … … 0 0 0 0

1998 1999 2000 2001 2002 2003 20040

0.2

0.4

0.6

0.8

1

1.2

API … … … 1.06 0.74 0.51 0.91

AFI … … … 0 0 0.01 0

AVI … … … 1.06 0.73 0.5 0.9

AMI … … … 0 0 0 0

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Malariometric Indices (API, AFI, AVI, AMI) in Moderate and High Risk Areas,

1998–2004

COSTA RICA: Malariometric Indices (API, AFI, AVI, AMI) in Moderate and High Risk Areas,

1998–2004

0

1

2

3

4

5

6

API 5.12 4.21 2.96 3.3 2.7 2.92 4.87

AFI 0.01 0.01 0.02 0 0 0.01 0

AVI 5.11 4.2 3.6 3.3 2.7 2.91 4.87

AMI 0 0 … 0 0 0 0

1998 1999 2000 2001 2002 2003 20040

1

2

3

4

5

6

API 5.12 4.21 2.96 3.3 2.7 2.92 4.87

AFI 0.01 0.01 0.02 0 0 0.01 0

AVI 5.11 4.2 3.6 3.3 2.7 2.91 4.87

AMI 0 0 … 0 0 0 0

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Annual Parasitic Index (API), 1998–2004

COSTA RICA: Annual Parasitic Index (API), 1998–2004

0

1

2

3

4

5

6

In All Risk Areas … … … 0.51 0.74 1.06 0.91

Moderate and High Risk Only 5.12 4.21 2.96 3.3 2.7 2.92 4.87

1998 1999 2000 2001 2002 2003 20040

1

2

3

4

5

6

In All Risk Areas … … … 0.51 0.74 1.06 0.91


1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Annual Index of P. falciparum (AFI), 1998–2004

COSTA RICA: Annual Index of P. falciparum (AFI), 1998–2004

0

0.002

0.004

0.006

0.008

0.01

0.012

0.014

0.016

0.018

0.02

In All Risk Areas … … … 0.01 0 0 0

Moderate and High Risk Only 0.01 0.01 0.02 0 0 0.01 0

1998 1999 2000 2001 2002 2003 20040

0.002

0.004

0.006

0.008

0.01

0.012

0.014

0.016

0.018

0.02

In All Risk Areas … … … 0.01 0 0 0

Moderate and High Risk Only 0.01 0.01 0.02 0 0 0.01 0

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Annual Index of P. vivax (AVI), 1998–2004

COSTA RICA: Annual Index of P. vivax (AVI), 1998–2004

0

1

2

3

4

5

6

In All Risk Areas … … … 0.5 0.73 1.06 0.9


1998 1999 2000 2001 2002 2003 20040

1

2

3

4

5

6

In All Risk Areas … … … 0.5 0.73 1.06 0.9


1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Annual Index of P. malariae (AMI), 1998–2004

COSTA RICA: Annual Index of P. malariae (AMI), 1998–2004

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

In All Risk Areas … … … 0 0 0 0

Moderate and High Risk Only 0 0 … 0 0 0 0

1998 1999 2000 2001 2002 2003 20040

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

In All Risk Areas … … … 0 0 0 0

Moderate and High Risk Only 0 0 … 0 0 0 0

1998 1999 2000 2001 2002 2003 2004



Trends in

Case Detection and

Diagnosis

Trends in

Case Detection and

Diagnosis



COSTA RICA: Passive vs. Active Case Detection, 1998–2004 (% of Blood Slides Examined)

COSTA RICA: Passive vs. Active Case Detection, 1998–2004 (% of Blood Slides Examined)

14.03

16.77

9.37

6.23

10.21

7.74

14

85.97

83.23

90.63

93.77

89.79

92.26

86

0 20 40 60 80 100 120

1998

1999

2000

2001

2002

2003

2004

Passive Active

14.03

16.77

9.37

6.23

10.21

7.74

14

85.97

83.23

90.63

93.77

89.79

92.26

86

0 20 40 60 80 100 120

1998

1999

2000

2001

2002

2003

2004

Passive Active



COSTA RICA: Annual Blood Examination Rate (ABER) in Malarious Areas, 1998–2004

COSTA RICA: Annual Blood Examination Rate (ABER) in Malarious Areas, 1998–2004

1,280,000

1,332,000

1,359,000

1,288,000

1,374,000

1,403,000

1,424,000

103,976

96,454

61,261

43,123

17,748

9,622

9,204

1998

1999

2000

2001

2002

2003

2004

Examined

Population at Risk /In Malarious Areas

1,280,000

1,332,000

1,359,000

1,288,000

1,374,000

1,403,000

1,424,000

103,976

96,454

61,261

43,123

17,748

9,622

9,204

1998

1999

2000

2001

2002

2003

2004

Examined

Population at Risk /In Malarious Areas



COSTA RICA: Slide Positivity Rate (SPR), 1998–2004COSTA RICA: Slide Positivity Rate (SPR), 1998–2004

17,748

5,148

3,998

1,879

1,363

1,021

718

1,289

103,976

96,454

61,261

43,123

9,622

9,204

1998

1999

2000

2001

2002

2003

2004

Examined

Positive17,748

5,148

3,998

1,879

1,363

1,021

718

1,289

103,976

96,454

61,261

43,123

9,622

9,204

1998

1999

2000

2001

2002

2003

2004

Examined

Positive



TreatmentTreatment



COSTA RICA: Antimalarial Drugs Used, 1998–2004COSTA RICA: Antimalarial Drugs Used, 1998–2004

0

100,000

200,000

300,000

400,000

500,000

Chloroquine &/or Amodiaquine @ 150mg 493,200 381,300 177,000 99,100 101,000 70,200 129,300

Primaquine @ 15mg 279,009 209,695 97,440 54,525 55,700 38,610 68,050

Sulfa/Pyrimethamine @ 500/25mg … … … … … … …

Mefloquine @250mg … … … … … … …

Artemisinine Derivatives (# of Tx) … … … … … … …

Quinine @ 300mg … … … … … … …

1998 1999 2000 2001 2002 2003 20040

100,000

200,000

300,000

400,000

500,000

Chloroquine &/or Amodiaquine @ 150mg 493,200 381,300 177,000 99,100 101,000 70,200 129,300

Primaquine @ 15mg 279,009 209,695 97,440 54,525 55,700 38,610 68,050

Sulfa/Pyrimethamine @ 500/25mg … … … … … … …

Mefloquine @250mg … … … … … … …

Artemisinine Derivatives (# of Tx) … … … … … … …

Quinine @ 300mg … … … … … … …

1998 1999 2000 2001 2002 2003 2004



Resources and

Financing

Resources and

Financing



COSTA RICA: National Budget and Non-Budgetary Contributions to Malaria Control Programs,

1998–2004 (in US$)

COSTA RICA: National Budget and Non-Budgetary Contributions to Malaria Control Programs,

1998–2004 (in US$)

1

10

100

1,000

10,000

100,000

1,000,000

10,000,000

ContributedFunds and Loans

National MalariaBudget

Total Budget

Contributed Funds and Loans 389 … … … … … …

National Malaria Budget 3,597,000 4,750,000 3,380,000 2,500,000 2,880,000 3,840,000 2,980,000

Total Budget 3,597,389 4,750,000 3,380,000 2,500,000 2,880,000 3,840,000 2,980,000

1998 1999 2000 2001 2002 2003 20041

10

100

1,000

10,000

100,000

1,000,000

10,000,000

ContributedFunds and Loans

National MalariaBudget

Total Budget

Contributed Funds and Loans 389 … … … … … …

National Malaria Budget 3,597,000 4,750,000 3,380,000 2,500,000 2,880,000 3,840,000 2,980,000

Total Budget 3,597,389 4,750,000 3,380,000 2,500,000 2,880,000 3,840,000 2,980,000

1998 1999 2000 2001 2002 2003 2004



COSTA RICA: Annual US$ Funds per Person in Malarious Areas, 1998–2004

COSTA RICA: Annual US$ Funds per Person in Malarious Areas, 1998–2004

0

0.5

1

1.5

2

2.5

3

3.5

4

US$ Funds per Person inMalarious Areas

2.81 3.56 2.49 1.94 1.82 2.74 2.09

1998 1999 2000 2001 2002 2003 20040

0.5

1

1.5

2

2.5

3

3.5

4

US$ Funds per Person inMalarious Areas

2.81 3.56 2.49 1.94 1.82 2.74 2.09

1998 1999 2000 2001 2002 2003 2004

Pan American Health Organization Malaria in Costa Rica, 1998–20041... Title of the presentation Author Title of the presentation Author MALARIA IN COSTA.

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