Spatiotemporal Analysis of Malaria Transmission in the Autonomous Indigenous Regions of Panama, Central America, 2015-2022.

Despite ongoing efforts for elimination, malaria continues to be a major public health problem in the Republic of Panama. For effective elimination, it is key that malaria foci and areas of high transmission are identified in a timely manner. Here, we study malaria transmission records for the 2015-2022 period, a time when cases have increased by a factor of ten. Using several methods to study spatial and spatiotemporal malaria confirmed case clusters at the level of localities, including LISA and scan, we found that cases are clustered across indigenous villages located within the autonomous indigenous regions of Ngäbe-Buglé, Guna Yala, and Embera, with the latter on the eastern border of Panama (with Colombia). We discuss the different factors that might be shaping the marked increase in malaria transmission associated with these clusters, which include an inflow of malaria-exposed migrating populations hoping to reach the USA, insufficient health services, and the lack of culturally sensitive actionable tools to reduce malaria exposure among the ethnically diverse and impoverished indigenous populations of Panama.

Trade, uneven development and people in motion: Used territories and the initial spread of COVID-19 in Mesoamerica and the Caribbean.

Mesoamerica and the Caribbean form a region comprised by middle- and low-income countries affected by the COVID-19 pandemic differently. Here, we ask whether the spread of COVID-19, measured using early epidemic growth rates (r), reproduction numbers (R t ), accumulated cases, and deaths, is influenced by how the 'used territories' across the regions have been differently shaped by uneven development, human movement and trade differences. Using an econometric approach, we found that trade openness increased cases and deaths, while the number of international cities connected at main airports increased r, cases and deaths. Similarly, increases in concentration of imports, a sign of uneven development, coincided with increases in early epidemic growth and deaths. These results suggest that countries whose used territory was defined by a less uneven development were less likely to show exacerbated COVID-19 patterns of transmission. Health outcomes were worst in more trade-dependent countries, even after controlling for the impact of transmission prevention and mitigation policies, highlighting how structural effects of economic integration in used territories were associated with the initial COVID-19 spread in Mesoamerica and the Caribbean.

Factores de riesgo asociados con la leishmaniasis cutánea en dos comunidades rurales de Panamá Oeste

Introducción: La leishmaniasis cutánea (LC) es una enfermedad zoonótica endémica en Panamá. Su agente causal son protozoarios del género Leishmania y la transmiten insectos flebotominos. Objetivo: Evaluar los factores de riesgos asociados con la LC y la diversidad de flebotominos en dos comunidades rurales de Panamá Oeste. Metodología: Se seleccionaron dos comunidades endémicas para LC: Trinidad de las Minas (TM), de alta incidencia y Las Pavas (LP), de baja incidencia. Los factores de riesgo asociados con la LC fueron evaluados mediante una encuesta aplicada a100 personas (TM: n=50; LP: n=50). Se colectaron flebotominos con trampas CDC durante tres noches consecutivas en temporada lluviosa y seca. Resultados: La mayoría de las personas confirmó conocer sobre la LC (TM: 96% y LP: 68%). No se encontraron diferencias significativas entre las características sociodemográficas, estructura de las viviendas, composición del peridomicilio y abundancia/diversidad de animales domésticos en ambas comunidades. El reporte de perezosos cercanos al peridomicilio fue mayor en TM (70%) vs LP (32%). La especie de flebotomino antropofílica más abundante durante la temporada seca fue Lutzomyia gomezi (TM: 40.1% y LP: 10.4%). Durante la temporada lluviosa fue Nyssomyia trapidoi (43.4%) en TM y Psychodopygus panamensis (75.7%) en LP. Las especies zoofílicas más comunes en ambas comunidades fueron Trichopygomyia triramula y Pressatia dysponeta. Conclusión: La mayor incidencia de LC en TM podría estar condicionada a su ecología montañosa, con una cobertura boscosa cercana más extensa y una mayor frecuencia de mamíferos reservorios silvestres. Se confirmó la presencia de vectores de LC en el peridomicilio de ambas comunidades. (provisto por Infomedic International)

Introduction: Cutaneous leishmaniasis (CL) is a zoonotic disease endemic in Panama. Its causal agent are protozoa of the genus Leishmania and is transmitted by phlebotomine sandflies. Objective: To evaluate the risk factors associated with CL and the diversity of phlebotomine sandflies in two rural communities in western Panama. Methodology: Two CL endemic communities were selected: Trinidad de las Minas (TM), with high incidence and Las Pavas (LP), with low incidence. The risk factors associated with CL were assessed by means of a survey applied to 100 people (TM: n=50; LP: n=50). Phlebotomine sandflies were collected with CDC traps during three consecutive nights in rainy and dry season. Results: The majority of people confirmed knowledge about CL (TM: 96% and LP: 68%). No significant differences were found between sociodemographic characteristics, housing structure, peridomicile composition and abundance/diversity of domestic animals in both communities. The report of sloths near the peridomicile was higher in TM (70%) vs LP (32%). The most abundant anthropophilic phlebotomine species during the dry season was Lutzomyia gomezi (TM: 40.1% and LP: 10.4%). During the rainy season it was Nyssomyia trapidoi (43.4%) in TM and Psychodopygus panamensis (75.7%) in LP. The most common zoophilic species in both communities were Trichopygomyia triramula and Pressatia dysponeta. Conclusion: The higher incidence of CL in TM could be conditioned to its mountainous ecology, with a more extensive nearby forest cover and a higher frequency of wild mammal reservoirs. The presence of CL vectors in the peridomicile of both communities was confirmed. (provided by Infomedic International)

Long-term transmission patterns and public health policies leading to malaria elimination in Panamá.

BACKGROUND: The present study provides a countrywide perspective of the malaria situation in Panamá over a long-term framework, with the purpose of identifying historical malaria resurgence events and their potential causes. METHODS: A descriptive-ecological study was conducted by analysing demographic and epidemiological annual malaria time series data in Panamá (1884-2019) using several data sources. Malaria intensity indicators were calculated during the study period. The effects of El Niño Southern Oscillation on malaria transmission were also analysed using a retrospective analysis of malaria cases between 1957 and 2019. RESULTS: Several factors were identified responsible for malaria resurgence in Panamá, mostly related with Malaria Control Programme weakening. During the past 20 years (2000-2019) malaria has progressively increased in prevalence within indigenous settlements, with a predominance of male cases and a high proportion (15% of total cases) in children less than 5 years old. During this period, a significant and increasing proportion of the Plasmodium falciparum cases were imported. Retrospective analysis (1957-2019) evidenced that ENSO had a significant impact on malaria transmission dynamics in Panamá. CONCLUSIONS: Data analysis confirmed that although authorities have been successful in focalizing malaria transmission in the country, there are still neglected issues to be solved and important intercultural barriers that need to be addressed in order to achieve elimination of the disease by 2022. This information will be useful for targeting strategies by the National Malaria Elimination Programme.

Malaria infection rates in Anopheles albimanus (Diptera: Culicidae) at Ipetí-Guna, a village within a region targeted for malaria elimination in Panamá.

The Panamá Canal construction encompassed one of the first examples of malaria elimination. Nevertheless, malaria has uninterruptedly persisted in Native American populations living within a few kilometers of the Panamá Canal. Here, we present results from a monthly longitudinal study (May 2016 to March 2018), whose goal was to quantitatively describe seasonal patterns of Plasmodium spp. infection in Anopheles albimanus Wiedemann, and its association with environmental covariates, at Ipetí-Guna, a village within a region targeted for malaria elimination in Panamá. To detect Plasmodium spp. infections we employed a standard nested PCR on DNA extracts from mosquito pools of varying size, which were then used to estimate monthly infection rates using a maximum likelihood method. The infection rate estimates (IR) were analyzed using time series analysis methods to study their association with changes in rainfall, temperature, NDVI (a satellite derived vegetation index), malaria cases and human biting rates (HBR). We found that mosquitoes were infected by Plasmodium vivax mainly from September to December, reaching a peak in December. Time series modeling showed malaria IR in An albimanus increased, simultaneously with HBR, and IR in the previous month. These results suggest that elimination interventions, such as mass drug administration, are likely to be more effective if deployed from the middle to the end of the dry season (March and April at Ipetí-Guna), when the likelihood of malaria infection in mosquitoes is very low and when curtailing human infections driving infections in mosquitoes can reduce malaria transmission, and increase the chance for elimination.

Population Dynamics of Anopheles albimanus (Diptera: Culicidae) at Ipetí-Guna, a Village in a Region Targeted for Malaria Elimination in Panamá.

Anopheles albimanus Wiedemann is a major malaria vector in Mesoamerica and the Caribbean whose population dynamics, in response to changing environments, has been relatively poorly studied. Here, we present monthly adult and larvae data collected from May 2016 to December 2017 in Ipetí-Guna, a village within an area targeted for malaria elimination in the República de Panamá. During the study period we collected a total of 1678 Anopheles spp. mosquitoes (1602 adults and 76 larvae). Over 95% of the collected Anopheles spp. mosquitoes were An. albimanus. Using time series analysis techniques, we found that population dynamics of larvae and adults were not significantly correlated with each other at any time lag, though correlations were highest at one month lag between larvae and adults and four months lag between adults and larvae. Larvae population dynamics had cycles of three months and were sensitive to changes in temperature with 5 months lag, while adult abundance was correlated with itself (1 month lag) and with the normalized difference vegetation index (NDVI) with three months lag. A key observation from our study is the absence of both larvae and adults of An. albimanus between January and April from environments associated with Guna population's daily activities, which suggests this time window could be the best time to implement elimination campaigns aimed at clearing Plasmodium spp. parasites from Guna populations using, for example, mass drug administration.

Climatic fluctuations and malaria transmission dynamics, prior to elimination, in Guna Yala, República de Panamá.

BACKGROUND: Malaria has historically been entrenched in indigenous populations of the República de Panamá. This scenario occurs despite the fact that successful methods for malaria elimination were developed during the creation of the Panamá Canal. Today, most malaria cases in the República de Panamá affect the Gunas, an indigenous group, which mainly live in autonomous regions of eastern Panamá. Over recent decades several malaria outbreaks have affected the Gunas, and one hypothesis is that such outbreaks could have been exacerbated by climate change, especially by anomalous weather patterns driven by the EL Niño Southern Oscillation (ENSO). RESULTS: Monthly malaria cases in Guna Yala (1998-2016) were autocorrelated up to 2 months of lag, likely reflecting parasite transmission cycles between humans and mosquitoes, and cyclically for periods of 4 months that might reflect relapses of Plasmodium vivax, the dominant malaria parasite transmitted in Panamá. Moreover, malaria case number was positively associated (P < 0.05) with rainfall (7 months of lag), and negatively with the El Niño 4 index (15 months of lag) and the Normalized Difference Vegetation Index, NDVI (8 months of lag), the sign and magnitude of these associations likely related to the impacts of weather patterns and vegetation on the ecology of Anopheles albimanus, the main malaria vector in Guna Yala. Interannual cycles, of approximately 4-year periods, in monthly malaria case numbers were associated with the El Niño 4 index, a climatic index associated with weather and vegetation dynamics in Guna Yala at seasonal and interannual time scales. CONCLUSION: The results showed that ENSO, rainfall and NDVI were associated with the number of malaria cases in Guna Yala during the study period. These results highlight the vulnerability of Guna populations to malaria, an infection sensitive to climate change, and call for further studies about weather impacts on malaria vector ecology, as well as the association of malaria vectors with Gunas paying attention to their socio-economic conditions of poverty and cultural differences as an ethnic minority.

Enzootic mosquito vector species at equine encephalitis transmission foci in the República de Panamá.

The identification of mosquito vector species present at arboviral enzootic transmission foci is important to understand transmission eco-epidemiology and to propose and implement prevention and control strategies that reduce vector-borne equine encephalitis transmission. The goal of this study was to identify mosquito species potentially involved in the transmission of enzootic equine encephalitis, in relation to their abundance and diversity at three endemic regions in the República de Panamá. We sampled adult mosquitoes during the dry and rainy season of Panamá. We employed CDC light traps with octanol, EV traps with CO2 and Trinidad 17 traps baited with live hamsters. Traps were deployed in the peridomicile and extradomicile of houses from 18:00 to 6:00 h. We estimated the abundance and diversity of sampled species. We collected a total of 4868 mosquitoes, belonging to 45 species and 11 genera, over 216 sampling nights. Culex (Melanoconion) pedroi, a major Venezuelan equine encephalitis vector was relatively rare (< 2.0% of all sampled mosquitoes). We also found Cx. (Mel) adamesi, Cx. (Mel) crybda, Cx. (Mel) ocossa, Cx. (Mel) spissipes, Cx. (Mel) taeniopus, Cx. (Mel) vomerifer, Aedes scapularis, Ae. angustivittatus, Coquillettidia venezuelensis, Cx. nigripalpus, Cx. declarator, Mansonia titillans, M. pseudotitillans and Psorophora ferox all species known to be vectorially competent for the transmission of arboviruses. Abundance and diversity of mosquitoes in the sampled locations was high, when compared with similar surveys in temperate areas. Information from previous reports about vectorial competence / capacity of the sampled mosquito species suggest that sampled locations have all the elements to support enzootic outbreaks of Venezuelan and Eastern equine encephalitides.

[Knowledge and risk factors related to Chagas' disease in two Panamanian communities where Rhodnius pallescens is the main vector]. / Conocimientos y factores de riesgo relacionados con la enfermedad de Chagas en dos comunidades panameñas donde Rhodnius pallescens es el vector principal.

INTRODUCTION: The implementation of surveillance, control and prevention measures for Chagas´ disease requires an integrated approach. The sustainability of programs depends on community participation supported on a basic understanding of the problem. OBJECTIVE: To evaluate the knowledge of people interviewed which facilitates or limits the surveillance, prevention and control of Chagas' disease in two endemic Panamanian communities where Rhodnius pallescens is the main vector. MATERIALS AND METHODS: A questionnaire assessed the knowledge and risk factors related to Chagas' disease in 201 people over 10 years of age from the endemic communities of Las Pavas and Lagartera Grande located on the western shore of Panama Canal. Additionally, with the help of the residents, the presence of triatomine bugs in 93 dwellings was evaluated during a year. RESULTS: Of those interviewed, 69.2% (139/201) had poor or very poor knowledge about Chagas' disease. Nearly 93% (187/201) was exposed to moderate or high risk factors. Triatomine bugs were collected in 20.4% (19/93) of the evaluated homes; 80% (66/76) of them were R. pallescens. Significant association was found between the presence of triatomines inside the houses and precarious housing (p<0.01). CONCLUSION: Despite having been exposed to health education-related programs, it is necessary to strengthen the basic knowledge about Chagas' disease in the two communities before establishing prevention and surveillance measures which involve active participation of its inhabitants.

Conocimientos y factores de riesgo relacionados con la enfermedad de Chagas en dos comunidades panameñas donde Rhodnius pallescens es el vector principal / Knowledge and risk factors related to Chagas´ disease in two Panamanian communities where Rhodnius pallescens is the main vector

Introducción. La implementación de los programas de vigilancia, prevención y control de la enfermedad de Chagas requiere una aproximación integral. La sostenibilidad de los programas depende de la participación comunitaria amparada en un conocimiento básico del problema. Objetivo. Evaluar los conocimientos de los entrevistados que facilitan o limitan la vigilancia, prevención y control de la enfermedad de Chagas en dos comunidades endémicas de Panamá donde Rhodnius pallescens es el vector principal. Materiales y métodos. Mediante un cuestionario se evaluaron los conocimientos y los factores de riesgo relacionados con la enfermedad de Chagas en 201 personas mayores de 10 años de las comunidades endémicas de Las Pavas y Lagartera Grande, ubicadas en la ribera oeste del Canal de Panamá. Con ayuda de los moradores también se evaluó la presencia de chinches triatominos en 93 viviendas a lo largo de un año. Resultados. De las personas entrevistadas, 69,2 % (139/201) tenía pocos o muy pocos conocimientos sobre la enfermedad de Chagas y 93 % (187/201) estaba expuesto a factores de riesgo moderados o altos. Se capturaron chinches triatominos en 20,4 % (19/93) de las viviendas evaluadas, de los cuales, el 86,8 % (66/76) era R. pallescens. Se encontró asociación significativa entre la presencia de chinches dentro de las viviendas y las viviendas catalogadas como precarias (p<0,01). Conclusión. A pesar de que en estas dos comunidades se han desarrollado programas de educación sanitaria, es necesario reforzar los conocimientos básicos sobre la enfermedad de Chagas antes de establecer medidas de prevención y vigilancia que involucren la participación activa de sus habitantes.

Introduction: The implementation of surveillance, control and prevention measures for Chagas´ disease requires an integrated approach. The sustainability of programs depends on community participation supported on a basic understanding of the problem. Objective: To evaluate the knowledge of people interviewed which facilitates or limits the surveillance, prevention and control of Chagas´ disease in two endemic Panamanian communities where Rhodnius pallescens is the main vector. Materials and methods: A questionnaire assessed the knowledge and risk factors related to Chagas´ disease in 201 people over 10 years of age from the endemic communities of Las Pavas and Lagartera Grande located on the western shore of Panama Canal. Additionally, with the help of the residents, the presence of triatomine bugs in 93 dwellings was evaluated during a year. Results: Of those interviewed, 69.2% (139/201) had poor or very poor knowledge about Chagas´ disease. Nearly 93% (187/201) was exposed to moderate or high risk factors. Triatomine bugs were collected in 20.4% (19/93) of the evaluated homes; 80% (66/76) of them were R. pallescens . Significant association was found between the presence of triatomines inside the houses and precarious housing (p<0.01). Conclusion: Despite having been exposed to health education-related programs, it is necessary to strengthen the basic knowledge about Chagas´ disease in the two communities before establishing prevention and surveillance measures which involve active participation of its inhabitants.

When climate change couples social neglect: malaria dynamics in Panamá.

A major challenge of infectious disease elimination is the need to interrupt pathogen transmission across all vulnerable populations. Ethnic minorities are among the key vulnerable groups deserving special attention in disease elimination initiatives, especially because their lifestyle might be intrinsically linked to locations with high transmission risk. There has been a renewed interest in malaria elimination, which has ignited a quest to understand factors necessary for sustainable malaria elimination, highlighting the need for diverse approaches to address epidemiological heterogeneity across malaria transmission settings. An analysis of malaria incidence among the Guna Amerindians of Panamá over the last 34 years showed that this ethnic minority was highly vulnerable to changes that were assumed to not impact malaria transmission. Epidemic outbreaks were linked with El Niño Southern Oscillations and were sensitive to political instability and policy changes that did not ensure adequate attention to the malaria control needs of the Gunas. Our results illustrate how the neglect of minorities poses a threat to the sustainable control and eventual elimination of malaria in Central America and other areas where ethnic minorities do not share the benefits of malaria control strategies intended for dominant ethnic groups.

Identificación de comportamientos saludables en el recurso humano de las ciencias de la salud del Ministerio de Salud de Panamá. 2006 / Identification of healthy behaviors in the human resource of the sciences of the health of the Department of Health of Panama.2006

Informa que los comportamientos humanos son decisivos en el estado de salud integral y bienestar de la población. Los trabajadores de la salud son facilitadores en los cambios de comportamientos de la gente, siempre y cuando también sean modelos en el ejercicio de comportamientos saludables y como agentes en la formulación y aplicación de las políticas públicas de salud del país.Esta investigación fue dirigida a la identificación de los comportamientos y estilos de vida saludables en el recurso humano de las ciencias de la salud relacionados con su condición física, dieta saludable, peso ideal, el no fumar, al consumo de bebidas alcohólicas, café, consumo de drogas, sexo seguro, exámenes para el control de la salud, control del estrés, la utilización de medidas de seguridad y precaución y los conocimientos y actitudes sobre la promoción de la salud.Fue una investigación básicamente cuantitativa, de corte transversal y de carácter descriptiva. La muestra fue de tipo probabilística y se seleccionó con base al universo de personas con formación en las ciencias de la salud que laboran en el nivel central, regional y local del Ministerio de Salud de Panamá. La información se recopiló mediante aplicación de instrumento pre-elaborado en el periodo de los meses de junio-agosto del 2006.Esta investigación pone en evidencia las debilidades de las acciones de promoción de la salud en el Sistema Nacional de Salud. El Ministerio de Salud es la Autoridad Sanitaria Nacional y por tanto el ente rector de la salud pública en el país. Tiene la responsabilidad de promover la salud de la población y por tanto la de sus propios funcionarios.

Muertes prematuras en Panamá: una estimación de la mortalidad evitable en 1990 y 2000 / Premature deaths in Panama: an estimation of the avoidable in 1990 and 2000

Informa que en este trabajo se analizan los años potenciales de vida perdidos (APVP) por muertes prematuras en Panamá en 1990 y 2000. Se estudian las causas de muerte por sexo, ocupación, población indígena o no, y distrito de residencia. Los APVP por muertes prematuras se calculan sin ajuste por omisión de defunciones y con ajuste por diferencias en la estructura por edad. Se destacan los resultados siguientes: En ambos sexos las principales causas de muertes prematuras en el país, en 1990 y 2000, fueron otras causas no transmisibles, seguidas por las causas externas. Las principales causas de muerte prematura en hombres para el 2000 fueron las causas externas, y para las mujeres otras causas no transmisibles. En el 2000, las principales causas de muerte prematura en indígenas fueron ciertas enfermedades infecciosas y parasitarias, seguido por otras causas no transmisibles, y la desnutrición, mientras que en la población no indígena se destacan otras causas no transmisibles, seguido por las causas externas, y ciertas enfermedades infecciosas y parasitarias (enfermedad por virus de la inmunodeficiencia humana (VIH). El trabajo llama la atención acerca de la importancia de los APVP por muertes prematuras como una información que debe complementar la mortalidad, y como evidencia para identificar las fuentes potenciales principales de incremento de la esperanza de vida en nuestro país, tanto en mujeres como en hombres, indígenas y no indígenas.

Evaluación del carácter de amigabilidad de los servicios que oferta el programa nacional de salud integral del adolescente en Panamá 2005 / Evaluation of the friendly character of the services offered by the National of program of comprensive health for adolescents in Panama 2005

Estudio de investigación de carácter descriptivo, y de corte transversal, que describe las características de amigabilidad de los servicios de salud que oferta el Programa Nacional de Salud Integral del Adolescente (PNSIA) desarrollado en las instalaciones del Ministerio de Salud y de la Caja de Seguro Social en el país. La evaluación incluyó encuestas pre elaboradas a funcionarios de salud y a adolescentes de 10 a 19 años, usuarios de los servicios en todas las regiones sanitarias del país. Los resultados señalan que las condiciones de eficiencia de los servicios de salud son en su mayoría deficiente para la atención integral del adolescente y las características de amigabilidad de los servicios que oferta el PNSIA del sector público de salud panameño se cumplen parcialmente

Evaluación del carácter de amigabilidad de los servicios que oferta el programa nacional de salud integral del adolescente en Panamá 2005 / Evaluation of the friendly character of the services offered by the National of Program of Comprensive Health for Adolescents in Panamá 2005

Estudio de investigación de carácter descriptivo, y de corte transversal, que describe las características de amigabilidad de los servicios de salud que oferta el Programa Nacional de Salud Integral del Adolescente (PNSIA) desarrollado en las instalaciones del Ministerio de Salud y de la Caja de Seguro Social en el país. La evaluación incluyó encuestas pre elaboradas a funcionarios de salud y a adolescentes de 10 a 19 años, usuarios de los servicios en todas las regiones sanitarias del país.Los resultados señalan que las condiciones de eficiencia de los servicios de salud son en su mayoría deficiente para la atención integral del adolescente y las características de amigabilidad de los servicios que oferta el PNSIA del sector público de salud panameño se cumplen parcialmente