The declaration of Suriname as the first malaria-free Amazonian country by the World Health Organization should spur other countries in the region affected by illegal mining and high migration, say disease specialists.
The small country on the northeastern coast of South America is one of the poorest in Latin America, heavily dependent on mining of natural resources such as gold and bauxite. More than 90 per cent of the land is covered in rainforest.
Roberto Montoya, regional malaria advisor for the Pan American Health Organization (PAHO), who has worked extensively in the region, told SciDev.Net: "The elimination of malaria in Suriname is a very important milestone because it shows that it is possible, even with jungle, gold mining, and dispersed indigenous populations, for health ministries to overcome these challenges."
The country, which is one of the smallest in South America with a population of less than 630,000 people, achieved eradication after nearly seven decades of work.
The certification last week (30 June), took the total of malaria-free countries in the Americas to 12, and the global total to 46, plus one territory.
The Amazon region encompasses nine countries and its abundant rainforests are an ideal breeding ground for mosquitoes, which carry the parasite that transmits malaria.
This is what makes Suriname's achievement even more significant, says Montoya.
"Being malaria-free means that our population is no longer at risk of contracting this disease," said Amar Ramadhin, Suriname's Minister of Health in a press statement.
"Furthermore, eliminating malaria will have positive effects on our health sector, boost the economy, and improve tourism."
He stressed that to maintain the status the country would need to conduct ongoing surveillance.
"We must continue to take the necessary measures to prevent the reintroduction of malaria," he urged.
Transmission hotspots
Suriname used two strategies to obtain the certificate, Montoya explained. One was reaching out to indigenous communities, which often meant travelling up to two hours by river to seek a diagnosis. The other was making contact with legal and illegal miners.
Gold mining and the resulting movement of workers is closely linked to malaria in South America, in countries such as Colombia, Venezuela, Brazil, and Guyana, according to Montoya.
This creates transmission hotspots that are difficult to control.
These populations self-medicate and incompletely follow treatments, which also leads to resistance problems."
Roberto Montoya, regional malaria advisor for the Pan American Health Organization
To counter this, health officials took rapid diagnostics tests and treatments directly to the people.
"Community members, including those associated with mining, were trained to administer medicines," the PAHO expert said.
"We went to the mining camps to create mechanisms to connect these informal actors," he added.
The switch from eight-day quinine treatment to other artemisinin-derived medicines in 2005 was also instrumental in fighting the disease, according to Montoya.
Angélica Knudson-Ospina, a malaria expert at the National University of Colombia, highlighted the importance of the political will demonstrated by Suriname, which is sometimes lacking.
"Suriname also had a very nice strategy for providing diagnostic and treatment kits, which encourages self-care among miners," she told SciDev.Net.
"It's a financial effort and requires the participation of many entities, including the owners of the mining companies, who must give their consent.
She added: "These networks must be built to bring so many stakeholders together. That's why political will is key."
Reactivation risk
Malaria is spread by female Anopheles mosquitoes, which transmit Plasmodium parasites. These parasites lodge in the human liver and cause symptoms including fever, vomiting, and anaemia.
In the Americas, the most common variant — found in three quarters of cases — is Plasmodium vivax, which is different to the more lethal Plasmodium falciparum, predominant in the African continent.
The predominant variant in the Americas persists after treatment and the parasite can remain dormant in the liver for many months, Montoya explained.
"It's harder to eliminate, and reactivation can occur after four months. Therefore, more treatment is required, with many days of pills," he said.
Other countries in the region on the path to eliminating malaria are Mexico, Costa Rica, the Dominican Republic, and French Guiana.
High caseloads of the disease persist in Brazil, Colombia, and Venezuela, as well as Peru and Haiti.
WHO certifies Suriname as malaria free after decades of efforts