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Executive SummaryBased on 1999 data, the total estimated population of the Amazon countries is 280 million, of which 42% (118 million) live in areas where ecological conditions favor malaria transmission. Of the latter, 93 million (33.2%) are exposed to low risk for malaria transmission, and the other 25 million (9.0%) live in areas of moderate to high risk of transmission. Currently, no systematic data nor in-depth information are available on resistance to antimalarial drugs in the Americas, but isolated studies have found resistance of Plasmodium falciparum, the more deadly form of malaria, to a number of the most commonly used drugs. In March 1998, the Pan American Health Organization (PAHO), Regional Office of the World Health Organization (WHO), sponsored an expert committee meeting in Manaus, Brazil, to develop standardized methods to assess the therapeutic efficacy of drugs used to treat P. falciparum malaria in the Americas. In that meeting, the lack of standardized protocols to evaluate and monitor treatment failure for P. vivax malaria became evident. In 1999, within the framework of WHO's Roll Back Malaria Initiative, and under PAHO's leadership, a regional strategy was developed for the Americas focusing on the Amazon region. National participants agreed to set up a surveillance network to determine and monitor the efficacy of malaria treatments. Other activities followed, and culminated in a meeting held in Salvador, Bahia, Brazil in March 2001. During discussions at the Bahia meeting, it was shown that current policies regarding malarial drugs in the region do not necessarily respond to scientific evidence, and that the scarcity of information on drug effectiveness limits its potential use for national decision-making regarding malaria treatment policies. Main Interventions and Issues
This PAHO project (RAVREDA, short for Red Amazónica de Resistencia contra las Drogas Antimaláricas, or the Amazon Network for Resistance to Antimalarial Drugs) supports the USAID's Amazon Malaria Initiative(AMI) objective that "Malaria control programs in target countries in the Amazon Basin subregion substantially incorporate selected best practices," and the USAID Latin America and Caribbean Regional Strategic Objective "More effective delivery of selected health services and policy interventions." The project also contributes to the worldwide goal of Roll Back Malaria Initiative to significantly reduce the global burden of malaria through interventions adapted to local needs. In consequence, the first steps in this joint project, called RAVREDA-AMI because it links the two initiatives, will be to develop a sentinel surveillance network to generate reliable and standardized drug efficacy information of antimalarial drug resistance in the Amazon countries, and to initiate drug efficacy studies in Brazil, Colombia, Ecuador, Guyana, Suriname, and Venezuela. USAID missions, in coordination with PAHO, will implement parallel activities in Bolivia and Peru, where both missions work jointly with national communicable diseases programs on malaria control. The USAID Amazon Malaria Initiative will be implemented during a five-year period. However, this document provides a proposal for PAHO's participation in the first year only, during which activities will be devoted to the establishment of the sentinel surveillance network, initiation of drug efficacy studies, and selected tools adaptation and testing activities. The budget required for implementing this proposal is US$ 1,382,000 (including program support costs). A detailed description of goals, expected results, indicators and activities, and the budget are provided in the body of the document.
Country Workplans
About RAVREDA-AMI
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