By Wyatt Massey
A binational initiative by Haiti and the Dominican Republic to combat malaria won a Malaria Champions award from the Pan American Health Organization on Nov. 6. The annual award, part of PAHO’s Malaria Day in the Americas, honored three projects around the world for their “outstanding work in interrupting malaria transmission and developing local systems to access malaria diagnosis and treatment,” according to a PAHO statement.
The project included the border communities of Ouanaminthe, in Haiti, and Dajabon, in the Dominican Republic. Thousands of people cross the border to buy and sell goods in Dajabon’s binational market. Malaria is a migration issue in the area, said Keyla Ureña, Centro Nacional para el Control de Enfermedades Tropicales (CENCET) Malaria Diagnostics and Treatment auditor.
“The border area is a challenge,” said Dr. Jean-Frantz Lemoine, Ministère de la Santé Publique et de la Population (MSPP) National Malaria Program coordinator. “Mosquitos need no passport or visa to cross the border, so there is a real coordination with the Dominicans.”
The joint effort received international attention for improving the monitoring, diagnosis and treatment of malaria by involving the private sector, community members and traditional health workers. An important step was standardizing how each health organization would respond to malaria cases, said Angel Solís, CENCET entomology and vector control coordinator.
According to a PAHO report, Haiti has the highest number of malaria cases in Central America and the Caribbean Islands. The upper estimates of cases is more than 200,000 in 2000 but fell to 100,000 in 2015. Yet, the country remained in the top-five globally for estimated cases with nine percent in 2015, according to the World Health Organization. However, percentage of cases ending in death has risen.
Nearly 1,000 cases of malaria were recorded in the province of Dajabon in 2007. So far in 2017, Dajabon workers have recorded only three cases, Ureña said.
Haitians given a diagnosis in Dajabon can be referred to treatment or have follow-ups done in Haiti because health workers on both sides of the border are communicating. Case-by-case investigations help workers determine where the source of the infection, said Estelius Alce, a MSPP epidemiologist.
Health workers also investigate and follow-up on cases of malaria. People in close proximity to the confirmed case are tested, too, using a rapid diagnostic test. These tests are a reliable way of detect malaria in areas with limited access to microscopes.
“It has been an important achievement, to harmonize, and to establish the same work policies in one or the other side of the border,” she said. “And this, truly, opens the door and all possibilities to eliminate malaria for the island of Hispaniola.”
Health workers on both sides of the border have shared ideas. For example, the Dominican Republic used a Haitian model for distributing mosquito nets and Haiti began using primaquine, a World Health Organization essential medicine for treating malaria.
“We are on the right path,” Alce said. “I am not a prophet, but I can predict that in a few more months we will have zero cases.”