Elsevier

The Lancet

Volume 354, Issue 9176, 31 July 1999, Pages 414-418
The Lancet

Public Health
Malaria control in Nicaragua: social and political influences on disease transmission and control activities

https://doi.org/10.1016/S0140-6736(99)02226-6Get rights and content
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Summary

Throughout Central America, a traditional malaria control strategy (depending on heavy use of organic pesticides) became less effective during the 1970s. In Nicaragua, an alternative strategy, based on frequent local epidemiological assessments and community participation, was developed in the 1980s. Despite war-related social instability, and continuing vector resistance, this approach was highly successful. By the end of the contra war, there finally existed organisational and ecological conditions that favoured improved malaria control. Yet the expected improvements did not occur. In the 1990s, Nicaragua experienced its worst recorded malaria epidemics. This situation was partly caused by the country's macroeconomic structural adjustment programme. Volunteers now take fewer slides and provide less treatment, malaria control workers are less motivated by the spirit of public service, and some malaria control stations charge for diagnosis or treatment. To “roll back malaria”, in Nicaragua at least, will require the roll-back of some erroneous aspects of structural adjustment.

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