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Reportamos no presente trabalho a caracterização epidemiológica da malária, seguida da implantação de um programa de controle da endemia em uma área de garimpo, localizada ao norte do estado do Amapá. Considera-se a influência desta região no número total de casos do estado e o impacto da doença na população representada pelos funcionários e empreiteiros da Mineração Novo Astro S/A, bem como pela comunidade da Vila de Lourenço, Município de Calçoene, Amapá e garimpos adjacentes. O impacto das ações de controle adotadas no âmbito do programa, caracterizam-se pela significativa redução da incidência da malária na área e a redução da morbi-mortalidade. Ressalta-se a importância da participação da iniciativa privada, principalmente aquelas que desenvolvem projetos de grande porte na região Amazônica brasileira, no controle das endemias prevalentes na região, particularmente a malária.

Objective: Evaluation of epidemiological, clinical and laboratory features of Plasmodium vivax malaria in children and adolescents.Methods: This study was carried out in the Malaria Program of the Evandro Chagas Institute (Belém, Pará), from January 1995 to November 1996. 100 children and adolescents with the diagnosis of P. vivax malaria (thick blood film) were randomly enrolled. A protocol was created to assess epidemiological, clinical and laboratory parameters of this pathology.Results: Malaria occurred in both sexes, and had a prevailing incidence among adolescents (37%). Most of the children and adolescents (92%) had been infected in the State of Pará. Autochthonous cases in the metropolitan area of Belém accounted for 34 % of the sample. Primary infection was seen in 80% of the patients. Fever was the major onset clinical symptom (88%). A history of typical febrile paroxysm was recorded in only 25% of the casuistic. In the first day of treatment (D0) fever (97%), chills (91%), pallor (85%), splenomegaly (46%) and hepatomegaly (29%) were some of the clinical features observed. Pallor (clinical signal) was found to be significantly (p=0.0004) associated with anemia (hemoglobin rate). There was a high significant negative correlation (p=0.0001) between delay of diagnosis (mean 12,5 days) and hemoglobin values. Regarding parasitological examination, just children and adolescents with positive results to hookworms were significantly (p=0.0133, p=0.0075) more anemic than those who had a positive parasitological examination to other helminths and/or protozoa species.Conclusions: Malaria affected children and adolescents from both sexes. An emphasis on epidemiological and clinical data is an important tool to the precocious diagnosis of the disease. Delay on diagnosis made anemia worse. ResumoObjetivo: Avaliação dos aspectos epidemiológicos, clínicos e laboratoriais da malária por Plasmodium vivax em crianças e adolescentes.Métodos: No ambulatório do Programa de Malária do Instituto Evandro Chagas (Belém-Pará), no período de janeiro de 1995 a novembro de 1996, foram estudadas de modo aleatório 100 crianças e adolescentes com diagnóstico positivo por gota espessa para malária por P. vivax. Elaborou-se um protocolo para avaliação dos aspectos epidemiológicos, clínicos e laboratoriais dessa patologia.Resultados: Acometimento de ambos os sexos, com predomí-nio entre os adolescentes (37%). As crianças e adolescentes em sua maioria (92%) adquiriram a infecção no Pará. Os casos autóctones, área metropolitana de Belém, representaram 34% da amostra. Primoinfecção ocorreu em 80% dos pacientes. Febre foi a manifestação clínica inicial mais freqüente (88%). Relato de paroxismo febril típico (febre terçã) foi obtido em somente 25% da casuística. No 1º dia de tratamento (D0) febre (97%), calafrio (91%), palidez (85%), esplenomegalia (46%) e hepatomegalia (29%) foram alguns dos sinais e sintomas observados. Houve significância estatística (p=0,0004) na correlação entre palidez (avaliação clínica) e anemia (taxa de hemo...

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Introduction: In remote areas of the Amazon Region, diagnosis of malaria by microscopy is practically impossible. This study aimed to evaluate the performance of two rapid diagnostic tests (RDTs) targeting different malaria antigens stored at room temperature in the Brazilian Amazon Region. Methodology: Performance of the OptiMal Pf/Pan test and ICT-Now Pf/Pan test was analyzed retrospectively in 1,627 and 1,602 blood samples, respectively. Tests were performed over a 15-month period. Kits were stored at room temperature in five community health centres located in the Brazilian Amazon Region. RDT results were compared with thick blood smear (TBS) results to determine sensitivity, specificity, and accuracy of the RDT. Results: The sensitivities of the OptiMal Pf/Pan test were 79.7% for Plasmodium falciparum malaria diagnosis and 85.7% for non-P. falciparum infections. The results showed a crude agreement of 88.5% for P. falciparum, and 88.3% for non-P. falciparum infections (Kappa index = 0.74 and 0.75, respectively). For the ICT-Now Pf/Pan test (CI 95%), the sensitivities were 87.9% for P. falciparum malaria diagnosis and 72.5% for non-P. falciparum infection. Crude agreement between the ICT-Now Pf/Pan test and TBS was 91.4% for P. falciparum and 79.7% for non-P. falciparum infection. The Kappa index was 0.81 and 0.59 for the final diagnosis of P. falciparum and non-P. falciparum, respectively. Higher levels of parasitaemia were associated with higher crude agreement between RDT and TBS. Conclusions: The sensitivities of RDTs stored at room temperature over a 15-month period and performed in field conditions were lower than those previously reported.