DOMINICAN REPUBLIC Figure 1

DOMINICAN REPUBLIC Figure 1. Malaria by Annual Parasite Index (API) at The Dominican Republic has reduced malaria by 59.8% municipality level (ADM2), Dominican Republic since the year 2000. Though the WHA 58.2 target for 2014 MDG 6C may not be reached by 2015, the country has achieved a notable decrease in morbidity (Figures 1 API and 2). In 2014, the Dominican Republic was classified per 1,000 people as being in the pre-elimination phase. In 2010, the No cases ≤ 0.1 country had a surge of cases after the earthquake struck 0.11 - 1 neighboring Haiti. Since then, morbidity has decreased Haiti 1.01 - 5 by 80%. 5.01 - 10 Dominican Republic 10.01 - 50 >50 Figure 2. Number of cases and deaths due to malaria in Dominican Republic, 2000-2014 ® 0 25 50 100 Kilometers Longitude/Latitude 4,000 20 Datum WGS84 Source: PAHO/CHA/VT 3,000 15 s e s a s h f c t o 2,000 10 ea D Dajabon is known for its binational market attracting umber N 1,000 4,000 5 many Haitians 20and Dominicans alike, leading to movement of people across the border. Approximately 0 0 2000 Haitians are allowed to enter the country twice 0 1 2 3 4 5 6 7 8 9 3,000 0 1 2 3 4 weekly to buy and15 sell goods since 2005 when the s 200 200 200 200 200 200 200 200 200 200 201 201 201 201 201 e market was established. Malaria is attributed to this s Confirmed Cases a P. falciparum & Mixed Deaths s h ■ f c ■ ■ immigration in Dajabon, but cases have decreased in P. falciparum & mixed Confirmed cases Deaths t o 2,000 10 the past year (17 casesea compared to 1000 in 2007) due to focused interventions,D improvements in umber N surveillance, and partner support. Municipality Province 1,000 5 Santo Domingo Norte Santo Domingo 5 10 110 Santo Domingo EsteTheS anprovincesto Domingo of13 Santo Domingo20 had an outbreak75 in The country investigates all cases and found that 37 13 10 45 Tamayo Baoruco 0 0 Neiba 2014,Baoru reportingco 16117 more cases23 from 2013 particularly43 cases were imported in 2014. During 2012-2014, 0 1 3 5 4 6 7 9 2 8 1 4 0 2 Las Yayas de Viajamina theAzu a municipalities6 of Santo0 Domingo North33 and there was 3 70 municipalities designated as stratum 2 Higuey La Altagracia 7 30 28 200 200 200 200 201 201 200 200 200 200 201 201 Santo Domingo East (Figure 3). In200 the northwestern 200 and 71 as201 stratum 1 (Figure 4). However, there were Cristobal Independencia 1 8 22 Santo Domingo* part Distofr itothe Naci onacountry,l 4 theConfi rmedmunicipality3 Cases of Dajabon18 P. falci parumhas & Mixed 14 municipalitiesDeaths with more than 1 case per 1,000 Dajabon decreasedDajabon its cases considerably99 51 in the past17 decade. inhabitants in 1 or more years (stratum 3). San Gregorio** San Cristobal 0 0 12 Decrease 0 50 100 0 50 100 150 0 50 100 Figure 3. Municipalities2012 with the 201highest3 number2014 of malaria cases in Dominican Republic, 2012-2014 Increase Municipality Province *Santo Domingo de Guzman **San Gregorio de Nigua Santo Domingo Norte Santo Domingo 5 10 110 Santo Domingo Este Santo Domingo 13 20 75 Tamayo Baoruco 13 10 45 Stratum 1 71 Stratum 2 Neiba Baoruco 17 70 23 43 Stratum 3 Las Yaya1s4 de Viajama Azua 6 0 33 0 Higue10 y 20 30 La Alt4agra0 cia 50 7 60 70 30 28 Number of municipalities Cristobal Independencia 1 8 22 *Stratum 1: No autochthonous malaria case in 2012-2014; Stratum 2: <1 case perS 1000anto inhab Domitaningots in *2012-2014; Distrito Nacional 4 3 18 Stratum 3: >1 case perD 1000ajabo inhabn itants in ≥1 year. Dajabon 99 51 17 San Gregorio** San Cristobal 0 0 12 Decrease 0 50 100 0 50 100 150 0 50 100 2012 2013 2014 Increase *Santo Domingo de Guzman **San Gregorio de Nigua Stratum 1 71 Stratum 2 70 Stratum 3 14 - 56 - 0 10 20 30 40 50 60 70 Number of municipalities *Stratum 1: No autochthonous malaria case in 2012-2014; Stratum 2: <1 case per 1000 inhabitants in 2012-2014; Stratum 3: >1 case per 1000 inhabitants in ≥1 year. Figure 4. Number of municipalities (ADM2) by strata in an incidence of 3.7 cases per 100,000 women. Men Dominican Republic, 2012-2014. between the ages of 20-24 had the highest incidence in 2014 (Figure 6). Stratum 1 71 Diagnosis and Treatment Stratum 2 70 Rapid diagnostic tests to detect malaria have been introduced in the past 5 years; however, microscopy Stratum 3 14 has been the primary method used to diagnose malaria (Figure 7). Around 80% of suspected cases were tested 0 20 40 60 80 through active case detection and 43% of all confirmed Number of municipalities cases in the country were confirmed through active *Stratum 1: No autochthonous malaria case in 2012-2014; surveillance. Age groups Stratum 2: < 1 case per 1000 inhabitants in 2012-2014; Stratum 3: > 1 case per 1000 inhabitants in ≥1 year. 50+ Chloroquine and primaquine is the first-line treatment 45-49 years for both P. falciparum and P. vivax infections. Studies Female on Hispaniola Island have shown that P. falciparum 40-44 years Male Anopheles albimanus is the principal malaria vector 35-39 years present on the Island in both the Dominican Republic continues to remain sensitive to chloroquine. Haiti and Haiti. All malaria cases are caused by P. falciparum, follows the same treatment regimen. 30-34 years though the country reported 5 P. vivax cases in 2014, 25-29 years Time from onset of symptoms to treatment has gradually all imported from Venezuela. Haiti, on the other hand, 20-24 years exclusively reported P. falciparum cases. worsened since 2012. Currently about 79% of patients receive treatment after more than 72 hours after onset 15-19 years 10-14 years Men in general tend to be more at risk of malaria in of symptoms (Figure 9). Many cases are reported in the Dominican Republic and accounted for 60.9% of Haitians, some of whom do not go to a health center 5-9 years all cases in 2014 (Figure 5). The incidence in men was when they are sick owing to their illegal immigration Under 5 status in the country. 5.8 cases per 100,000 men in 2014, while women had 50 25 0 25 50 Confirmed cases Figure 6. Malaria incidence by age and sex in Figure 5. Malaria cases by age and sex in Dominican Republic, 2014 Dominican Republic, 2014 600,000 100% 10 Female Age groups 10 9 Male 50+ 450,000 75% le 8 d SPR) 45-49 years ( ne e i t peop 6 a 40-44 years Female am 6 x 300,000 50% 000 e , e Male 5 l 35-39 years 100 4 sitivity R o eop P P per 4 30-34 years s 150,000 25% de e s Sli a 25-29 years C 2 2 20-24 years 1 0 0% 0 1 6 9 2 4 5 7 8 3 1 2 0 3 0 1 4 15-19 years 200 200 200 200 201 201 200 200 200 200 200 201 201 Under 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ 200 201 10-14 years 5 yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs RDTs Examined Blood Slides Examined SPR (%) 5-9 years Under 5 50 25 0 25 50 Confirmed cases 4,000 100% First-line treatments Confirmed Cases 3,000 75% s 63% e s s e 73% a s 79% a f c o f c 600,000 100% o 10 Female 2,000 50% 10 age t 9 Male en c umber N 450,000 75% er P 25% 23% le 8 1,000 10% d SPR) ( 8% ne e i t peop 10% 6 a 10% 7% am 0% 6 x 300,000 50% 0 000 e , 4 7 0 8 1 9 2 3 5 6 0 1 2 3 4 e 5 l 2012 2013 2014 100 4 sitivity R 200 200 200 200 201 200 200 201 201 200 200 200 201 200 201 o eop P P >72 hours 48-72 hours 24-48 hours <24 hours per 4 s 150,000 25% de e s Sli a C 2 2 1 0 0% - 57 - 0 1 6 9 2 4 5 7 8 3 1 2 0 3 0 1 4 200 200 200 200 201 201 200 200 200 200 200 201 201 Under 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+ 200 201 5 yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs RDTs Examined Blood Slides Examined SPR (%) 4,000 100% First-line treatments Confirmed Cases 3,000 75% s 63% e s s e 73% a s 79% a f c o f c o 2,000 50% age t en c umber N er P 23% 1,000 25% 10% 8% 10% 10% 7% 0 0% 4 7 0 8 1 9 2 3 5 6 0 1 2 3 4 2012 2013 2014 200 200 200 200 201 200 200 201 201 200 200 200 201 200 201 >72 hours 48-72 hours 24-48 hours <24 hours Age groups 50+ 45-49 years 40-44 years Female Male 35-39 years 30-34 years 25-29 years 20-24 years 15-19 years 10-14 years 5-9 years Under 5 50 25 0 25 50 Confirmed cases Age groups 50+ 45-49 years 600,000 100% 10 Female 10 40-44 years Female 9 Male Male 35-39 years 450,000 75% le 8 d SPR) 30-34 years ( ne e i t peop 6 25-29 years a am 6 x 300,000 50% 000 e , e 20-24 years 5 l 100 4 sitivity R o 15-19 years eop P P per 4 s 150,000 25% de e s 10-14 years Sli a C 2 5-9 years 2 1 0 0% Under 5 0 1 6 9 2 4 5 7 8 3 1 2 0 3 0 1 4 200 200 200 200 201 201 200 200 200 200 200 201 201 Under 5-9 10-150 4 15-192520-24 25-209 30-34 35-3259 40-44 45-450 9 50+ 200 201 5 yrs yrs yrs yrsConfiyrrmeds casyress yrs yrs yrs yrs RDTs Examined Blood Slides Examined SPR (%) Figure 7.

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