Guatemala Region of the Americas

I. Epidemiological prole Population (UN Population Division) 2017 % Parasites and vectors High transmission (>1 case per 1000 population) 2.3M 14 Major plasmodium species: P.falciparum: 0 (%) , P.vivax: 99 (%) Low transmission (0-1 case per 1000 population) 10.5M 62 Major anopheles species: An. albimanus, An. pseudopunctipennis, An. darlingi Malaria free (0 cases) 4.1M 25 Total 16.9M

Reported cases and deaths Estimates Reported conrmed cases (health facility): 3743 Estimated cases: 4.7K [4K, 6.1K] Conrmed cases at community level: 0 Conrmed cases from private sector: - Reported deaths: 0 Estimated deaths: 1 [0, 3]

II. Intervention policies and strategies Yes/ Year Intervention Policies/Strategies Medicine Year adopted No adopted Antimalaria treatment policy ITN ITNs/LLINs distributed free of charge Yes 2006 First-line treatment of unconrmed malaria - - ITNs/LLINs distributed to all age groups Yes 2006 First-line treatment of P. falciparum CQ+PQ - IRS IRS is recommended Yes - For treatment failure of P. falciparum CQ+PQ - DDT is used for IRS No - Treatment of severe malaria QN - Larval control Use of Larval Control Yes 2005 Treatment of P. vivax CQ+PQ(14d) - IPT IPT used to prevent malaria during pregnancy NA - Dosage of primaquine for radical treatment of P. vivax 0.25 mg/Kg (14 days) Diagnosis Patients of all ages should receive diagnostic test Yes 2012 Type of RDT used - Malaria diagnosis is free of charge in the public sector Yes - Therapeutic efcacy tests (clinical and parasitological failure, %) Treatment ACT is free for all ages in public sector No - Medicine Year Min Median Max Follow-up No. of studies Species has never The sale of oral artemisinin-based monotherapies (oAMTs) - Resistance status by insecticide class (2010-2017) and use of class for malaria vector control (2017) been 1 2 3 allowed Insecticide class Years (%) sites Vectors Used Single dose of primaquine (0.25 mg base/kg) is used as Carbamates 2011-2017 0% (10) - No Yes - gametocidal medicine for P. falciparum Organochlorines 2014-2014 0% (4) - No Primaquine is used for radical treatment of P. vivax Yes 1970 Organophosphates 2011-2011 50% (4) An. albimanus No Pyrethroids 2011-2017 12.5% (16) An. albimanus Yes G6PD test is a requirement before treatment with primaquine No - Directly observed treatment with primaquine is undertaken No 2000 1Percent of sites for which resistance conrmed and total number of sites that reported data (n) System for monitoring of adverse reaction to antimalarials exists No 2009 2Principal vectors that exhibited resistance Surveillance ACD for case investigation (reactive) Yes - 3Class used for malaria vector control in 2017 ACD at community level of febrile cases (pro-active) Yes - Mass screening is undertaken - - Uncomplicated P. falciparum cases routinely admitted No - Uncomplicated P. vivax cases routinely admitted No - Case and foci investigation undertaken Case reporting from private sector is mandatory Yes 2000

III. Charts Sources of nancing Government expenditure by intervention in 2017

20M

15M

10M Contribution($USm) 5M

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Insecticides & spray materials ITNs Diagnostic testing Others WHO/UNICEF USAID/PMI Worldbank (USD) Antimalarial medicines Monitoring and evaluation Global Fund (USD) Government contribution Human resources & technical assistance Management and other costs

IV. Coverage Coverage of ITN and IRS Cases tested and treated in public sector

100 100%

75 75%

50 50% Population

(%)Suspected cases tested 25%

0 0%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 At high risk protected with ITNs At high risk protected with IRS % of the population who slept under an ITN the previous night (survey) Suspected cases tested Antimalarials distributed vs reported cases % of households with at least 1 ITN (survey) Primaquine distributed vs reported P. v. cases

V. Impact Cases treated Test positivity

100% 100%

75% 75%

50% (%) 50% Tests (%)

25% 25%

0% 0%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 % fever cases <5 seeking treatment at public HF (survey) Reporting completeness Slide positivity rate RDT positivity rate

Source: DHS 2015

V. Impact Conrmed malaria cases per 1000 and ABER Malaria admissions and deaths

5 5 4 8

4 4 3 6 Deaths

3 3 ABER (%)

2 4 Admissions 2 2 Cases per 1000

1 2

1 1

0 0 0 0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Admissions (all species) Admissions (P. vivax)) Deaths (all species) ABER Cases(all species) Cases (P. vivax) Deaths (P. vivax))

Footnotes (est.) : WHO estimates based on the survey World Malaria Report 2018