HONDURAS Figure 1. Malaria by Annual Parasite Index (API) at municipality level (ADM2), Honduras 2014 Since 2010, malaria in Honduras has continuously declined after having increased in previous years. Honduras successfully accomplished the WHA58.2 target for MCG 6C, and in 2014, achieved a 90% Belize decrease in morbidity compared to 2000 (Figures 1 and 2). A reduction of 37.7% of cases was reported in 2014 from the previous year. About 31 municipalities had more than 1 case per 1,000 inhabitants in one or more years (stratum 3), while 90 municipalities had less than 1 case per 1,000 inhabitants in all 3 years Guatemala during 2012-2014 (stratum 2) (Figure 3). Honduras

Figure 2. Number of cases and deaths due to API malaria in Honduras, 2000-2014 per 1,000 people No cases El Salvador 40,000 4 ≤ 0.1 0.11 - 1

Nicaragua 1.01 - 5 30,000 3 ® 5.01 - 10 0 25 50 100

s Kilometers 10.01 - 50

s e Longitude/Latitude

s Datum WGS84 >50

f c a Source: PAHO/CHA/VT t h a o 20,000 2 r 40,000 4 Stratum 1 177 D e

mb e 40,000 4 Stratum 2 90 N u 10,000 1 Figure 3. Number of municipalities (ADM2) by strata in 30,000 3 Stratum 3 31 Honduras, 2012-2014.30,000 3 s

0 50 100 150 200 s e s

0 0 s f c a t h

Number of municipalities s e a o 9 8 7 6 5 4 3 2 1 0 20,000 2 0 1 2 3 4 r s 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 D e

f c a 177

Stratum 1 t h 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 a *Stratum 1: No autochthonous malaria case in 2012-2014; o 20,000 2 mb e r

Stratum 1 177 D e

Stratum 2: <1 case per 1000 inhabitants in 2012-2014; N u Stratum 2 90 Stratum 3: >1 case per 1000 inhabitants in 2012-2014. ■C onP. fifalciparumrmed Cases & mixed ■ ConfirmedP. falciparum cases & Mix ■ ed Deaths Deaths mb e

Stratum 2 90 N u 10,000 1 Stratum 3 31 The northeastern rainforest area of La Moskitia lies along 10,000 1 Stratum 3 31 0 50 100 150 200 the Atlantic coast and has the highest incidence of malaria 0 0 Municipality Department in the countryAg eas groups well as the Mesoamerican sub-region. Number of municipalities 2 5 4 7 9 1 6 0 50 100 150 200 0 3 8 0 2 1 4 3 0 0 0 0 1 1 1 50+ 0 0 0 0 0 0 0 0 1 1 Puerto Lempira Gracias A Dios 870 1,769 7Combined,42 the departments of GraciasNumber oaf mDiosunici pandalities Colón 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 5 4 7 9 1 6 0 3 8 0 2 1 4 45-49 years *Stratum 1: No autochthonous malaria case in 2012-2014; 3 0 0 0 0 1 1 1 Female 0 0 0 0 0 0 1 1 Tocoa Colon 513 332 460 reported 69.1% of all cases in the country in 2014. The Stratum 2: <1 case per 1000 inhabitants in 2012-2014; 2 0 2 0 2 0 2 0 2 0 2 0 2 0 *Stratum 1: No autochthonous40-44 years malaria case in 2012-2014; 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 Trujillo Colon 1,376 466 290 municipality of Puerto Lempira in Gracias a Dios hadMa thele Stratum 3: >1 case per 1000 inhabitants in 2012-2014. Confirmed Cases P. falciparum & Mixed Deaths Stratum 2: <1 case35 pe-3r9 1000 years inhabitants in 2012-2014; Villeda Morales Gracias A Dios 274 390 238 highestStratum 3: number >1 case30 pe of-3r4 1000cases years inhab in Hondurasitants in 2012 (Figure-2014. 4). Confirmed Cases P. falciparum & Mixed Deaths Sonaguera Colon 560 442 217 25-29 years Brus Laguna Gracias A Dios 167 234 182 Figure 4. Municipalities20-24 years with the highest number of malaria cases in Honduras, 2012-2014 15-19 years Municipality Department Age groups Saba Colon 244 126 179 10-14 years Puerto Lempira Gracias A Dios 870 1,769 742 50+ 54 181 155 Municipality Department Age groups Danli El Paraiso 5-9 years 45-49 years Puerto Lempira Gracias A Dios 870 1,769 Tocoa 742 Colon 50+ 513 332 460 Female Olanchito Yoro 279 147 86 Under 5 45-49 years 40-44 years Tocoa Colon 513 332 Trujillo460 Colon 1,376 466 Female 290 Male Roatan Bay Islands 149 119 80 150 100 50 0 50 100 150 40-44 years 35-39 years Male Trujillo Colon Confirmed ca1s,3e7s6 466 Vill29e0da Morales Gracias A Dios 274 390 238 30-34 years Decrease Increase 0 500 1000 1500 0 500 1000 1500 0 500 1000 1500 35-39 years 2012 2013 201Vill4 eda Morale*58s % of cGarsaecis awser Ae Di cloassifis ed in 27the4 presented age groups. 390 Son238aguera Colon 30-34 years 560 442 217 25-29 years Sonaguera Colon 560 442 B21ru7s Laguna Gracias25-29 A Dios years 167 234 182 20-24 years 15-19 years Brus Laguna Gracias A Dios 167 234 18Sa2ba Colon 20-24 years 244 126 179 15-19 years 10-14 years 80 Saba Colon 244 126 17Da9nli El Paraiso 54 181 155 10-14 years 5-9 years 54 181 155 279 147 86 Danli El Paraiso Olanchito Yoro 5-9 years Under 5 Olanchito Yoro 279 147 8Ro6 atan Bay IslandsUnder 5 149 119 80 150 100 50 0 50 100 150 Roatan Bay Islands 149 119 80 Confirmed cases Decrease Increase 0 500150100100 0150050 0 05005100001010500150 0 500 1000 1500 2012 Confirmed cases2013 2014 *58% of cases were classified in the presented age groups. Decrease Increase 0 500 1000 1500 0 500 1000 1500 0 500 1000 1500 2012 2013 2014 *58% of cases were classified in the presented age groups.

80 80

- 78 -

40,000 4

30,000 3 s s e s f c a t h a o 20,000 2 r

Stratum 1 177 D e mb e

Stratum 2 90 N u 10,000 1 Stratum 3 31

0 50 100 150 200 0 0 Number of municipalities 2 5 4 7 9 1 6 0 3 8 0 2 1 4 3 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 2 0 2 0 2 0 2 0 2 0 2 0 2 0 *Stratum 1: No autochthonous malaria case in 2012-2014; 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 Stratum 2: <1 case per 1000 inhabitants in 2012-2014; Stratum 3: >1 case per 1000 inhabitants in 2012-2014. Confirmed Cases P. falciparum & Mixed Deaths Figure 5. Malaria cases by age and sex in Honduras, 2014 between 2010 and 2013 the number of malaria cases Municipality Department Age groups in pregnant women increased from 22 to 92 although Puerto Lempira Gracias A Dios 870 1,769 742 50+ the total number of cases decreased, implying that 45-49 years surveillance has improved in recent years. Tocoa Colon 513 332 460 Female 40-44 years Trujillo Colon 1,376 466 290 Male 35-39 years Priority Groups Villeda Morales Gracias A Dios 274 390 238 30-34 years The most affected populations in Honduras are the indigenous peoples, especially those of the Miskito 560 442 217 25-29 years Sonaguera Colon ethnic group who reside in Gracias a Dios. Other affected 20-24 years Brus Laguna Gracias A Dios 167 234 182 ethnic groups are the Tawaka in Wampusirpi and the 15-19 years Saba Colon 244 126 179 Pech in Olancho. Migratory populations, especially along 10-14 years Danli El Paraiso 54 181 155 the Nicaraguan border, report a high number of cases. 5-9 years These are mostly the Miskito people who have families Olanchito Yoro 279 147 86 Under 5 in both countries. Roatan Bay Islands 149 119 80 150 100 50 0 50 100 150 Confirmed cases Decrease Increase 0 500 1000 1500 0 500 1000 1500 0 500 1000 1500 Figure 6. Blood slides examined, RDTs examined, *58% of cases were classified in the presented age groups. 2012 2013 2014 andFig SPRure 6 in. B Honduras,lood slides 2000-2014examined, RDTs examined, and SPR in Honduras, 2000-2014 200,000 24% ) 80 Particularly, the municipality of Wampusirpi in Gracias a Dios S P R and Jose Santos Guardiola in the Bay Islands have shown 150,000 18% ( e n e d i a t

significant decline in malaria: from 702 cases in 2009 to 2 R y t e x a m 100,000 12%

cases in 2014 and from 184 cases to 11 cases, respectively. v i i e This has been achieved through a massive distribution t

Figure 3. Number of municipalities (ADM2) by strata in P o s i of LLINs coupled with improved quality of surveillance P e o p l 50,000 6% d e Honduras, 2012-2014. i and community participation in both municipalities. The S l agrarian conflict in the valley of Bajo Aguan and ensuing 0 0%

social unrest led to an outbreak of malaria in 2012 in Colon 2 0 2 0 1 2 0 2 0 3 2 0 4 2 0 5 2 0 6 2 0 7 2 0 8 2 0 9 2 0 1 2 0 1 2 0 1 2 0 1 3 2 0 1 4

and Yoro departments. RDTs Examined Blood Slides Examined SPR(%) Anopheles albimanus is the main malaria vector species. Malaria due to P. vivax is predominant, though Honduras has the highest amount of P. falciparum cases in the Mesoamerican sub-region. The number ofP. falciparum cases, however, reduced by 52.4% during 2013- Diagnosis and Treatment 2014. Lately, P. falciparum transmission has expanded Microscopy is the primary method for diagnosis (Figure and been established in Tocoa municipality of Colon 6). In 2013, the country embarked on a process of department. establishing community health posts with voluntary collaborators using RDTs for diagnosis in Puerto Lempira. The number of cases in males was only slightly higher This is being expanded to other areas in the department than females in 2014 with both sexes having an of Gracias a Dios. The number of people examined incidence rate of nearly 22 cases per 100,000 people through active case detection has more than doubled in (Figure 5). Younger age groups are more at risk for 2014 from the previous year. The SPR has continued to malaria particularly those aged 10-24 years old. decrease in recent years (consistent with case reporting) and was 2.23 in 2014. The malaria in pregnancy rate in 2014 was 34 cases per 100,000 pregnant women, which was lower than the Chloroquine with primaquine is used as the first-line rate for non-pregnant women of child-bearing age (50 treatment for both P. falciparum and P. vivax infections. cases per 100,000 women). Country guidelines indicate A 2009 study found cholorquine to be an efficacious that all pregnant women should be tested for malaria treatment for P. falciparum in Honduras (14). Since then, at each prenatal visit in all endemic areas. The policy antimalarial resistance surveillance through molecular is largely followed in some departments but not in the markers has demonstrated that the P. falciparum entire country. The lower incidence in pregnant women, parasite continues to be sensitive to chloroquine. Deaths thus, seems due to inadequate quality of surveillance in recent years have occurred in people returning from data. This can be further corroborated by the fact that Africa with malaria resistant to chloroquine.

- 79 - 200,000 24%

150,000 18% R) d S P e ( i n t e m

x a 100,000 12% e l e sitivity R a op P e P o 50,000 6% e Sli d

0 0% 2 6 7 0 3 4 5 8 9 1 2 4 0 1 3 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0

RDTs Examined Blood Slides Examined SPR(%)

200,000 24%

150,000 18% 300,000 R) d S P e ( First-line treatments i n t e m le 200,000 Confirmed Cases

x a 100,000 12% e l e f pe op sitivity R a op o P e P o e

50,000 6% m be r 100,000 Sli d N u

0 0% 2 6 7 0 3 4 5 8 9 1 0 2 4 0 1 3 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 2 0 9 7 8 3 6 5 4 1 2 0 3 4 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 2 0 200 201 200 201 200 201 200 200 200 200 201 200 200 200 201 FigureRDTs Ex7.am Numberined of malariaBlood Slide scases Examine dand thoseSPR(% ) Figure 8. Time between first symptom and treated with first-line treatment in Honduras, initiation of treatment in Honduras, 2010-2014 2000-2014 100% 26% 300,000 80% 36% 38% 55%

First-line treatments s

s e 72%

le 27% 200,000 Confirmed Cases 60% f c a 19% 15% o f pe op o t ag e

n 40% 19% 18% c e 19%

r 26% m be r 100,000 P e N u 9% 20% 8% 26% 29% 21% 0 18% 13% 0% 1 2 0 9 7 8 3 6 5 1 4 2 0 3 4 2010 2011 2012 2013 2014 200 201 200 201 201 200 200 200 200 200 201 200 200 200 201

>72 hours 48-72 hours 24-48 hours <24 hours The percentage of cases treated in a timely manner

appears100% to have worsened since 2012 (Figure 8); however, measurements of time26% changed throughout 36% Funding150,000 these80 %years, thereby3 8biasing% the data. Therefore data 55% The government has allotted funds for malaria control. froms previous years cannot be compared accurately. d

s e 72% 60% 27% Thee Global Fund has been the main contributor of ct f c a 19% 15% e t 100,000 o external funding since 2003 (Figure 10). Additional

Vector Control pr o

t ag e

fundinge has been provided by USAID through the l n 40% A campaign19 %to distribute18% ITNs in the departments c e 19%

r 26%

AMI/RAVREDAeo p project since 2008. PAHO/WHO has P e of Gracias a Dios and Colon occurred in 2013, which P 50,000 8% 9% continuously provided technical support and financial most20 %likely contributed to the reduced incidence in 26% 29% 21% resources for specific activities. 18% 13% these0 %departments (Figure 9). The use of IRS has 0 1 1 2 2 0 0 9 7 8 3 3 6 5 4 also increased2010 in recent2011 years20 1and2 currently2013 protects2014 4 20 0 20 1 20 0 20 1 20 0 20 1 20 0 20 0 20 0 20 1 20 0 20 0 20 0 20 0 more than 100,000 people. Confirmed resistance to Figure 10. Funding for malaria in Honduras, 20 1 pyrethroid>72 hours insecticide48-72 h owasurs found24-48 in h oCatacamas,urs <24 hou rOlanchos 2000-2014People protected by IRS and in Comayagua departments among An. albimanus People protected by ITNs in 2013 and 2014. No resistance has been found to pyrethroids elsewhere in the country. $4.0M

$3.0M

Figure 9. People protected by IRS and by ITNs in s) n o

Honduras, 2000-2014 illi m $2.0M n i (

$ US 150,000 $1.0M

d e $0.0M ct e 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 t 100,000 pr o 20 0 20 0 20 0 20 0 20 0 20 0 20 0 20 0 20 0 20 0 20 1 20 1 20 1 20 1 20 1

e l Government Global Fund USAID Others eo p

P 50,000

0 1 1 2 0 2 0 9 7 8 3 3 6 5 4 4 20 0 20 1 20 0 20 0 20 1 20 1 20 0 20 0 20 0 20 0 20 1 20 0 20 0 20 0 20 1

People protected by IRS People protected by ITNs

$4.0M

$3.0M s) n o illi m $2.0M n i (

$ US $1.0M

$0.0M 2 4 6 1 0 1 3 5 7 8 0 2 4 9 3 20 0 20 0 20 0 20 1 20 0 20 0 20 0 20 0 20 0 20 0 20 1 20 1 20 1 20 0 20 1

Government Global Fund USAID Others - 80 -

82

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