HAITI Figure 1. Malaria by Annual Parasite Index (API) at commune level (ADM3), Haiti 2014 Haiti has the highest number of malaria cases among the Caribbean Islands and Central American countries (17,696 in 2014). Inadequate coverage of surveillance CubaAPI in previous years preempts assessing progress of the per 1,000 people country towards meeting its RBM and WHA 58.2 goals No cases ≤ 0.1 for MDG 6C (Figures 1 and 2). 0.11 - 1 1.01 - 5 Figure 2. Number of cases and deaths due to 5.01 - 10 malaria in Haiti, 2000-2014 10.01 - 50 >50 No data Haiti 90,000 120 s 60,000 80 e s a s h f c t o ea ® D 0 25 50 Kilometers umber 30,000 40 N Longitude/Latitude Datum WGS84 Source: PAHO/CHA/VT 0 0 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 is presumed. A death registry has not been available in 200 200 200 200 200 200 200 200 200 200 201 201 201 201 201 the country since 2004, when there were reported 24 *Confirmed cases were not reported during 2002-2003. deaths or 0.5% of all deaths reported and classified that ■ P.P. falciparum falciparum & & m mixedixed ■ ConfirmedConfirmed Ccasesases ■ Deaths Deaths year. In neighboring Dominican Republic with similar epidemiology, better surveillance, and quality of health- care, case fatality rates of 8 deaths per 1,000 malaria cases were reported, much higher than that estimated After the 2010 earthquake, malaria increased in Haiti (0.5 deaths per 1,000 malaria cases). dramatically, though it is difficult to assess the validity of data collected during this period. Data collected from Recently, there has been a country-wide effort of years prior to the earthquake were of poor quality, improving testing with the roll-out of RDTs, moving and that from 2010 may include people tested more away from giving treatment to patients presumptively, than once due to the chaotic atmosphere following and increased focus on receiving complete reports from the disaster. There were 9 malaria-related deaths all health centers as part of the Test-Treat-Track (T3) reported in 2014, though considerable under-reporting strategy. In 2014, 94.5% of the 273,707 suspected Figure 3. Communes (ADM3) with the highest malaria cases in Haiti, 2012-2014 Commune Department Croix Des Bouquets Ouest 3,076 1,842 1,989 Delmas Ouest 2,284 1,919 1,822 Stratum 2 33 Petit Goave Ouest 1,510 1,336 1,164 Carrefour Ouest 1,025 1,059 1,036 Port au Prince Ouest 1,342 856 767 Stratum 3 96 Dame Marie Grand-Anse 71 160 642 Cabaret Ouest 182 205 516 Ganthier Ouest 1,041 753 502 No information 11 Gros Morne Artibonite 112 72 490 Jeremie Grand-Anse 557 587 465 Petion Ville Ouest 626 326 404 0 50 100 Port De Paix Nord-Ouest 2,931 1,123 395 Number of communes Leogane Ouest 321 67 370 *Stratum 1: No autochthonous malaria case during Gressier Ouest 117 548 359 2012-2014; Anse d'Hainault Grand-Anse 84 33 334 Stratum 2: <1 case per 1000 inhabitants during 2012-2014; Decrease 0 3,000 0 3,000 0 3,000 Stratum 3: >1 case per 1000 inhabitants in more than 1 year during 2012-2014 Increase 2012 2013 2014 - 74 - 175,000 150,000 125,000 le 100,000 peop f o 75,000 umber N 50,000 25,000 0 3 2 4 5 8 0 1 6 7 9 1 0 3 4 2 200 201 200 200 200 200 201 201 201 200 200 200 200 200 201 *Data unavailable for 2000, 2002-2003, 2008-2009. First-line treatments Confirmed cases 4M 100% 3M 75% ) s) % on illi SPR ( m e n i t ( 2M 50% a ned i am x sitivity R e o e P l 1M 25% de eop Sli P 0M 0% 0 2 3 5 7 8 1 4 6 9 0 2 3 1 4 200 200 200 200 200 200 201 201 201 200 200 200 200 201 201 Blood Slides Examined SPR (%) Commune Department Croix Des Bouquets Ouest 3,076 1,842 1,989 2,284 1,919 1,822 Stratum 2 33 Commune Department Delmas Ouest Croix Des Bouquets Ouest 3,076 1,842 Petit1 G,98oa9ve Ouest 1,510 1,336 1,164 Delmas Ouest 2,284 1,919 Carre1,82fou2r OuestStratum 2 1,02353 1,059 1,036 1,342 856 767 Petit Goave Ouest 1,510 1,336 Figure1,P16 or4.4t au Number Prince of communesOuest Owing to this improvementStratu inm 3 surveillance, it becomes96 Carrefour Ouest 1,025 1,059 (ADM3)1,03Dame6 by Mar strataie in Haiti,Grand-A 2012-2014nse 71 160 642 Cabaret Ouest 182 205 more516 reasonable to believe that the Marmelade Port au Prince Ouest 1,342 856 767 Stratum 3 96 Ganthier Ouest 1,041 753 commune502 in Artibonite department had zero (0) cases in Commune Department Dame Marie Grand-Anse 71 160 642 No information 11 Gros Morne Artibonite 112 72 490 Croix Des Bouquets Ouest Cabaret 3,07O6uest 181,842 2 205 1,989 516 2014. All of the 466 suspected cases in 2014 were tested, 1,041 753 502 Jeremie Grand-Anse 557 587 465 Ganthier Ouest 11 54% with RDTs, and none were confirmed positive with Delmas Ouest 2,284 1,919 1,822 Stratum 2 No information33 0 50 100 Gros Morne Artibonite 112 72 490 Petion Ville Ouest 626 326 reports404 having been received for all 12 months. However, Petit Goave Ouest Jeremie1,510 Grand-Anse 1,336557 158,167 4 465 Port De Paix Nord-Ouest 2,931 1,123 395 Number of communes Leogane Ouest 321 67 the37 0Artibonite department itself received only 85% of Carrefour Ouest Peti1on,02 Ville5 Ouest 1,059 626 132,036 6 404 0 50 100 *Stratum 1: No autochthonous malaria case during Port De Paix Nord-Ouest 2,931 1,123 395 Gressier Ouest 117 Number of communes 548 monthly359 reports from2012-2014 its ;health centers in 2014 for a Port au Prince Ouest 1,342 856 767 Stratum 3 96 Leogane Ouest 321 67 370 Anse d'Hainault Grand-Anse 84 33 total334 of 2,001 confirmedStratum 2: <1 malariacase per 1000cases inhab reported.itants during Studies Dame Marie Grand-Anse 71 160 642 *Stratum 1: No autochthonous malaria case during 2012-2014; Gressier Ouest 117 548 359 Decrease 2012-2014; 0 3,000 0 3,000 conducted0 3 in,00 the0 departmentStratum 3: >1 ca shavee per 1000 reported inhabitan tsprevalence in more than of Cabaret Ouest 18A2nse d'Hainault Grand-20Anse5 84 51363 334 Stratum 2: <1 case per 1000 inhab201itants2 during 2013 2014 1 year during 2012-2014 Increase 2012-2014; malaria parasite in rural areas of 3.1% and 3% in women Ganthier Ouest 1,041 753 502 Decrease 0 3,000 0 3,000 0 No informat3,000ion Stratum1 31: >1 case per 1000 inhabitants in more than of child-bearing age (35,36). 1 year during 2012-2014 Gros Morne Artibonite 112 Increase 72 2012 490 2013 2014 557 587 465 Jeremie Grand-Anse Figure 5. Number of malaria cases and those 626 326 404 0 50 100 Petion Ville Ouest treated with first-line treatment in Haiti, 2000-2014 Port De Paix Nord-Ouest 2,931 1,123 395 Number of communes Leogane Ouest 321 67 370 *Stratum 1: No autochthonous malaria case during 175,000 Gressier Ouest 117 548 359 2012-2014; 150,000 Stratum 2: <1 case per 1000 inhabitants during Anse d'Hainault Grand-Anse 84 33 334 175,000 2012-2014; 125,000 Decrease 0 3,000 0 3,000 0 3,000 St150rat,um000 3: >1 case per 1000 inhabitants in more than le 100,000 peop 2012 2013 2014 1 125year,00 dur0 ing 2012-2014 f o Increase le 75,000 100,000 peop umber f o N 50,000 malaria75,000 cases were tested with microscopy or RDT, increasing from 72.4% and 68.9% in 2013 and 2012, 25,000 umber N 50,000 respectively (Figure 6). Only 11.9% of suspected cases 0 0 1 2 3 4 5 6 7 8 9 were25 ,00treated0 presumptively decreasing from 41.8% 0 1 2 3 4 and 36.3%0 in 2012 and 2013, respectively (Figure 5). 200 200 200 200 200 200 200 200 200 200 201 201 201 201 201 3 2 4 5 8 0 1 6 7 9 1 0 3 4 Furthermore, the proportion of health units reporting2 *Data unavailable for 2000, 2002-2003, 2008-2009. 200 201 200 200 200 200 201 201 201 175,000 200 200 200 200 200 201 monthly to the national malaria program increased to First-line treatments Confirmed cases *Data unavailable for 2000, 2002-2003, 2008-2009. 150,000 83% in 2014 from 60% in 2013 and 67% in 2012. This impliesFirst-li nethat trea tmendatats reportedCon fibyrmed Haiti cases have become more 125,000 le reliable and trends can be aptly measured in subsequent 100,000 years. Although the department of Ouest contains the peop f o communes with the highest malaria cases in the country 75,000 and accounts for 53% of all cases (Figure 3), prevalence Figure 6. Blood slides examined and SPR in Haiti, umber in the department in subsequent surveys has been N 50,000 2000-2014 reportedly4M low (0.3-3%) (35).