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      Malaria is increasing in Indigenous and artisanal mining areas in the Brazilian Amazon

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      Nature Medicine
      Springer Science and Business Media LLC

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          Challenges for malaria elimination in Brazil

          Brazil currently contributes 42 % of all malaria cases reported in the Latin America and the Caribbean, a region where major progress towards malaria elimination has been achieved in recent years. In 2014, malaria burden in Brazil (143,910 microscopically confirmed cases and 41 malaria-related deaths) has reached its lowest levels in 35 years, Plasmodium falciparum is highly focal, and the geographic boundary of transmission has considerably shrunk. Transmission in Brazil remains entrenched in the Amazon Basin, which accounts for 99.5 % of the country’s malaria burden. This paper reviews major lessons learned from past and current malaria control policies in Brazil. A comprehensive discussion of the scientific and logistic challenges that may impact malaria elimination efforts in the country is presented in light of the launching of the Plan for Elimination of Malaria in Brazil in November 2015. Challenges for malaria elimination addressed include the high prevalence of symptomless and submicroscopic infections, emerging anti-malarial drug resistance in P. falciparum and Plasmodium vivax and the lack of safe anti-relapse drugs, the largely neglected burden of malaria in pregnancy, the need for better vector control strategies where Anopheles mosquitoes present a highly variable biting behaviour, human movement, the need for effective surveillance and tools to identify foci of infection in areas with low transmission, and the effects of environmental changes and climatic variability in transmission. Control actions launched in Brazil and results to come are likely to influence control programs in other countries in the Americas.
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            Gold miners augment malaria transmission in indigenous territories of Roraima state, Brazil

            Background Endemic malaria is present in all 15 municipalities of Roraima state, Brazilian Amazonia. Knowledge of epidemiological data of specific populations can guide health policies to formulate effective strategies for integrated control of health-disease care. This study aims to ascertain when, where and who fell ill with malaria in Roraima state from 2010 to 2020. Methods This descriptive study was based on statistical secondary surveillance data through the analysis of relationships underlying numbers of cases, hospitalizations and deaths using the Malaria Epidemiological Surveillance Information System, Mortality Information System and Hospitalization Information System. Results From 2010 to 2020, there were 138,504 autochthonous cases, 26,158 Venezuelan imported cases, 3765 hospitalizations, and 77 deaths from malaria reported in Roraima. Annual parasitic incidence and the number of hospitalizations showed impressive changes over the period, but without significantly correlating with number of deaths. The proportion of Plasmodium falciparum infections had significant shifts throughout this study. Malaria prevalence in indigenous and mining areas has been increasing since 2014. Conclusion The presence of miners in indigenous areas is a reality that has been contributing to the increase of malaria cases in Roraima. The need to implement health policies that also meet this contingent is reinforced.
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              Human impacts outpace natural processes in the Amazon

              Amazonian environments are being degraded by modern industrial and agricultural activities at a pace far above anything previously known, imperiling its vast biodiversity reserves and globally important ecosystem services. The most substantial threats come from regional deforestation, because of export market demands, and global climate change. The Amazon is currently perched to transition rapidly from a largely forested to a nonforested landscape. These changes are happening much too rapidly for Amazonian species, peoples, and ecosystems to respond adaptively. Policies to prevent the worst outcomes are known and must be enacted immediately. We now need political will and leadership to act on this information. To fail the Amazon is to fail the biosphere, and we fail to act at our peril. The Amazon rainforest is a biodiversity hotspot under threat from ongoing land conversion and climate change. Two Analytical Reviews in this issue synthesize data on forest loss and degradation in the Amazon basin, providing a clearer picture of its current status and future prospects. Albert et al . reviewed the drivers of change in the Amazon and show that anthropogenic changes are occurring much faster than naturally occurring environmental changes of the past. Although deforestation has been widely documented in the Amazon, degradation is also having major impacts on biodiversity and carbon storage. Lapola et al . synthesized the drivers and outcomes of Amazon forest degradation from timber extraction and habitat fragmentation, fires, and drought. —BEL Two Reviews spotlight the threats of ongoing deforestation and degradation in the Amazon. BACKGROUND The Amazon is a critical component of the Earth climate system whose fate is embedded within that of the larger planetary emergency. The Amazon is the most species-rich subcontinental-scale ecosystem and is home to more than 10% of all named plant and vertebrate species, concentrated into just 0.5% of Earth’s surface area. The Amazon rainforest is also a critical component of the Earth climate system, contributing about 16% of all terrestrial photosynthetic productivity and strongly regulating global carbon and water cycles. Amazonian ecosystems are being rapidly degraded by human industrial activities. A cumulative total of 17% of the original forest have already been cleared, and 14% replaced, by agricultural land use. After millions of years serving as an immense global carbon pool, under further warming the Amazon rainforest is predicted to become a net carbon source to the atmosphere. Some regions have already made the transition, with forest respiration and burning outpacing forest photosynthesis. ADVANCES In this Review, we compare rates of anthropogenic and natural environmental changes in the Amazon and South America and in the larger Earth system. We focus on deforestation and carbon cycles because of their critical roles on the Amazon and Earth systems. Data for South America were compiled for the Science Panel for the Amazon (SPA) Assessment Report, which details the many dimensions of the Amazon as a regional entity of the Earth system. The SPA report, coauthored by 240 scientists from 20 countries, documents epoch-scale transformations in Amazonian biodiversity, ecosystem function, and cultural diversity. We found that rates of anthropogenic processes that affect Amazonian ecosystems are up to hundreds to thousands of times faster than other natural climatic and geological phenomena. These anthropogenic changes reach the scale of millions of square kilometers within just decades to centuries, as compared with millions to tens of millions of years for evolutionary, climatic, and geological processes. The main drivers of Amazonian habitat destruction and degradation are land-use changes (such as land clearing, wildfires, and soil erosion), water-use changes (such as damming and fragmenting rivers and increased sedimentation from deforestation), and aridification from global climate change. Additional important threats come from overhunting and overfishing, introduction of invasive exotic species, and pollution from the mining of minerals and hydrocarbons. OUTLOOK Given the outsized role of the Amazon in our planetary hydrological cycle, large-scale deforestation of this region is expected to push the whole Earth system across a critical threshold to a qualitatively different global climate regime. Quite aside from biodiversity losses, such a transformation will have multifarious and catastrophic consequences for human welfare, including widespread water and food insecurity that will lead to mass migrations and political instability. The key message is that Amazonian environments are being degraded by human industrial activities at a pace far above anything previously known, imperiling its vast biodiversity reserves and globally important ecosystem services. The Amazon is now perched to transition rapidly from a largely forested to a nonforested landscape, and the changes are happening much too rapidly for Amazonian species, peoples, and ecosystems to respond adaptively. Policies to prevent the worst outcomes are known and must be enacted immediately. We now need political will and leadership to act on this information. To fail the Amazon is to fail the biosphere, and we fail to act at our peril.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                Nature Medicine
                Nat Med
                Springer Science and Business Media LLC
                1078-8956
                1546-170X
                March 27 2023
                Article
                10.1038/s41591-023-02280-0
                36973412
                7702caa8-5aae-4620-9c27-daf62bdd4b4f
                © 2023

                https://www.springernature.com/gp/researchers/text-and-data-mining

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