William Arnold, a traveler to Texas. Miller about preparations for Thanksgiving. Areas placed under German administration included the Protectorate of Bohemia and MoraviaReichskommissariat Ostland encompassing the Baltic states and Belarusand Reichskommissariat Ukraine. Miller discussing the highs and lows life in Alaska. Following a month-long series of attacks by members of the SA on Jewish businesses lwy synagogues, on 1 April Hitler declared a national boycott of Jewish businesses. From onward, Soviet POWs were viewed as a source of forced labour, and received better treatment so they could work.
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Epidemiology and control of malaria in Colombia. A limited number of severe and complicated cases have resulted in mortality, which is a downward trend that has been maintained over the last few years. The purpose of this paper is to review the progress of malaria-eradication activities and control measures over the past century within the eco-epidemiologic context of malaria transmission together with official consolidated morbidity and mortality reports.
Key words: Plasmodium falciparum - Plasmodium vivax - endemic transmission - intervention measures - morbidity-mortality reports. Malaria remains one of the most serious public health problems worldwide with an estimated 1, billion people living in permanent risk of contracting the disease Hay et al.
In the American continent, malaria transmission occurs between southern Mexico and northern regions of Argentina Carter The number of reported cases in the American continent decreased from 1,18 million in to , in WHO , which represents 0.
Although both P. The tropical location and geographical characteristics of the country favour the existence of a diversity of geographic regions with a variety of climates and an abundance of anopheline vectors. Additionally, there is dynamic migration of infected human populations across the country, which contributes to the spread of disease and dissemination of drug-resistant malaria parasites Arango et al.
Malaria occurs mainly in areas with poor access to an already fragile healthcare system Carter However, in such regions as the Pacific coast, the P.
The greater number of P. Additionally, there are multiple small foci where P. Most of the Colombian population is concentrated in the Andean Mountain region in cities more than 1, meters above sea level masl with sufficient sanitation and, therefore, little or no risk of malaria transmission. This phenomenon is aggravated by the concurrent presence of malaria parasites, multiple mosquito vectors and low levels of host immunity. In this paper, we describe the eco-epidemiological conditions that favour malaria transmission in Colombia together with a review of official reports and epidemiological information on malaria morbidity and mortality from government records obtained from the Ministries of Social Protection, Agriculture and Environment, all of which are related to malaria control activities.
Epidemiology of malaria in Colombia - Malaria transmission in Colombia exhibits an unstable, endemic-epidemic pattern of transmission with significant variability among the different transmission areas. These figures indicate a significant concentration of malaria transmission in a limited population scattered over a wide geographic region. Malaria transmission in Colombia: environmental considerations - Most Colombian territory is located north of the Equator in an inter-tropical zone and has variable altitudes ranging from , masl Mantilla et al.
Diverse geographic regions of the country, such as the Pacific and Caribbean coasts, the grassland plains and Orinoquia and the Amazonian Region, have predominant microepidemiologic and environmental features with adequate conditions for vector breeding and malaria transmission. Such features include tropical humid forest vegetation, low to dense forests, savannas, plains and valleys, wooded foothills, mountains and deserts MS This geographic and ecological diversity strongly influences general social structures, as well as economic, political and cultural determinants, consequently resulting in a lifestyle promoting endemic and epidemic malaria transmission Breilh , Castellanos The key variable that determines the intensity and prevalence of malaria is the migration of non-immune populations to endemic areas.
Furthermore, the migration of infected, symptomatic individuals and asymptomatic parasite carriers from endemic areas to areas where malaria had been eliminated now present favourable ecological conditions for malaria transmission. Additionally, intense deforestation due to illicit agriculture and uncontrolled mining has favoured the establishment of mosquito breeding sites and the maintenance of high anopheline densities MPS b.
Forty-one Anopheles species have been identified worldwide as primary vectors of P. Recently, other species, including Anopheles Nyssorhynchus oswaldoi , Anopheles N. Principal Colombian transmission areas Despite its relatively wide range of malaria transmission, Colombia has four main transmission areas Fig.
Malaria transmission increased in Brazil in ; however, both Peru and Brazil have shown a decreasing trend in malaria cases over the past few years.
It has a warm and humid climate, especially in Bajo Cauca, and includes a wide expanse of plains and hills with altitudes between masl. These geographical conditions and economic activities, such as mining, the banana agro-industry, cattle production and the timber industry, have provided a conducive environment for malaria transmission.
Since the s, this region has maintained a high malaria burden and predominance of P. The Pacific coast - The region is one of the most endemic, characterized by a vast and humid rainforest populated mainly by Afro-Colombian and Indigenous communities that are scattered along the coastal forests.
It is considered the second most important location for malaria in the country. In the northern region, the population is mainly of African descent and has a high prevalence of haemoglobinopathies and Duffy-negative phenotypes and is thus refractory to P. This phenomenon results in a larger proportion of P. Gold and platinum mining activities favour the presence of permanent mosquito breeding sites Carmona , ; in addition, fish farms are an important breeding source for Anopheles spp at the periphery of urban centres.
This area is characterized by environmental degradation, inadequate housing, limited access to public services and health care and, particularly, migration of non-immune populations. The Orinoquia is a lowland region with considerable hydrographic sources that have provided mosquito breeding sites and ecological conditions for malaria transmission with an API of 6.
The 2, reported malaria cases in this area represent approximately 2. The indigenous population is composed of numerous ethnic groups and a more limited number of immigrant settlers, who are most affected by malaria. However, due to its vast territorial expanse and low population density, the magnitude of the problem in this region is relatively less important with regard to total disease burden in the country; the API for this region in was 1.
A total of 6, malaria cases, or 5. Malaria morbidity - Reports since the s show that the lowest level of documented malaria cases in Colombia was in Fig. However, morbidity has steadily increased with a change in the prevalence of Plasmodium species. In the s and early s, P. Since , P. During the last decade particularly in the last 5 years , there has been a reduction of P. In the last seven years, a slow and modest decline in transmission was registered, which was probably attributable to improvements in diagnostic coverage and timely treatment.
More recently, the introduction of artemisinin derivates combination therapy ACT in combination with a clear reduction in the extension of endemic areas as an outcome of different strategies for malaria control has resulted in a reduction in the at-risk population. Regarding the target ages, young adults between years of age are the most affected, probably due to occupational factors. In some regions, children under the age of 15 represent an important proportion of malaria morbidity, which is probably associated with intra and peri-domiciliary transmission.
Ethnic diversity, together with inherent cultural differences, also has contributed to significant changes in the transmission dynamics in different regions of the country. Although there may be a degree of underreporting, malaria mortality has maintained a decreasing trend, primarily because of improvements in coverage and access to diagnosis and treatment in endemic priority areas. According to the National Administrative Department of Statistics DANE , the number of deaths has decreased from 90 in to 55 in ; however, SIVIGILA has reported deaths per year in the last three years and, regarding pregnant women, two deaths have been reported up to the 18th Epidemiologic Week in Although this number could be higher, considering the magnitude of the endemic and difficulties in access to services in high-risk regions, this number is of great concern for health services.
Information about Plasmodium species and complications of malaria related to mortality was provided by the Colombian NIH from Control and elimination strategies - Colombian fight against malaria during the XX century - Colombia has invested significant efforts to control and eradicate malaria transmission since the first half of the past century.
Mosquito control campaigns were first initiated in certain ports and were subsequently extended to all cities. In , a campaign against malaria and uncinariasis was implemented through soil decontamination and, an year later, the systematic compilation of official malaria diagnostic records was initiated.
By , the Malariology Campaign was created in agreement with the International Cooperative Service of Public Health to promote antimalarial activities in the most endemic areas of the country.
Since , there has been an increased focus on the feasibility of eliminating mosquito breeding sites using strategies such as pond drainage and land-filling activities at the outskirts of villages. In addition, the discovery of synthetic antimalarials, documentation of the residual insecticide effects of DDT and the impact of sanitation measures have also increased the possibility of malaria elimination and eradication.
During the preparation phase , the Service demonstrated that the number of malaria cases in Colombia was the highest in the American continent. Therefore, the attack phase of the Eradication Campaign was initiated with the goal of covering the entire malaria endemic area of the country with DDT spraying SNEM , Although the results were far from satisfactory, the campaign was extended until , as the program was restructured and the control strategy initiated.
As shown in Fig. The first phase showed a rapid increase in malaria transmission in which 25,, cases were reported in the country at the beginning of the s, with a significant increase to over 75, cases by the beginning of the s. Because of the appearance of P. Since , a third phase of malaria transmission appeared in which a general upward trend in malaria morbidity has been seen SNEM This objective was to be achieved by targeting areas in which transmission persisted and additionally aimed to avoid malaria resurgence in areas where malaria had already been eliminated.
A centralized malaria-control policy was maintained until when an operative decentralization of the campaign was initiated based on the principles of the Global Malaria Control Strategy GMCS WHO , Padilla In , the operative strategy of Roll Back Malaria was adopted and a program of institutional strengthening to improve technical and institutional responses was initiated.
Unfortunately, the situation continued to deteriorate. Additional participation included the following entities: the Ministry of Agriculture and Employment, the inhabitants report from DANE, entomological reports from the Colombian NIH, control and interventions from NMCP and participation of communities and individuals at risk as part of integrated malaria control programs Kroeger et al. Malaria treatment has been limited to cases with passive and active parasitological diagnosis by thick blood smears.
The treatment policy has consisted of radical cure and schemes for P. A total of Appropriate therapeutic policies on early treatment are the main determinant of success for control measures.
For P. However, malaria treatment is included in the package of health services in which the purchase and distribution of medications to the regions is centralized and dependent on the Ministry of Social Protection MPS. Although private health systems are also involved in malaria diagnosis and early treatment, the situation is particularly complicated in endemic areas that are difficult to access and exhibit a high level of population dispersion. In , CQ resistance was first reported in Colombia.
Since , many other antimalarial drug treatment failures have been reported Osorio et al. The policy was assessed in and the analysis showed levels of treatment failure of In the past several years, a significant reduction in the number of cases of malaria attributed to P. According to national guidelines, the current first-line treatment in Colombia for uncomplicated P.
In Colombia, CQ remains highly effective against P. Although malaria intervention activities have included other measures, such as the use of long-lasting impregnated nets LLIN , the reduction has also been influenced by concurrent climate changes that have affected disease transmission characteristics across the region and, in the last few years, a significant reduction in the number of cases was observed: , cases in decreased to 79, cases in WHO Perspectives - Malaria is considered a serious public health problem in Colombia, primarily due to the number of malaria cases that are mainly caused by P.
Focal and variable transmission has been modified by the interaction between structural socioeconomic, political and cultural influences developed in variable eco-epidemiologic scenarios. In addition, the geographic features of the territory favour widespread transmission. Social problems in rural areas, which have persisted over the last 50 years, promote the transmission of malaria and adversely affect malaria control efforts.
The malaria control measures implemented in Colombia over different periods have achieved important reductions in mortality. Encouraging results were obtained with the use of CQ therapy and DTT spraying during malaria eradication campaigns, but multidrug resistance forced changes in malaria control strategies.
Although such strategies have had an important impact on malaria control in Colombia, there is a need to find solutions to the problem of health care for poor and underserved populations, where malaria is simply one of many other public health problems.
The strategy of selective control, primarily involving the ability to stratify and prioritize actions, along with an understanding of the dynamics of transmission according to GMCS, has never been properly adopted. Changes in the health system have failed to strengthen capacity at local levels.
He committed suicide while awaiting trial at Nuremberg for war crimes. He volunteered for the army on the outbreak of World War I in and spent two years in the artillery before training as an aerial artillery spotter  with Artillery Flier Detachment In July his aircraft was shot down over France and he was taken prisoner of war. It has been suggested that he suffered a traumatic brain injury in the crash; for the rest of his life he spoke with a stammer and suffered bouts of erratic behaviour, aggravated by heavy drinking. After the war Ley returned to university, gaining a doctorate in He was employed as a food chemist by a branch of the giant IG Farben company, based in Leverkusen in the Ruhr. Enraged by the French occupation of the Ruhr in , Ley became an ultra- nationalist and joined the Nazi Party soon after reading Adolf Hitler 's speech at his trial following the Beer Hall Putsch in Munich.
1945 LEY 0074 PDF
Painter, Park terrace, Wayville. Up to 6 priority, get vour. On 17 MayHitler gave a speech before the Reichstag outlining his desire for world peacewhile at the same time accepting an offer from American President Franklin D. Arthur Hartstuff to unknown reporting various visits within the Pine Ridge reservation. The number of women enrolled in post-secondary schools dropped fromin to 51, in Draft of a letter to George Washington regarding possible British troop movements from Detroit [incomplete]. The German state from tounder the dictatorship of Adolf Hitler.