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Additional file 1: Table S1. Knowledge of household heads on malaria. Table S2. Attitudes of household heads on malaria. Table S3. Malaria prevention practices among household heads. Table S4. Malaria episodes and household by basin. Table S5. Direct cost from the provider perspective for uncomplicated malaria by P. vivax in Mazan district 2017 (US$). Table S6. Direct cost from the provider perspective for uncomplicated malaria by P. falciparum in Mazan district 2017 (US$). Table S7. Direct and indirect costs from the patient perspective for uncomplicated malaria by P. vivax in Mazan district 2017 (US$). Table S8. Direct and indirect costs from the patient perspective for uncomplicated malaria by P. falciparum in Mazan district 2017 (US$).

Peru is an upper-middle-income country, but a large part of the population is still unable to benefit from such economic growth, with poverty rates exceeding 40% in rural areas, mainly in the Andean and the Amazon Regions. Malaria remains a significant public health problem in the Peruvian Amazon, mainly in Loreto department where both P.vivax and P. falciparum coexist (ratio: 5/1), accounting for more than 95% of Peru’s malaria cases in 2017 (52,280 cases). 2019-09-05

Background: Faced with the resurgence of malaria in the Peruvian Amazon since 2012, malaria surveillance was enhanced by adding a local active case detection (ACD) strategy to the routine passive case detection (PCD) as a reactive measure in selected communities with unusual number of cases during high transmission season (HTS). We assessed the short-effectiveness of this local ACD-based strategy in four Peruvian Amazonian riverine communities. Methods: A cohort study was conducted in June-July 2015 in Mazan, Loreto. Four consecutive ACD interventions (using light microscopy (LM) and treatment of confirmed infections) at intervals of 10 days were conducted in four riverine communities (Gamitanacocha-GAM, Primero de Enero-PRI, Libertad-LIB, and Urco Miraño-URC) that previously reported unusual number of cases. Blood samples were also collected on filter paper for later PCR. The effectiveness of the local strategy was calculated by dividing the number of infections detected in ACD visits using LM by the total number infections identified by PCR. Results: Of the total 933 censused people in the area, 88.1% were found in at least one of the four ACD visits. 54.2% had confirmed infections by PCR; among them 5 had two infections during the study period. Most infections were asymptomatic (270/451, 59.9%) and due to P. vivax (360/451, 79.8%). P. falciparum infections and P. vivax-P. falciparum co-infections accounted for 15.3% and 4.9% of total infections. Only 22.8% of the total 451 PCR confirmed infections were accurately detected using LM during the four ACD visits. Children aged 5-14 years, and farming as main economic activity were associated with P. vivax infections. Conclusion: Although repeated and consecutive ACD interventions using LM increase the opportunity of detecting and treating malaria infections during HTS, the number of detected infections would be far from the “true” number of infections detected by a highly sensitive diagnostic test. 2019-09-05

En áreas donde P. falciparum y P. vivax coexisten, como en la Región Loreto, la incidencia de P. falciparum ha ido disminuyendo más rápidamente respecto a P. vivax, el cual persiste como principal causa de malaria y constituye el principal reto para la eliminación de la malaria (17). El presente estudio confirmará que P. vivax es el principal causante de malaria grave en la Región Loreto, especie considerada por mucho tiempo como causante de malaria “benigna”(18). Por ello, la importancia de conocer las características clínicas y epidemiológicas de malaria grave por especie, complicaciones más frecuentes, comorbilidades, evolución; lo cual, permitirá a los profesionales de la Salud una mejor vigilancia y manejo de la enfermedad. Los estudios sobre malaria grave realizados a nivel nacional y en la Región Loreto, utilizaron los criterios de gravedad de la OMS del año 2000 y del Ministerio de Salud del año 2015 respectivamente. Con el fin que nuestro estudio pueda compararse con la literatura internacional utilizaremos los criterios de gravedad establecidos por la OMS del año 2014. Por otro lado, la identificación de los costos que involucra malaria, permitirá mejorar el nivel de conocimiento de la población afectada sobre la enfermedad, lo cual es importante para el desarrollo de estrategias de prevención y control de la malaria de parte del Estado con participación de dicha población. (Just.) Trabajo de investigacion

Objectives. To assess long-lasting insecticide - treated bednet (LLITN) ownership, retention and usage one year after their distribution in Loreto, Peru. Materials and methods. from July to September 2007, 26,185 LLITNs Olyset Net ® were delivered in 194 targeted communities in the Peruvian Amazon region, covering 45,331 people. Two cross-sectional community-based surveys in December 2007 and July 2008 were undertaken in a sample of 60 targeted communities (30.9% out of the total). A semi-structured questionnaire was used to collect necessary data to calculate LLITN ownership, retention and usage indicators. Results. High LLITN household ownership was showed in both surveys (99.9% and 98.7%, respectively). LLITN/ person ratio decreased from 0.58 at the end of the LLITN delivery to 0.51 in the second survey, estimating LLITN retention of 87% after 1 year of intervention. In the first survey, 99.0% of all children 5 years and 96,0% of pregnant women slept under a LLITN the previous night, while in the second survey, 77.7% of children 5 years and 66.3% of pregnant women slept under a LLITN the previous night. Big mesh size of LLITN had low people´s acceptability, reaching only 39.0% in the second survey. Conclusions. Although universal LLITN household ownership remained high, their LLITN usage levels have decreased during one-year follow-up period. Objetivos. Evaluar la posesión, retención y uso de mosquiteros tratados con insecticida de larga duración (MTILD) luego de un año de su distribución en Loreto, Perú. Materiales y métodos. De julio a septiembre de 2007 se distribuyeron 26 185 MTILD Olyset Net® en 194 comunidades objetivo de Loreto, que protegieron a 45 331 personas. Posteriormente, se realizaron visitas de monitoreo (primera en diciembre de 2007 y segunda en julio de 2008) a los hogares de una muestra de 60 comunidades objetivo (30,9% del total), colectándose mediante un cuestionario semiestructurado los datos necesarios para el cálculo de indicadores de posesión, retención y uso de los MTILD. Resultados. En ambas visitas, la posesión de MTILD en hogares fue elevada (99,9% y 98,7%, respectivamente). La razón MTILD/persona disminuyó de 0,58 al momento de la distribución a 0,51 en la segunda visita, estimándose una retención al año de MTILD de 87%. En la primera visita, 99,0% de los niños 5 años y 96,0% de las embarazadas durmieron bajo un MTILD la noche anterior, mientras que en la segunda visita, 77,7% de los niños5 años y 66,3% de las embarazadas durmieron bajo un MTILD la noche anterior. El tamaño de los agujeros de la trama de los MTILD tuvo una baja aceptabilidad por parte del a población durante la segunda visita (39,0%). Conclusiones. Si bien la posesión de MTILD en los hogares se ha mantenido elevada, su uso por la población beneficiada ha disminuido durante el año de seguimiento.