What was the impact of government intervention on malaria cases in the Yanomami indigenous lands?

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Jacqueline Aguiar Barros, Fabiana Granja, Pedro Eduardo Lima Siqueira, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7402800/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Dec, 2025 Read the published version in Malaria Journal → Version 1 posted 10 You are reading this latest preprint version Abstract Background Roraima has recently experienced an increase in malaria cases, particularly among the Yanomami indigenous group, due to the presence of illegal miners. In January 2023, a Public Health Emergency was declared in the Yanomami Indigenous Land (YIL) because of a severe humanitarian crisis. This aims to assess the impact of the 2023 government effort to remove miners from the YIL on the local malaria burden. Methods A descriptive retrospective study was performed using secondary data from Brazil’s Health Information System (SIS), including confirmed cases (SIVEP-Malaria), hospitalizations (SIH), and deaths (SIM) due to malaria in Roraima from 2021 to 2024. Results Between January 2021 and December 2024, Roraima (RR) reported 117,214 autochthonous cases of malaria. Unexpectedly, following the 2023 intervention, there was a significant increase in cases (from 52,210 to 65,004; p = 0.0005). Hospitalizations decreased (from 789 to 638; p = 0.0304), but no significant change in the number of deaths (111 overall; p = 09089) was observed. P. vivax was the predominant species (p < 0001), while P. falciparum and mixed P. falciparum + P. vivax infections were associated with the highest lethality (p < 0.0001). Children aged 0–9 years had the highest mortality rate (p = 0.0005), and young adults aged 20–39 years accounted for nearly all hospitalizations (p < 0.0001). Men experienced more cases (p = 0.0031), yet women had a higher mortality rate (p = 0.0031), with indigenous people being the most affected (p = 0.0155). Malaria cases in the DSEI-Yanomami from 2021 to 2024 decreased in the municipalities of Mucajaí, Iracema, and Caracaraí, whereas Alto Alegre saw an increase in 2024. Interestingly, imported cases exported from RR decreased in Maranhão (− 95.5%), Pará (− 86.8%), and Amazonas (− 71.5%). Conclusions Although indigenous malaria cases have increased, the intervention was linked to fewer hospitalizations. Strategies should target indigenous populations, especially children, and mining areas, focusing on early diagnosis, integrated surveillance, and care for vulnerable groups. Malaria Plasmodium Indigenous Health Amazon Yanomami miners Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Malaria continues to be a major global public health issue. In 2023, there were 263 million cases and 597,000 deaths in 83 endemic countries, including French Guiana. In the Americas, the incidence declined by 65.4% from 2000 to 2023, but Brazil, Venezuela, and Colombia account for 76.8% of cases, with Plasmodium vivax infections constituting 72.1% of the total [ 1 ]. In Brazil, malaria transmission is endemic in the Legal Amazon, which accounts for 99.9% of autochthonous cases due to ecological conditions that favor the proliferation of the Anopheles darlingi vector [ 2 ]. Although the country has set targets to eliminate Plasmodium falciparum by 2030 and all local malaria cases by 2035 [ 3 ], illegal mining activities in Indigenous territories have become a major obstacle to reaching these goals [ 4 ]. Illegal mining greatly affects malaria patterns through various interconnected mechanisms. Specifically, the environmental changes caused by the activity, such as excavating craters that serve as ideal breeding grounds for the disease-carrying mosquitoes, and deforestation that encourages the migration of these mosquitoes from the forest to populated areas. This movement increases the mosquito population and raises the rate of malaria in indigenous communities [ 5 , 6 ]. Additionally, increased cross-border human movement promotes the reintroduction of parasites. At the same time, the concentration of vulnerable populations with limited healthcare access raises the risk of severe cases and ongoing disease transmission. These factors, working together, sustain the active spread of malaria, especially in border areas among Brazil, Colombia, Venezuela, and Guyana [ 1 , 7 , 8 , 9 ]. This situation disproportionately impacts indigenous peoples and traditional communities, groups already facing systemic health disparities, such as high rates of illness and death from preventable diseases, acute malnutrition, and maternal and infant mortality. These issues are amplified by social factors, including structural poverty, stigma, and geographic and cultural barriers to healthcare access [ 1 ]. In Brazil, there has been a notable rise in malaria cases in indigenous villages and mining regions, particularly since 2016 [ 10 ]. This pattern is closely connected to the expansion of mining activities in the Amazon, as shown by data from MapBiomas. From 1985 to 2020, mining activity remained relatively steady, with moderate growth from the late 1980s to the mid-2010s, followed by a sharp and ongoing increase starting in 2016 [ 11 ]. Indigenous lands (ILs) in the Brazilian Amazon have been heavily affected by deforestation. From 2019 to 2021, deforestation in ILs increased by 195% compared to the previous three years. The most common human activity reported within these territories was illegal mining [ 12 ]. In 2023, autochthonous malaria cases in ILs accounted for 40.0% (55,974 cases) of the country’s total reported cases. Analysis by state showed that Amazonas and Roraima had the highest incidence rates. Among the Special Indigenous Health Districts (DSEIs), the Yanomami region was the most affected, representing 55.7% (31,206 cases) of all notifications in these areas. Roraima has recently experienced an increase in malaria cases, particularly among the Yanomami indigenous people, due to illegal mining activities in the area [ 7 , 9 ]. The seriousness of this issue led to a declaration of emergency because of inadequate aid in the YIL, which was declared a Public Health Emergency of National Importance (ESPIN) in 2023 after more than 20,000 malaria cases were reported, underscoring urgent humanitarian concerns [ 14 ]. The federal response, including efforts to remove illegal miners and enhance support for the Yanomami community, represented a structural intervention. Nevertheless, it is essential to assess its specific impact on the epidemiological patterns of the disease. This study aims to assess the impact of federal intervention in the YIL on malaria transmission patterns. It will analyze trends over time, by population, and geographically in cases, hospitalizations, and deaths, as well as the spatial and temporal distribution of the disease and the potential risk of spreading to other regions of Brazil. The findings may help develop more effective public policies focused on improving control strategies in endemic areas and strengthening health surveillance systems. Additionally, this research seeks to support progress toward national malaria elimination goals, aligning with global efforts to reduce the disease's burden on vulnerable populations. Methods To achieve the objectives, a retrospective descriptive study was conducted using secondary data from the Health Information System (SIS), including confirmed cases, hospitalizations, and deaths from malaria in Roraima from 2021 to 2024. This period enabled comparison of scenarios before (2021–2022) and after (2023–2024) the federal intervention in the YIL in January 2023. The state of Roraima is situated in the far northern region of Brazil, sharing borders with Venezuela and Guyana internationally, and with the states of Amazonas and Pará within the country. It covers an area of 224,298.98 km² and has an estimated population of 652,713 residents [ 15 ]. It includes 15 municipalities and two DSEIs, the Yanomami DSEI and the East DSEI. The Yanomami Special Indigenous Health District (DSEI Yanomami) covers about 96,650 km² and serves an estimated Indigenous population of 33,335 people across Roraima and Amazonas states. In Roraima, the YIL includes the municipalities of Alto Alegre, Amajari, Caracaraí, Iracema, and Mucajaí [ 16 ]. The DSEI East, which spans 39,129 km² and includes indigenous lands within a total territory of 69,754 km², covers the entire eastern half of Roraima state. It has approximately 61,121 Indigenous residents across 11 municipalities, including Boa Vista (the capital), Alto Alegre, Amajari, Bonfim, Cantá, Normandia, Pacaraima, Uiramutã, São João da Baliza, São Luiz do Anauá, and Caroebe [ 17 ]. Notably, Rorainopolis is the only municipality without an approved Indigenous Area, while Alto Alegre and Amajari are part of both DSEIs. Morbidity data were collected from the Malaria Epidemiological Surveillance Information System (SIVEP-Malaria). Cases transmitted within Roraima were considered autochthonous. Diagnostic confirmation was based on detecting Plasmodium spp through thick smears and rapid diagnostic tests (RDTs). Positive cure verification slides (CVS) were excluded from the analysis. Cases were analyzed by year of notification, parasite species, and demographic profile (age group, sex, and race). Transmission was categorized as occurring in indigenous areas (DSEI-Yanomami and DSEI-Leste) and non-indigenous areas (rural/settlement, urban, and mining). The flow of exported cases was defined as malaria cases originating in Roraima (autochthonous cases within the state) but reported in other Brazilian states, based on records from SIVEP-Malaria in the Amazon Region and the Notifiable Diseases Information System (SINAN). Data on deaths and hospitalizations were collected from the Mortality Information System (SIM) and the Hospital Information System (SIH), respectively, using codes B50 to B54 according to the International Classification of Diseases (ICD-10), which are specific to malaria. These records were organized by year, parasite species, sex, and age group, allowing analysis of the profile of severe cases. Statistical analyses were conducted using GraphPad Prism v.10.5.0 software. Data normality was checked with the Shapiro-Wilk and Kolmogorov-Smirnov tests. For group comparisons, both parametric tests (Student's t-test, ANOVA, and Tukey) and nonparametric tests (Mann-Whitney, Kruskal-Wallis, Dunn’s test, Wilcoxon, and Friedman) were employed depending on the data distribution, with a significance level of p < 0.05. The maps were created using QGIS software (version 3.28.10; QGIS Development Team, 2023), based on spatial data of mining areas in Roraima state obtained from the MapBiomas platform (Collection 7.1; MapBiomas, 2022). The geopolitical boundaries of Brazil and the polygons of Indigenous Lands were sourced from the Brazilian Institute of Geography and Statistics [ 18 ]. This study did not require approval from a research ethics committee because it used only secondary, publicly available, and anonymized data, in accordance with Resolution No. 446/2011 of the National Health Council. Results From January 2021 to December 2024, the state of Roraima recorded 117,214 cases of autochthonous malaria. There was a notable rise in disease incidence during the post-intervention period (n = 65,004 cases) compared to the pre-intervention period (n = 52,210 cases) (p = 0.0005). Regarding hospitalizations, the total was 14,725, with a significant decrease from the pre-intervention period (n = 789) to the post-intervention period (n = 638) (p = 0.0304). Meanwhile, malaria-related deaths showed no significant difference (p = 0.9089). Out of 111 recorded deaths during this period, 57 occurred in the pre-intervention phase and 54 in the post-intervention phase (Fig. 2 ). Malaria caused by P. vivax was the most common among local cases (p < 0.0001), while P. falciparum and mixed malaria were associated with higher lethality (p < 0.0001). Children aged 0–9 years experienced greater mortality (p = 0.0005), whereas young adults aged 20–39 had more hospitalizations (p < 0.0001). Men accounted for more cases (p = 0.0031) and hospitalizations (p = 0.0107), but women exhibited higher mortality (p = 0.0031). Indigenous populations were the most affected (p = 0.0155), with no significant annual variation (p > 0.05) (Table 1 ). Table 1 Malaria cases, hospitalizations, and deaths by species, age, sex, and race in Roraima, 2021–2024. Category Subcategory Autochthonous Cases Hospitalizations Deaths 2021 2022 2023 2024 2021 2022 2023 2024 2021 2022 2023 2024 Malaria parasite species P. falciparum (Pf) and Pf + Pv 7,550 8,824 10,381 8,540 59 155 139 64 11 12 15 7 P. vivax (Pv) 22,492 21,286 29,052 25,683 240 284 223 142 10 17 16 12 P. malariae 4 1 1 54 1 0 0 0 0 0 0 1 Unspecified 0 0 0 0 13 35 43 27 6 1 2 1 % P. falciparum 25.13 29.30 26.32 24.91 4.71 8.18 8.58 6.87 40.74 40.00 45.45 33.33 Age group 0–9 6,677 4,721 10,290 11,283 70 80 106 74 9 12 16 16 10–19 5,267 3,850 7,611 7,504 43 49 51 35 5 4 6 1 20–39 9,663 12,480 11,303 8,128 171 265 185 82 5 7 4 2 40–59 3,775 4,543 4,406 2,920 25 67 50 25 8 5 2 2 60+ 624 610 850 709 4 13 13 17 0 2 5 0 Gender Female 10,441 9,362 15,026 14,213 100 219 189 124 15 19 18 11 Male 15,565 16,842 19,434 16,331 213 255 216 109 12 11 15 10 Race Indigenous 14,706 10,584 24,083 26,685 65 62 105 78 15 22 29 20 Non-indigenous 11,257 15,620 10,377 3,859 173 229 267 155 11 8 4 1 No data 43 0 0 0 75 183 33 0 1 0 0 0 Total 30,046 30,111 39,434 34,277 1,252 1,896 1,620 932 27 30 33 21 Source: Sivep-Malaria, SIM, SIH. The DSEI-Yanomami experienced the highest malaria burden in the municipalities of Alto Alegre, Amajari, Iracema, and Caracaraí, with significant differences (p < 0.05) compared to urban, rural, and mining areas. In Mucajaí, however, mining areas were the primary focus of transmission (p < 0.001). There were no significant differences between urban and rural areas in any municipality, indicating that transmission is more linked to specific factors, such as activities in indigenous or mining territories (Fig. 3 ). The available data allow us to observe, albeit preliminarily, a divergent trend in the epidemiological curves among the studied municipalities. While Amajari, Mucajaí, Iracema, and Caracaraí showed a decreasing trend in malaria cases in the DSEI-Yanomami from 2021 to 2024, Alto Alegre displayed the opposite pattern, with a noticeable increase in cases in 2024 (Fig. 3 ). Regarding autochthonous cases in Roraima exported to other states in Brazil, it was observed that the states of Pará, Amazonas, and Maranhão were classified as high risk both before and after the intervention periods (annual average > 300 cases), and the frequencies observed in each state were statistically significant (p < 0.0001). However, the number of cases per year shows a gradual decline, with decreases of 92.5% in Maranhão (963 to 72 cases), 86.8% in Pará (463 to 61), and 71.5% in Amazonas (375 to 107) between 2022 and 2024. New spatial patterns also emerge, such as increasing cases in Mato Grosso and Amapá, indicating a shift in case exportation during the post-intervention period (Fig. 4 ). Discussion The results of this study reveal a complex malaria situation in Roraima from 2021 to 2024, characterized by a significant rise in autochthonous cases after interventions, while hospitalizations decreased and death rates remained steady. This pattern suggests that the measures taken have improved disease detection and clinical management. However, they were not sufficient to stop transmission, especially in key areas like the YIL. The Yanomami, the largest semi-isolated indigenous group in the Americas, face significant healthcare challenges due to their geographic and logistical circumstances. The YIL covers a vast, remote area with limited access, requiring nearly complete (99%) reliance on air transport for medical supplies and personnel. This dependence, combined with the high mobility of the population, creates structural barriers to effective malaria diagnosis and treatment. The complexity of healthcare delivery is further increased by the widespread dispersion of villages across the territory. These factors lead to prolonged malaria transmission chains, especially in remote communities, because of delays in diagnosis and treatment. Geographic isolation and logistical hurdles hinder timely medical interventions, raising both epidemiological risks and demand for health services [ 19 ]. In early 2023, roughly 5,224 indigenous people lacked access to healthcare at the main centers of Kayanaú, Homoxi, Hakoma, Ajaraní, Haxiú, Xitei, and Palimiú [ 20 ]. The restructuring of healthcare in the YIL was based on three strategic axes designed to improve care for the indigenous population. The first axis focused on the YIL, which is large and hard to access, relying mostly on air logistics (99%) and hosting a highly mobile population. This creates structural challenges in diagnosing and treating malaria. The operational complexity, along with the widespread dispersion of villages, leads to more epidemiological incidents and increased demand for health services. Failures in timely diagnosis, worsened by geographic barriers and dependence on air transport, extend transmission chains, especially in remote areas [ 19 ]. The second axis involved increasing the number of healthcare professionals in the territory to improve coverage and resolution capacity. The third axis aimed to expand access to timely diagnosis and treatment of malaria to reduce its morbidity and mortality [ 14 , 19 ]. In 2024, malaria tests rose sharply to 260,251, a 43.9% increase from 2023 (180,906 tests). This growth indicates expanded access to diagnosis and treatment. Overall, diagnostic testing increased by 4.4%, with active detection up 4.8% and passive detection by 2.6%. Active detection involves health teams actively seeking out cases in communities through mass testing, including testing asymptomatic individuals during home visits, which allows for timely treatment and follow-up. These results show improved surveillance coverage and greater access to diagnosis [ 20 ]. Vector control measures were also intensified, including environmental assessments, removal of breeding sites such as mining craters, sanitation efforts, and indoor spraying to reduce transmission. These actions have strengthened the malaria response in the YIL [ 20 ]. During the study period, malaria cases decreased in areas of the DSEI-Yanomami that include the municipalities of Amajari, Caracaraí, Iracema, and Mucajaí. Conversely, the municipality of Alto Alegre showed the opposite trend, with continuous increases in cases during the same period. This epidemiological difference partly reflects the demographic characteristics of the Alto Alegre region, which contains 57.6% of the indigenous population of the DSEI in Roraima (11,871 out of 20,601) and is home to 165 villages spread across a large area [ 19 ]. The increase in malaria cases among Indigenous populations, compared to the proportional decline in mining areas and urban zones, indicates higher transmission within these groups despite emergency interventions. While improved surveillance and diagnostic capabilities may have enhanced case detection, the data show an ongoing health crisis driven by environmental degradation, population movement, and the weakening of local healthcare systems. Assistance in this region is coordinated through 12 Base Centers (Alto Mucajaí, Aratha-U, Baixo Mucajaí, Hakoma, Haxiu, Palimiú, Parafuri, Surucucu, Uraricoera, Waikás, Waputha, and Xitei), many of which faced significant operational problems before federal intervention [ 19 ]. The increase in malaria cases reflects both improved detection following the intervention and the actual spread of the disease due to previous neglect. Reactivating the base centers was crucial for identifying previously hidden cases but also highlighted the need for sustainable health services in the region. Another important factor was the rise in illegal mining during the pre-intervention period, especially in the regions of Alto Alegre and Mucajaí. The Uraricoera River, which has long been the most affected by this activity, serves as the main route for miners entering Yanomami territory. Remote sensing data show that 52.3% of the area damaged by illegal mining is in its bed, followed by the Mucajaí-Couto de Magalhães hydrographic system (28.7%) and the Parima-Catrimani basins (19%), both vital for the subsistence of indigenous communities (Fig. 1 ) [ 21 ]. Although efforts to prevent intrusion have been made, active illegal mining sites still operate along the border with Venezuela, maintaining malaria transmission in Alto Alegre, a border municipality (Fig. 1 ). In this region, there is intense illegal mineral extraction on both sides of the border, with frequent movement of Yanomami people and miners between territories [ 9 , 12 ]. Evidence indicates that some infections diagnosed on the Brazilian side originate in cross-border mining areas and are later reintroduced into villages, where they sustain local transmission cycles despite progress in emergency response [ 22 , 23 ]. This pattern is supported by the detection of 54 cases of Plasmodium malariae in Venezuelan indigenous people, reinforcing the role of illegal mining as a pathway for spreading the disease across political borders. The high rate of asymptomatic infections in the Yanomami population, as consistently documented in numerous studies, presents a challenge for malaria control [ 24 , 25 ]. These subclinical cases act as silent reservoirs, sustaining parasitic transmission even during periods of apparent control [ 26 , 27 ]. This epidemiological situation is especially critical because of the dominance of Plasmodium vivax in the region, which is associated with high morbidity and mortality among vulnerable groups, particularly children, pregnant women, and indigenous populations, as shown by the data from this study. These findings emphasize the need to develop targeted and specific therapeutic strategies for these subgroups. Regarding the Yanomami indigenous population, the Brazilian Ministry of Health has started implementing Tafenoquine and Glucose-6-phosphate dehydrogenase (G6PD) testing at the Yanomami DSEI (RR) to improve adherence to P. vivax malaria treatment by replacing a 7-day course of primaquine with a single dose of tafenoquine, which helps prevent P. vivax relapses. This strategy is justified by the high transmission rates in the area and logistical challenges that hinder adherence to the standard 7-day primaquine regimen. The protocol includes screening for G6PD deficiency and careful monitoring of adverse effects, following Pan American Health Organization (PAHO) recommendations and aligning with national malaria control strategies for traditional populations. The increased severity linked to P. falciparum single infections or mixed P. vivax coinfections emphasizes the urgent need for accurate diagnosis. Evidence indicates that missing mixed plasmodial infections, especially when mistaken for P. vivax alone, leads to inadequate P. falciparum treatment, allowing parasitemia to persist and potentially develop into severe illness. This clinical challenge is particularly important in endemic areas with high co-infection rates. To address this diagnostic problem, two main strategies are essential: (i) ongoing training to enhance microscopists' ability to correctly identify species in mixed infections; and (ii) using additional diagnostic methods that offer higher sensitivity and specificity. Combining these strategies is vital to ensure appropriate treatment, significantly reducing the risk of progression to severe cases and death. The high malaria death rate among children in their first decade highlights the urgent need for prevention strategies targeting early childhood and adolescence. Regular use of insecticide-treated nets (ITNs), active testing in high-transmission areas, and community-based educational efforts in Indigenous households and schools are crucial actions. Cases in children under five are especially concerning, as they face higher risks of severe medical complications and long-term effects [ 7 , 9 ]. This increased vulnerability is due to their still-developing immune systems and higher likelihood of recurrent infections. Notably, the states of Pará, Amazonas, and Maranhão became the main recipients of local malaria cases from Roraima, with significant declines following federal intervention. These findings support recent studies that identified malaria linked to gold mining in Roraima as a widespread phenomenon, with strong flows to Pará, Amazonas, Rondônia, and Mato Grosso, as well as routes to the Southeast and South of Brazil, and even cross-border movements of imported cases from Venezuela and the Guianas [ 9 , 29 ]. The high mobility of miners poses a major challenge to controlling and eliminating malaria. Infected people often travel between different regions and borders, which can lead to the reintroduction of the parasite into areas where transmission has already been reduced or stopped. Furthermore, this constant movement can accelerate the spread of parasites resistant to antimalarial drugs, making surveillance and treatment more difficult [ 30 , 31 , 32 ]. The irregular movement of miners in the Amazon poses a major challenge to eliminating malaria in South America. This group, often in unstable migratory situations, demonstrates low compliance with health services, encounters difficulties in obtaining timely diagnoses, and tends to self-medicate more frequently, all of which increase the risk of transmission. This evidence underscores the urgent need for coordinated strategies between countries, including enhanced epidemiological surveillance in border areas and targeted approaches for mobile populations [ 29 , 33 ]. Eliminating malaria in border areas requires strong cooperation between Brazil's federal units and international partners, including data sharing and alignment of public policies. In the Amazon, subregional platforms could monitor the two main transmission routes: (a) Venezuela-Guyana-Brazil and (b) Suriname-French Guiana-Brazil. Key challenges include resistance to antimalarial drugs and difficulties in reaching mobile populations. Innovative approaches, such as administering tafenoquine to vulnerable groups, are essential for developing region-specific responses [ 33 ]. Additionally, initiatives like the Malakit project, which distributes self-tests and medicines in remote areas, show potential for reducing transmission related to human displacement, especially along key routes [ 7 , 9 ]. Conclusions Federal intervention in the YIL in 2023 led to improvements, such as increased healthcare staff and supplies. However, ongoing structural issues keep malaria transmission high, especially in the municipality of Alto Alegre, demonstrating that short-term measures are not enough. For a lasting reduction in the disease, an integrated approach is necessary, combining ongoing planning, stable funding, efficient logistics, and a stronger presence of healthcare teams in the area. The transition from emergency measures to a long-term plan involves strengthening primary healthcare, training local community health workers, expanding integrated surveillance (including prompt diagnosis and vector control), and improving management within the DSEI. The success of these efforts depends on ongoing commitment from multiple institutions, in accordance with national malaria elimination guidelines. Within the scope of national malaria elimination, the YIL experience highlights the importance of coordinated regional policies that combine therapeutic innovations and cross-border governance. Sustainable progress depends on balancing rapid response systems with long-term investments in healthcare infrastructure to protect this vulnerable population. Abbreviations IBGE Brazilian Institute of Geography and Statistics DSEIs Special Indigenous Health Districts SIS Health Information System (SIS) SIVEP-Malaria Malaria Epidemiological Surveillance Information System SIM Mortality Information System SIH Hospitalization Information System SINAN Notifiable Diseases Information System CID-10 International Disease Classification RR Roraima Yanomami Indigenous Land (YIL) ILs Indigenous Lands ESPIN Public Health Emergency of National Importance SIS Health Information System RDTs Rapid Diagnostic Tests CVS Cure Verification Slides G6PD Glucose-6-phosphate dehydrogenase PAHO Pan American Health Organization ITNs Insecticide-Treated Nets. Declarations Ethics approval Not applicable Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação Oswaldo Cruz (Fiocruz), Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Secretaria de Vigilância em Saúde e Ambiente / Ministério da Saúde (SVSA/MS). MFFC is supported by CNPq, Brazil, through a Productivity Research Fellowship, and is “Cientista do Nosso Estado” by Faperj. Author Contribution Conceptualization: JAB, MFFC; Formal analysis: JAB, FG, PELS, MFFC; Investigation: JAB, ISE, RRC, MFFC; Software: JAB, PELS; Writing original draft: JAB, FG, MFFC, ISE, RRC; Supervision: MFFC; Review & editing: JAB, FG, MFFC, ISE, RRC. Preparation of all figures and table: JAB Acknowledgement Núcleo de Controle da Malária, Departamento de Vigilância Epidemiológica, Coordenação Geral de Vigilância em Saúde /SESAU-RR. Data Availability The data are openly available at the following links: https://public.tableau.com/app/profile/mal.ria.brasil/vizzes and https://datasus.saude.gov.br/informacoes-de-saude-tabnet/ References World Health Organization. World malaria report 2024: addressing inequity in the global malaria response. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. Ministry of Health (BR). Secretariat of Health and Environmental Surveillance. Epidemiological Bulletin: Characterization of malaria in special areas of the Amazon region [Internet]. Brasília: Ministry of Health; 2024 Oct [cited 2025 Aug 12]; 55(14):1–14. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2024/boletim-epidemiologico-volume-55-no-14.pdf Brazil. Ministry of Health. Health Surveillance Secretariat. Department of Immunization and Communicable Diseases. Eliminate Malaria Brazil: National Malaria Elimination Plan. 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Available from: https://www.in.gov.br/en/web/dou/-/portaria-gm/ms-n-28-de-20-de-janeiro-de-2023-455680143 , Accessed 2025 Jul 11. Brazilian Institute of Geography and Statistics. Population estimates for Brazil and federative units. 2022. Available from: https://www.ibge.gov.br , Accessed 2022 Jul 07. Special Secretariat for Indigenous Health (SESAI). Demographic data from Indigenous Health Districts. Brasília: Ministry of Health. 2025. Available from: http://www.saudeindigena.gov.br , Accessed 2025 Jul 07. Federal University of Roraima (UFRR). East Roraima Indigenous Health District: General overview. Boa Vista: UFRR Telehealth; [2025]. Available from: https://ufrr.br/telessaude/dsei-leste-de-roraima-panorama-geral/ , Accessed 2025 Jul 10. Brazilian Institute of Geography and Statistics (IBGE). Vectors of Geopolitical Limits, of Indigenous Lands. Available from: https://www.ibge.gov.br/geociencias/downloads-geociencias.html , Accessed 2025 Jul 10. Brazil, Ministry of Health. Action plan of the Public Health Emergency Operations Center for healthcare deprivation in Yanomami Territory. Brasília: Ministry of Health; 2024. Available from: https://www.gov.br/saude/pt-br/composicao/svsa/coes/coe-yanomami/publicacoes-tecnicas , Accessed 2025 Jun 11. Brazil. Ministry of Health. Special Secretariat for Indigenous Health. Report 07: Performance of Working Groups in Yanomami Indigenous Territory. DSEI Yanomami; 2024. Available from: https://www.gov.br/saude/pt-br/composicao/svsa/coes/coe-yanomami/informes/missao-yanomami-informe-07/view , Accessed 2025 Jul 10. Yanomami HA, Wnasseduume A. Amazonia; Hutukara Associação Yanomami & AssociaçãoWanasseduume Ye’kwana: Boa Vista. Brazil: Roraima; 2021. p. 52p. Murta FLG, Marques LLG, Santos APC, et al. Perceptions about malaria among Brazilian gold miners in an Amazonian border area: perspectives for malaria elimination strategies. Malar J. 2021;20:286. https://doi.org/10.1186/s12936-021-03820-0 . Gonzalez Daza W, Muylaert RL, Sobral-Souza T, Lemes Landeiro V. Malaria Risk Drivers in the Brazilian Amazon: Land Use—Land Cover Interactions and Biological Diversity. Int J Environ Res Public Health. 2023;20:6497. https://doi.org/10.3390/ijerph20156497 . Fontoura PS, Finco BF, Lima NF, de Carvalho JF Jr, Vinetz JM, Castro MC, Ferreira MU. Reactive Case Detection for Plasmodium vivax Malaria Elimination in Rural Amazonia. PLoS Negl Trop Dis. 2016;10(12):e0005221. 10.1371/journal.pntd.0005221 . Rodrigues PT, Johansen IC, Ladeia WA, Esquivel FD, Corder RM, Tonini J, Calil PR, Fernandes ARJ, Fontoura PS, Cavasini CE, Vinetz JM, Castro MC, Ferreira MU, Mâncio Lima Cohort Study Working Group. Lower Microscopy Sensitivity with Decreasing Malaria Prevalence in the Urban Amazon Region, Brazil, 2018–2021. Emerg Infect Dis. 2024;30(9):1884–94. 10.3201/eid3009.240378 . Wells TN, Burrows JN, Baird JK. Targeting the hypnozoite reservoir of Plasmodium vivax: the hidden obstacle to malaria elimination. Trends Parasitol. 2010;26(3):145–51. 10.1016/j.pt.2009.12.005 . Lin JT, Saunders DL, Meshnick SR. The role of submicroscopic parasitemia in malaria transmission: what is the evidence? Trends Parasitol. 2014;30(4):183–90. 10.1016/j.pt.2014.02.004 . Kotepui M, Kotepui KU, De Jesus Milanez G, Masangkay FR. Plasmodium spp. mixed infection leading to severe malaria: a systematic review and meta-analysis. Sci Rep. 2020;10(1):11068. 10.1038/s41598-020-68082-3 . Barros JA, Granja F, Silva DDSE, Citó AC, Peterka C, Ferreira-da-Cruz MF. A snapshot of a representative Brazilian state of illegal mining in indigenous areas during the era of malaria elimination. Cad Saude Publica. 2024;40(6):e00224023. 10.1590/0102-311XEN224023 . Laporta GZ, Grillet ME, Rodovalho SR, Massad E, Sallum MAM. Reaching the malaria elimination goal in Brazil: a spatial analysis and time-series study. Infect Dis Poverty. 2022;11(1):39. 10.1186/s40249-022-00945-5 . Grillet ME, Moreno JE, Hernández-Villena JV, Vincenti-González MF, Noya O, Tami A, Paniz-Mondolfi A, Llewellyn M, Lowe R, Escalante AA, Conn JE. Malaria in Southern Venezuela: The hottest hotspot in Latin America. PLoS Negl Trop Dis. 2021;15(1):e0008211. 10.1371/journal.pntd.0008211 . De Salazar PM, Cox H, Imhoff H, Alexandre JSF, Buckee CO. The association between gold mining and malaria in Guyana: a statistical inference and time-series analysis. Lancet Planet Health. 2021;5(10):e731–8. 10.1016/S2542-5196(21)00203-5 . Douine M, Lambert Y, Musset L, et al. Malaria in Gold Miners in the Guianas and the Amazon: Current Knowledge and Challenges. Curr Trop Med Rep. 2020;7:37–47. https://doi.org/10.1007/s40475-020-00202-5 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 Dec, 2025 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Revision requested 15 Oct, 2025 Reviews received at journal 15 Oct, 2025 Reviews received at journal 08 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 28 Aug, 2025 Reviewers invited by journal 26 Aug, 2025 Editor assigned by journal 21 Aug, 2025 Submission checks completed at journal 21 Aug, 2025 First submitted to journal 18 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7402800","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":507010914,"identity":"12cc62c3-026f-46f0-b95c-a0614bb8e227","order_by":0,"name":"Jacqueline Aguiar Barros","email":"","orcid":"","institution":"Núcleo de Controle da Malária/DVE/CGVS/SESAU-RR","correspondingAuthor":false,"prefix":"","firstName":"Jacqueline","middleName":"Aguiar","lastName":"Barros","suffix":""},{"id":507010916,"identity":"5d00cc59-de2e-446b-a314-a7f74c5b6d36","order_by":1,"name":"Fabiana Granja","email":"","orcid":"","institution":"Centro de Estudos da Biodiversidade da Universidade Federal de Roraima - CBio/UFRR","correspondingAuthor":false,"prefix":"","firstName":"Fabiana","middleName":"","lastName":"Granja","suffix":""},{"id":507010923,"identity":"237d7f6a-649c-4e3c-8a83-f8bb3dadb601","order_by":2,"name":"Pedro Eduardo Lima Siqueira","email":"","orcid":"","institution":"Centro de Informações Estratégicas em Vigilância em Saúde/SVS-S/SMSA/Boa Vista/RR","correspondingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"Eduardo Lima","lastName":"Siqueira","suffix":""},{"id":507010925,"identity":"2ac8dbf5-3f9e-4648-9a24-8d8a76702385","order_by":3,"name":"Ivyson Silva Epifânio","email":"","orcid":"","institution":"Distrito Sanitário Especial Indígena Yanomami (DSEI-Y)","correspondingAuthor":false,"prefix":"","firstName":"Ivyson","middleName":"Silva","lastName":"Epifânio","suffix":""},{"id":507010926,"identity":"de2b8849-5c2f-4a86-9caa-572b68ed211f","order_by":4,"name":"Ronan Rocha Coelho","email":"","orcid":"","institution":"Coordenação de Eliminação da Malária - CEMA, Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde","correspondingAuthor":false,"prefix":"","firstName":"Ronan","middleName":"Rocha","lastName":"Coelho","suffix":""},{"id":507010927,"identity":"3238505e-e223-4e61-9f28-a5dcffc5af3e","order_by":5,"name":"Maria de Fátima Ferreira da Cruz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYDAC5oMPQJQcG4isMIAK4tXClgxWZgzWcoYULYkNYC0wq/Hp0G1jZvxc2VaX3sfe/IDhQIGNvPmM9AfMhXtwazE7xswsebaNLbeN55gBwwGDNMM5NxISmGc8w6Plfv8xxsY2ntw2iRwG5g8GhxMkJBIOMPMcwGsLG1CLRDobUAvQFpCWxAZitBgkIGlJZiCkhVmy4VyCIcgvB0B+mcHzjOHwDPxaGD82lNXJy7c3P3xw4I+NvAR7+sPHBXi0oIADGIxRMApGwSgYBeQBAErmSXbCAK7uAAAAAElFTkSuQmCC","orcid":"","institution":"Centro de Pesquisa, Diagnóstico e Treinamento em Malária, CPDMal, FIOCRUZ/RJ","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"de Fátima Ferreira da","lastName":"Cruz","suffix":""}],"badges":[],"createdAt":"2025-08-18 21:08:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7402800/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7402800/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-025-05744-5","type":"published","date":"2025-12-20T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90542972,"identity":"aa62d8f8-8809-4282-bd18-80aae75bbde3","added_by":"auto","created_at":"2025-09-04 00:09:27","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":574543,"visible":true,"origin":"","legend":"\u003cp\u003eMap of Roraima's territorial layout: municipalities, indigenous lands, mining sites, rivers, borders\u003c/p\u003e","description":"","filename":"Figure1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7402800/v1/37c75f0479712991a877f341.jpeg"},{"id":90542971,"identity":"911177bd-4150-4d27-98f3-5e88631441e8","added_by":"auto","created_at":"2025-09-04 00:09:27","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":113342,"visible":true,"origin":"","legend":"\u003cp\u003eMalaria cases, hospitalizations, and deaths by month/year, Roraima, 2021–2024. Legend: Intervention period in the Yanomami indigenous land (red line). Source: Sivep-Malaria, SIM, SIH.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7402800/v1/adcfc5e919e02b4b95efd9b3.jpg"},{"id":90540949,"identity":"5ae603fd-6bc2-4fe8-b330-b136d498e50d","added_by":"auto","created_at":"2025-09-03 23:53:27","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":179580,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of malaria cases by specific area in municipalities within Yanomami Indigenous Land (2021–2024). Legend: Intervention period in the Yanomami Indigenous Land (red line). Source: Sivep-Malaria.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7402800/v1/e38e2332f25f7636e1851f3b.jpg"},{"id":90540943,"identity":"1acdd882-a8d4-46a5-8a1f-06c3d856234b","added_by":"auto","created_at":"2025-09-03 23:53:27","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":195251,"visible":true,"origin":"","legend":"\u003cp\u003eMalaria cases exported from Roraima: spatial-temporal trends before and after the Yanomami intervention. Legend: (A) Case export flow (maps); (B) Annual trend in the most affected states by case exports (Maranhão, Amazonas, and Pará), with the intervention period highlighted by a red line. Source: Sivep-Malaria.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7402800/v1/f55c25102ee3a2313c9ab767.jpg"},{"id":98814154,"identity":"95e0caec-34ea-4411-acc7-87b9e797b92c","added_by":"auto","created_at":"2025-12-22 16:11:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1759774,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7402800/v1/af238700-a9cd-4c4a-9aee-beaecebe6860.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"What was the impact of government intervention on malaria cases in the Yanomami indigenous lands?","fulltext":[{"header":"Background","content":"\u003cp\u003eMalaria continues to be a major global public health issue. In 2023, there were 263\u0026nbsp;million cases and 597,000 deaths in 83 endemic countries, including French Guiana. In the Americas, the incidence declined by 65.4% from 2000 to 2023, but Brazil, Venezuela, and Colombia account for 76.8% of cases, with \u003cem\u003ePlasmodium vivax\u003c/em\u003e infections constituting 72.1% of the total [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Brazil, malaria transmission is endemic in the Legal Amazon, which accounts for 99.9% of autochthonous cases due to ecological conditions that favor the proliferation of the \u003cem\u003eAnopheles darlingi\u003c/em\u003e vector [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although the country has set targets to eliminate \u003cem\u003ePlasmodium falciparum\u003c/em\u003e by 2030 and all local malaria cases by 2035 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], illegal mining activities in Indigenous territories have become a major obstacle to reaching these goals [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIllegal mining greatly affects malaria patterns through various interconnected mechanisms. Specifically, the environmental changes caused by the activity, such as excavating craters that serve as ideal breeding grounds for the disease-carrying mosquitoes, and deforestation that encourages the migration of these mosquitoes from the forest to populated areas. This movement increases the mosquito population and raises the rate of malaria in indigenous communities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, increased cross-border human movement promotes the reintroduction of parasites. At the same time, the concentration of vulnerable populations with limited healthcare access raises the risk of severe cases and ongoing disease transmission. These factors, working together, sustain the active spread of malaria, especially in border areas among Brazil, Colombia, Venezuela, and Guyana [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis situation disproportionately impacts indigenous peoples and traditional communities, groups already facing systemic health disparities, such as high rates of illness and death from preventable diseases, acute malnutrition, and maternal and infant mortality. These issues are amplified by social factors, including structural poverty, stigma, and geographic and cultural barriers to healthcare access [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Brazil, there has been a notable rise in malaria cases in indigenous villages and mining regions, particularly since 2016 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This pattern is closely connected to the expansion of mining activities in the Amazon, as shown by data from MapBiomas. From 1985 to 2020, mining activity remained relatively steady, with moderate growth from the late 1980s to the mid-2010s, followed by a sharp and ongoing increase starting in 2016 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIndigenous lands (ILs) in the Brazilian Amazon have been heavily affected by deforestation. From 2019 to 2021, deforestation in ILs increased by 195% compared to the previous three years. The most common human activity reported within these territories was illegal mining [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn 2023, autochthonous malaria cases in ILs accounted for 40.0% (55,974 cases) of the country\u0026rsquo;s total reported cases. Analysis by state showed that Amazonas and Roraima had the highest incidence rates. Among the Special Indigenous Health Districts (DSEIs), the Yanomami region was the most affected, representing 55.7% (31,206 cases) of all notifications in these areas.\u003c/p\u003e\u003cp\u003eRoraima has recently experienced an increase in malaria cases, particularly among the Yanomami indigenous people, due to illegal mining activities in the area [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The seriousness of this issue led to a declaration of emergency because of inadequate aid in the YIL, which was declared a Public Health Emergency of National Importance (ESPIN) in 2023 after more than 20,000 malaria cases were reported, underscoring urgent humanitarian concerns [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The federal response, including efforts to remove illegal miners and enhance support for the Yanomami community, represented a structural intervention. Nevertheless, it is essential to assess its specific impact on the epidemiological patterns of the disease.\u003c/p\u003e\u003cp\u003eThis study aims to assess the impact of federal intervention in the YIL on malaria transmission patterns. It will analyze trends over time, by population, and geographically in cases, hospitalizations, and deaths, as well as the spatial and temporal distribution of the disease and the potential risk of spreading to other regions of Brazil. The findings may help develop more effective public policies focused on improving control strategies in endemic areas and strengthening health surveillance systems. Additionally, this research seeks to support progress toward national malaria elimination goals, aligning with global efforts to reduce the disease's burden on vulnerable populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eTo achieve the objectives, a retrospective descriptive study was conducted using secondary data from the Health Information System (SIS), including confirmed cases, hospitalizations, and deaths from malaria in Roraima from 2021 to 2024. This period enabled comparison of scenarios before (2021\u0026ndash;2022) and after (2023\u0026ndash;2024) the federal intervention in the YIL in January 2023.\u003c/p\u003e\u003cp\u003eThe state of Roraima is situated in the far northern region of Brazil, sharing borders with Venezuela and Guyana internationally, and with the states of Amazonas and Par\u0026aacute; within the country. It covers an area of 224,298.98 km\u0026sup2; and has an estimated population of 652,713 residents [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It includes 15 municipalities and two DSEIs, the Yanomami DSEI and the East DSEI.\u003c/p\u003e\u003cp\u003eThe Yanomami Special Indigenous Health District (DSEI Yanomami) covers about 96,650 km\u0026sup2; and serves an estimated Indigenous population of 33,335 people across Roraima and Amazonas states. In Roraima, the YIL includes the municipalities of Alto Alegre, Amajari, Caracara\u0026iacute;, Iracema, and Mucaja\u0026iacute; [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The DSEI East, which spans 39,129 km\u0026sup2; and includes indigenous lands within a total territory of 69,754 km\u0026sup2;, covers the entire eastern half of Roraima state. It has approximately 61,121 Indigenous residents across 11 municipalities, including Boa Vista (the capital), Alto Alegre, Amajari, Bonfim, Cant\u0026aacute;, Normandia, Pacaraima, Uiramut\u0026atilde;, S\u0026atilde;o Jo\u0026atilde;o da Baliza, S\u0026atilde;o Luiz do Anau\u0026aacute;, and Caroebe [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Notably, Rorainopolis is the only municipality without an approved Indigenous Area, while Alto Alegre and Amajari are part of both DSEIs.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMorbidity data were collected from the Malaria Epidemiological Surveillance Information System (SIVEP-Malaria). Cases transmitted within Roraima were considered autochthonous. Diagnostic confirmation was based on detecting \u003cem\u003ePlasmodium spp\u003c/em\u003e through thick smears and rapid diagnostic tests (RDTs). Positive cure verification slides (CVS) were excluded from the analysis. Cases were analyzed by year of notification, parasite species, and demographic profile (age group, sex, and race). Transmission was categorized as occurring in indigenous areas (DSEI-Yanomami and DSEI-Leste) and non-indigenous areas (rural/settlement, urban, and mining). The flow of exported cases was defined as malaria cases originating in Roraima (autochthonous cases within the state) but reported in other Brazilian states, based on records from SIVEP-Malaria in the Amazon Region and the Notifiable Diseases Information System (SINAN).\u003c/p\u003e\u003cp\u003eData on deaths and hospitalizations were collected from the Mortality Information System (SIM) and the Hospital Information System (SIH), respectively, using codes B50 to B54 according to the International Classification of Diseases (ICD-10), which are specific to malaria. These records were organized by year, parasite species, sex, and age group, allowing analysis of the profile of severe cases.\u003c/p\u003e\u003cp\u003eStatistical analyses were conducted using GraphPad Prism v.10.5.0 software. Data normality was checked with the Shapiro-Wilk and Kolmogorov-Smirnov tests. For group comparisons, both parametric tests (Student's t-test, ANOVA, and Tukey) and nonparametric tests (Mann-Whitney, Kruskal-Wallis, Dunn\u0026rsquo;s test, Wilcoxon, and Friedman) were employed depending on the data distribution, with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eThe maps were created using QGIS software (version 3.28.10; QGIS Development Team, 2023), based on spatial data of mining areas in Roraima state obtained from the MapBiomas platform (Collection 7.1; MapBiomas, 2022). The geopolitical boundaries of Brazil and the polygons of Indigenous Lands were sourced from the Brazilian Institute of Geography and Statistics [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study did not require approval from a research ethics committee because it used only secondary, publicly available, and anonymized data, in accordance with Resolution No. 446/2011 of the National Health Council.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFrom January 2021 to December 2024, the state of Roraima recorded 117,214 cases of autochthonous malaria. There was a notable rise in disease incidence during the post-intervention period (n\u0026thinsp;=\u0026thinsp;65,004 cases) compared to the pre-intervention period (n\u0026thinsp;=\u0026thinsp;52,210 cases) (p\u0026thinsp;=\u0026thinsp;0.0005). Regarding hospitalizations, the total was 14,725, with a significant decrease from the pre-intervention period (n\u0026thinsp;=\u0026thinsp;789) to the post-intervention period (n\u0026thinsp;=\u0026thinsp;638) (p\u0026thinsp;=\u0026thinsp;0.0304). Meanwhile, malaria-related deaths showed no significant difference (p\u0026thinsp;=\u0026thinsp;0.9089). Out of 111 recorded deaths during this period, 57 occurred in the pre-intervention phase and 54 in the post-intervention phase (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMalaria caused by \u003cem\u003eP. vivax\u003c/em\u003e was the most common among local cases (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), while \u003cem\u003eP. falciparum\u003c/em\u003e and mixed malaria were associated with higher lethality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Children aged 0\u0026ndash;9 years experienced greater mortality (p\u0026thinsp;=\u0026thinsp;0.0005), whereas young adults aged 20\u0026ndash;39 had more hospitalizations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Men accounted for more cases (p\u0026thinsp;=\u0026thinsp;0.0031) and hospitalizations (p\u0026thinsp;=\u0026thinsp;0.0107), but women exhibited higher mortality (p\u0026thinsp;=\u0026thinsp;0.0031). Indigenous populations were the most affected (p\u0026thinsp;=\u0026thinsp;0.0155), with no significant annual variation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMalaria cases, hospitalizations, and deaths by species, age, sex, and race in Roraima, 2021\u0026ndash;2024.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSubcategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003eAutochthonous Cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e\u003cp\u003eHospitalizations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c14\" namest=\"c11\"\u003e\u003cp\u003eDeaths\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eMalaria parasite species\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eP. falciparum (Pf) and Pf\u0026thinsp;+\u0026thinsp;Pv\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,550\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8,824\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10,381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8,540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eP. vivax (Pv)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22,492\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21,286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29,052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25,683\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eP. malariae\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnspecified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e% \u003cem\u003eP. falciparum\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e24.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e8.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e40.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e40.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e45.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e33.33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eAge group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026ndash;9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,721\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10,290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11,283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,267\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,850\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7,611\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7,504\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u0026ndash;39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9,663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12,480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11,303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8,128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3,775\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,543\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4,406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2,920\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e624\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e610\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e850\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e709\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10,441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9,362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15,026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14,213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15,565\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16,842\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19,434\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16,331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14,706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10,584\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24,083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26,685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-indigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11,257\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15,620\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10,377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,859\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e267\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo data\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e30,046\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e30,111\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e39,434\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e34,277\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e1,252\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e1,896\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e1,620\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e932\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e27\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cb\u003e33\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e\u003cb\u003e21\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSource: Sivep-Malaria, SIM, SIH.\u003c/p\u003e\u003cp\u003eThe DSEI-Yanomami experienced the highest malaria burden in the municipalities of Alto Alegre, Amajari, Iracema, and Caracara\u0026iacute;, with significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared to urban, rural, and mining areas. In Mucaja\u0026iacute;, however, mining areas were the primary focus of transmission (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). There were no significant differences between urban and rural areas in any municipality, indicating that transmission is more linked to specific factors, such as activities in indigenous or mining territories (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe available data allow us to observe, albeit preliminarily, a divergent trend in the epidemiological curves among the studied municipalities. While Amajari, Mucaja\u0026iacute;, Iracema, and Caracara\u0026iacute; showed a decreasing trend in malaria cases in the DSEI-Yanomami from 2021 to 2024, Alto Alegre displayed the opposite pattern, with a noticeable increase in cases in 2024 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eRegarding autochthonous cases in Roraima exported to other states in Brazil, it was observed that the states of Par\u0026aacute;, Amazonas, and Maranh\u0026atilde;o were classified as high risk both before and after the intervention periods (annual average\u0026thinsp;\u0026gt;\u0026thinsp;300 cases), and the frequencies observed in each state were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). However, the number of cases per year shows a gradual decline, with decreases of 92.5% in Maranh\u0026atilde;o (963 to 72 cases), 86.8% in Par\u0026aacute; (463 to 61), and 71.5% in Amazonas (375 to 107) between 2022 and 2024. New spatial patterns also emerge, such as increasing cases in Mato Grosso and Amap\u0026aacute;, indicating a shift in case exportation during the post-intervention period (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study reveal a complex malaria situation in Roraima from 2021 to 2024, characterized by a significant rise in autochthonous cases after interventions, while hospitalizations decreased and death rates remained steady. This pattern suggests that the measures taken have improved disease detection and clinical management. However, they were not sufficient to stop transmission, especially in key areas like the YIL.\u003c/p\u003e\u003cp\u003eThe Yanomami, the largest semi-isolated indigenous group in the Americas, face significant healthcare challenges due to their geographic and logistical circumstances. The YIL covers a vast, remote area with limited access, requiring nearly complete (99%) reliance on air transport for medical supplies and personnel. This dependence, combined with the high mobility of the population, creates structural barriers to effective malaria diagnosis and treatment. The complexity of healthcare delivery is further increased by the widespread dispersion of villages across the territory. These factors lead to prolonged malaria transmission chains, especially in remote communities, because of delays in diagnosis and treatment. Geographic isolation and logistical hurdles hinder timely medical interventions, raising both epidemiological risks and demand for health services [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn early 2023, roughly 5,224 indigenous people lacked access to healthcare at the main centers of Kayana\u0026uacute;, Homoxi, Hakoma, Ajaran\u0026iacute;, Haxi\u0026uacute;, Xitei, and Palimi\u0026uacute; [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The restructuring of healthcare in the YIL was based on three strategic axes designed to improve care for the indigenous population. The first axis focused on the YIL, which is large and hard to access, relying mostly on air logistics (99%) and hosting a highly mobile population. This creates structural challenges in diagnosing and treating malaria. The operational complexity, along with the widespread dispersion of villages, leads to more epidemiological incidents and increased demand for health services. Failures in timely diagnosis, worsened by geographic barriers and dependence on air transport, extend transmission chains, especially in remote areas [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The second axis involved increasing the number of healthcare professionals in the territory to improve coverage and resolution capacity. The third axis aimed to expand access to timely diagnosis and treatment of malaria to reduce its morbidity and mortality [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn 2024, malaria tests rose sharply to 260,251, a 43.9% increase from 2023 (180,906 tests). This growth indicates expanded access to diagnosis and treatment. Overall, diagnostic testing increased by 4.4%, with active detection up 4.8% and passive detection by 2.6%. Active detection involves health teams actively seeking out cases in communities through mass testing, including testing asymptomatic individuals during home visits, which allows for timely treatment and follow-up. These results show improved surveillance coverage and greater access to diagnosis [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVector control measures were also intensified, including environmental assessments, removal of breeding sites such as mining craters, sanitation efforts, and indoor spraying to reduce transmission. These actions have strengthened the malaria response in the YIL [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDuring the study period, malaria cases decreased in areas of the DSEI-Yanomami that include the municipalities of Amajari, Caracara\u0026iacute;, Iracema, and Mucaja\u0026iacute;. Conversely, the municipality of Alto Alegre showed the opposite trend, with continuous increases in cases during the same period. This epidemiological difference partly reflects the demographic characteristics of the Alto Alegre region, which contains 57.6% of the indigenous population of the DSEI in Roraima (11,871 out of 20,601) and is home to 165 villages spread across a large area [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe increase in malaria cases among Indigenous populations, compared to the proportional decline in mining areas and urban zones, indicates higher transmission within these groups despite emergency interventions. While improved surveillance and diagnostic capabilities may have enhanced case detection, the data show an ongoing health crisis driven by environmental degradation, population movement, and the weakening of local healthcare systems.\u003c/p\u003e\u003cp\u003eAssistance in this region is coordinated through 12 Base Centers (Alto Mucaja\u0026iacute;, Aratha-U, Baixo Mucaja\u0026iacute;, Hakoma, Haxiu, Palimi\u0026uacute;, Parafuri, Surucucu, Uraricoera, Waik\u0026aacute;s, Waputha, and Xitei), many of which faced significant operational problems before federal intervention [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The increase in malaria cases reflects both improved detection following the intervention and the actual spread of the disease due to previous neglect. Reactivating the base centers was crucial for identifying previously hidden cases but also highlighted the need for sustainable health services in the region. Another important factor was the rise in illegal mining during the pre-intervention period, especially in the regions of Alto Alegre and Mucaja\u0026iacute;. The Uraricoera River, which has long been the most affected by this activity, serves as the main route for miners entering Yanomami territory. Remote sensing data show that 52.3% of the area damaged by illegal mining is in its bed, followed by the Mucaja\u0026iacute;-Couto de Magalh\u0026atilde;es hydrographic system (28.7%) and the Parima-Catrimani basins (19%), both vital for the subsistence of indigenous communities (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough efforts to prevent intrusion have been made, active illegal mining sites still operate along the border with Venezuela, maintaining malaria transmission in Alto Alegre, a border municipality (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In this region, there is intense illegal mineral extraction on both sides of the border, with frequent movement of Yanomami people and miners between territories [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Evidence indicates that some infections diagnosed on the Brazilian side originate in cross-border mining areas and are later reintroduced into villages, where they sustain local transmission cycles despite progress in emergency response [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This pattern is supported by the detection of 54 cases of \u003cem\u003ePlasmodium malariae\u003c/em\u003e in Venezuelan indigenous people, reinforcing the role of illegal mining as a pathway for spreading the disease across political borders.\u003c/p\u003e\u003cp\u003eThe high rate of asymptomatic infections in the Yanomami population, as consistently documented in numerous studies, presents a challenge for malaria control [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These subclinical cases act as silent reservoirs, sustaining parasitic transmission even during periods of apparent control [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This epidemiological situation is especially critical because of the dominance of \u003cem\u003ePlasmodium vivax\u003c/em\u003e in the region, which is associated with high morbidity and mortality among vulnerable groups, particularly children, pregnant women, and indigenous populations, as shown by the data from this study. These findings emphasize the need to develop targeted and specific therapeutic strategies for these subgroups.\u003c/p\u003e\u003cp\u003eRegarding the Yanomami indigenous population, the Brazilian Ministry of Health has started implementing Tafenoquine and Glucose-6-phosphate dehydrogenase (G6PD) testing at the Yanomami DSEI (RR) to improve adherence to \u003cem\u003eP. vivax\u003c/em\u003e malaria treatment by replacing a 7-day course of primaquine with a single dose of tafenoquine, which helps prevent \u003cem\u003eP. vivax\u003c/em\u003e relapses. This strategy is justified by the high transmission rates in the area and logistical challenges that hinder adherence to the standard 7-day primaquine regimen. The protocol includes screening for G6PD deficiency and careful monitoring of adverse effects, following Pan American Health Organization (PAHO) recommendations and aligning with national malaria control strategies for traditional populations.\u003c/p\u003e\u003cp\u003eThe increased severity linked to \u003cem\u003eP. falciparum\u003c/em\u003e single infections or mixed \u003cem\u003eP. vivax\u003c/em\u003e coinfections emphasizes the urgent need for accurate diagnosis. Evidence indicates that missing mixed plasmodial infections, especially when mistaken for \u003cem\u003eP. vivax\u003c/em\u003e alone, leads to inadequate \u003cem\u003eP. falciparum\u003c/em\u003e treatment, allowing parasitemia to persist and potentially develop into severe illness. This clinical challenge is particularly important in endemic areas with high co-infection rates. To address this diagnostic problem, two main strategies are essential: (i) ongoing training to enhance microscopists' ability to correctly identify species in mixed infections; and (ii) using additional diagnostic methods that offer higher sensitivity and specificity. Combining these strategies is vital to ensure appropriate treatment, significantly reducing the risk of progression to severe cases and death.\u003c/p\u003e\u003cp\u003eThe high malaria death rate among children in their first decade highlights the urgent need for prevention strategies targeting early childhood and adolescence. Regular use of insecticide-treated nets (ITNs), active testing in high-transmission areas, and community-based educational efforts in Indigenous households and schools are crucial actions. Cases in children under five are especially concerning, as they face higher risks of severe medical complications and long-term effects [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This increased vulnerability is due to their still-developing immune systems and higher likelihood of recurrent infections.\u003c/p\u003e\u003cp\u003eNotably, the states of Par\u0026aacute;, Amazonas, and Maranh\u0026atilde;o became the main recipients of local malaria cases from Roraima, with significant declines following federal intervention. These findings support recent studies that identified malaria linked to gold mining in Roraima as a widespread phenomenon, with strong flows to Par\u0026aacute;, Amazonas, Rond\u0026ocirc;nia, and Mato Grosso, as well as routes to the Southeast and South of Brazil, and even cross-border movements of imported cases from Venezuela and the Guianas [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe high mobility of miners poses a major challenge to controlling and eliminating malaria. Infected people often travel between different regions and borders, which can lead to the reintroduction of the parasite into areas where transmission has already been reduced or stopped. Furthermore, this constant movement can accelerate the spread of parasites resistant to antimalarial drugs, making surveillance and treatment more difficult [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe irregular movement of miners in the Amazon poses a major challenge to eliminating malaria in South America. This group, often in unstable migratory situations, demonstrates low compliance with health services, encounters difficulties in obtaining timely diagnoses, and tends to self-medicate more frequently, all of which increase the risk of transmission. This evidence underscores the urgent need for coordinated strategies between countries, including enhanced epidemiological surveillance in border areas and targeted approaches for mobile populations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEliminating malaria in border areas requires strong cooperation between Brazil's federal units and international partners, including data sharing and alignment of public policies. In the Amazon, subregional platforms could monitor the two main transmission routes: (a) Venezuela-Guyana-Brazil and (b) Suriname-French Guiana-Brazil. Key challenges include resistance to antimalarial drugs and difficulties in reaching mobile populations. Innovative approaches, such as administering tafenoquine to vulnerable groups, are essential for developing region-specific responses [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, initiatives like the Malakit project, which distributes self-tests and medicines in remote areas, show potential for reducing transmission related to human displacement, especially along key routes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFederal intervention in the YIL in 2023 led to improvements, such as increased healthcare staff and supplies. However, ongoing structural issues keep malaria transmission high, especially in the municipality of Alto Alegre, demonstrating that short-term measures are not enough. For a lasting reduction in the disease, an integrated approach is necessary, combining ongoing planning, stable funding, efficient logistics, and a stronger presence of healthcare teams in the area.\u003c/p\u003e\u003cp\u003eThe transition from emergency measures to a long-term plan involves strengthening primary healthcare, training local community health workers, expanding integrated surveillance (including prompt diagnosis and vector control), and improving management within the DSEI. The success of these efforts depends on ongoing commitment from multiple institutions, in accordance with national malaria elimination guidelines.\u003c/p\u003e\u003cp\u003eWithin the scope of national malaria elimination, the YIL experience highlights the importance of coordinated regional policies that combine therapeutic innovations and cross-border governance. Sustainable progress depends on balancing rapid response systems with long-term investments in healthcare infrastructure to protect this vulnerable population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIBGE\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBrazilian Institute of Geography and Statistics\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSEIs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSpecial Indigenous Health Districts\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSIS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHealth Information System (SIS)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSIVEP-Malaria\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMalaria Epidemiological Surveillance Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSIM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMortality Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSIH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospitalization Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSINAN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNotifiable Diseases Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCID-10\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Disease Classification\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRoraima\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eYanomami Indigenous Land (YIL)\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eILs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIndigenous Lands\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eESPIN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePublic Health Emergency of National Importance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSIS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHealth Information System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRDTs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eRapid Diagnostic Tests\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCVS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCure Verification Slides\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eG6PD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlucose-6-phosphate dehydrogenase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePAHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePan American Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eITNs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInsecticide-Treated Nets.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis work was supported by the Conselho Nacional de Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico (CNPq), Funda\u0026ccedil;\u0026atilde;o Oswaldo Cruz (Fiocruz), Funda\u0026ccedil;\u0026atilde;o Carlos Chagas Filho de Amparo \u0026agrave; Pesquisa do Estado do Rio de Janeiro (FAPERJ), Secretaria de Vigil\u0026acirc;ncia em Sa\u0026uacute;de e Ambiente / Minist\u0026eacute;rio da Sa\u0026uacute;de (SVSA/MS). MFFC is supported by CNPq, Brazil, through a Productivity Research Fellowship, and is \u0026ldquo;Cientista do Nosso Estado\u0026rdquo; by Faperj.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: JAB, MFFC; Formal analysis: JAB, FG, PELS, MFFC; Investigation: JAB, ISE, RRC, MFFC; Software: JAB, PELS; Writing original draft: JAB, FG, MFFC, ISE, RRC; Supervision: MFFC; Review \u0026amp; editing: JAB, FG, MFFC, ISE, RRC. Preparation of all figures and table: JAB\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eN\u0026uacute;cleo de Controle da Mal\u0026aacute;ria, Departamento de Vigil\u0026acirc;ncia Epidemiol\u0026oacute;gica, Coordena\u0026ccedil;\u0026atilde;o Geral de Vigil\u0026acirc;ncia em Sa\u0026uacute;de /SESAU-RR.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data are openly available at the following links: https://public.tableau.com/app/profile/mal.ria.brasil/vizzes and https://datasus.saude.gov.br/informacoes-de-saude-tabnet/\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. World malaria report 2024: addressing inequity in the global malaria response. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of Health (BR). Secretariat of Health and Environmental Surveillance. Epidemiological Bulletin: Characterization of malaria in special areas of the Amazon region [Internet]. Bras\u0026iacute;lia: Ministry of Health; 2024 Oct [cited 2025 Aug 12]; 55(14):1\u0026ndash;14. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2024/boletim-epidemiologico-volume-55-no-14.pdf\u003c/span\u003e\u003cspan address=\"https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2024/boletim-epidemiologico-volume-55-no-14.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrazil. Ministry of Health. Health Surveillance Secretariat. Department of Immunization and Communicable Diseases. Eliminate Malaria Brazil: National Malaria Elimination Plan. Bras\u0026iacute;lia: Ministry of Health; 2022. p. 60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCastro MC, Peterka C. Malaria is increasing in Indigenous and artisanal mining areas in the Brazilian Amazon. Nat Med. 2023;29(4):762\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41591-023-02280-0\u003c/span\u003e\u003cspan address=\"10.1038/s41591-023-02280-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMassad E, Coutinho FAB. Vectorial capacity, basic reproduction number, force of infection and all that: formal notation to complete and adjust their classical concepts and equations. 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Curr Trop Med Rep. 2020;7:37\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40475-020-00202-5\u003c/span\u003e\u003cspan address=\"10.1007/s40475-020-00202-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Malaria, Plasmodium, Indigenous Health, Amazon Yanomami, miners","lastPublishedDoi":"10.21203/rs.3.rs-7402800/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7402800/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRoraima has recently experienced an increase in malaria cases, particularly among the Yanomami indigenous group, due to the presence of illegal miners. In January 2023, a Public Health Emergency was declared in the Yanomami Indigenous Land (YIL) because of a severe humanitarian crisis. This aims to assess the impact of the 2023 government effort to remove miners from the YIL on the local malaria burden.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA descriptive retrospective study was performed using secondary data from Brazil\u0026rsquo;s Health Information System (SIS), including confirmed cases (SIVEP-Malaria), hospitalizations (SIH), and deaths (SIM) due to malaria in Roraima from 2021 to 2024.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBetween January 2021 and December 2024, Roraima (RR) reported 117,214 autochthonous cases of malaria. Unexpectedly, following the 2023 intervention, there was a significant increase in cases (from 52,210 to 65,004; p\u0026thinsp;=\u0026thinsp;0.0005). Hospitalizations decreased (from 789 to 638; p\u0026thinsp;=\u0026thinsp;0.0304), but no significant change in the number of deaths (111 overall; p\u0026thinsp;=\u0026thinsp;09089) was observed. \u003cem\u003eP. vivax\u003c/em\u003e was the predominant species (p\u0026thinsp;\u0026lt;\u0026thinsp;0001), while \u003cem\u003eP. falciparum\u003c/em\u003e and mixed \u003cem\u003eP. falciparum\u003c/em\u003e\u0026thinsp;+\u0026thinsp;\u003cem\u003eP. vivax\u003c/em\u003e infections were associated with the highest lethality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Children aged 0\u0026ndash;9 years had the highest mortality rate (p\u0026thinsp;=\u0026thinsp;0.0005), and young adults aged 20\u0026ndash;39 years accounted for nearly all hospitalizations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Men experienced more cases (p\u0026thinsp;=\u0026thinsp;0.0031), yet women had a higher mortality rate (p\u0026thinsp;=\u0026thinsp;0.0031), with indigenous people being the most affected (p\u0026thinsp;=\u0026thinsp;0.0155). Malaria cases in the DSEI-Yanomami from 2021 to 2024 decreased in the municipalities of Mucaja\u0026iacute;, Iracema, and Caracara\u0026iacute;, whereas Alto Alegre saw an increase in 2024. Interestingly, imported cases exported from RR decreased in Maranh\u0026atilde;o (\u0026minus;\u0026thinsp;95.5%), Par\u0026aacute; (\u0026minus;\u0026thinsp;86.8%), and Amazonas (\u0026minus;\u0026thinsp;71.5%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eAlthough indigenous malaria cases have increased, the intervention was linked to fewer hospitalizations. Strategies should target indigenous populations, especially children, and mining areas, focusing on early diagnosis, integrated surveillance, and care for vulnerable groups.\u003c/p\u003e","manuscriptTitle":"What was the impact of government intervention on malaria cases in the Yanomami indigenous lands?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 23:53:19","doi":"10.21203/rs.3.rs-7402800/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-15T19:42:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T16:26:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-08T15:04:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227035859194570101617478525181319614688","date":"2025-10-01T23:22:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329325931862866445543331408764482277810","date":"2025-09-30T18:33:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86687758265590057059785543843207404417","date":"2025-08-28T15:21:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-26T14:40:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-21T14:48:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-21T14:47:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-08-18T20:52:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4cf75845-2e1b-4b0e-be82-c6050d3ab15d","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:05:41+00:00","versionOfRecord":{"articleIdentity":"rs-7402800","link":"https://doi.org/10.1186/s12936-025-05744-5","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2025-12-20 15:57:58","publishedOnDateReadable":"December 20th, 2025"},"versionCreatedAt":"2025-09-03 23:53:19","video":"","vorDoi":"10.1186/s12936-025-05744-5","vorDoiUrl":"https://doi.org/10.1186/s12936-025-05744-5","workflowStages":[]},"version":"v1","identity":"rs-7402800","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7402800","identity":"rs-7402800","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}