Epidemiology and social factors of malaria in the Yanomami Indigenous Territory: a critical review of the challenges of control and elimination

Abstract

Malaria in the Yanomami Indigenous Territory (YIT) constitutes a serious public health concern and has been hyperendemic since 1987, following the arrival of illegal gold miners in the area. Disease transmission has steadily increased since 2013, particularly among children. It escalated into a crisis in 2019, driven by the intensification of illegal mining and environmental, sociocultural, and political factors, and reached approximately 33,000 cases in 2024. Although the declaration of a Public Health Emergency in 2023 led to advancements in surveillance and diagnosis, the incidence of cases remains elevated. Nevertheless, there was a remarkable reduction in malaria-related mortality, evidenced by a 42% decrease in deaths and a 47% decline in the case-fatality rate, even in the context of persistently high notification rates. Barriers to control include limited access to remote communities, ecological degradation that favours vector proliferation, a high prevalence of submicroscopic infections, and sociocultural constraints. Expanded diagnostic capacity and a reinforced workforce are essential but insufficient without addressing the underlying structural causes. This mini-review summarises and critically discusses the epidemiological trends of malaria in YIT, as well as the social, environmental, cultural, and operational factors that sustain transmission.