Elimination Strategy for Malaria in El Salvador: a Retrospective Study

El Salvador, a small country with limited resources, was declared by the World Health Organization to have eliminated malaria on February 25, 2021. This study retrospectively investigated the evolution of strategies utilized to reduce malaria incidence and eliminate it in El Salvador. A retrospective systematic review of the malaria cases from 1960 until 2019 was carried out by analyzing the data from the MOH surveillance system, as well as a historical analysis of documents from El Salvador MOH, PAHO/WHO, and UN El Salvador Malaria Eradication Program since its origin in the 1950s. The peak of malaria cases in the country was observed in 1980 with 95,835 cases when the Civil War started with a subsequent decline reaching 0 indigenous cases in 2017, 2018, and 2019 with only 1 imported case in 2019. Although its neighboring countries Guatemala and Honduras maintain active malaria transmission, El Salvador interrupted transmission with 0 malaria indigenous cases reported from 2017 onwards leading to its certification of malaria elimination in the middle of the COVID-19 pandemic. Key strategies employed by El Salvador included the utilization of voluntary collaborators, optimizing medical treatment regimens, consistent domestic funding, environmental modifications targeting large mosquito breeding sites, decentralizing diagnostic laboratories, and establishing a national surveillance system with stratification of malaria-risk areas. El Salvador is an example of a success story of malaria elimination without the use of vaccination.