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Malaria intensity indicators were calculated during the study period. The effects of El Ni\u00f1o Southern Oscillation on malaria transmission were also analysed using a retrospective analysis of malaria cases between 1957 and 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Several factors were identified responsible for malaria resurgence in Panam\u00e1, mostly related with Malaria Control Programme weakening. During the past 20\u00a0years (2000\u20132019) malaria has progressively increased in prevalence within indigenous settlements, with a predominance of male cases and a high proportion (15% of total cases) in children less than 5\u00a0years old. During this period, a significant and increasing proportion of the\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      cases were imported. Retrospective analysis (1957\u20132019) evidenced that ENSO had a significant impact on malaria transmission dynamics in Panam\u00e1.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Data analysis confirmed that although authorities have been successful in focalizing malaria transmission in the country, there are still neglected issues to be solved and important intercultural barriers that need to be addressed in order to achieve elimination of the disease by 2022. This information will be useful for targeting strategies by the National Malaria Elimination Programme.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-020-03329-y","type":"journal-article","created":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T06:04:12Z","timestamp":1595484252000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Long-term transmission patterns and public health policies leading to malaria elimination in Panam\u00e1"],"prefix":"10.1186","volume":"19","author":[{"given":"Lisbeth","family":"Hurtado","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Cumbrera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chystrie","family":"Rigg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milixa","family":"Perea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"Santamar\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5301-2764","authenticated-orcid":false,"given":"Luis Fernando","family":"Chaves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianik","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Romero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Lasso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Caceres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azael","family":"Salda\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6669-4290","authenticated-orcid":false,"given":"Jose E.","family":"Calzada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,23]]},"reference":[{"key":"3329_CR1","unstructured":"The Sanitation of the Panama Canal. 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This research was considered by the Comit\u00e9 de Bio\u00e9tica de la Investigaci\u00f3n del Instituto Conmemorativo Gorgas de Estudios de la Salud and deemed exempt (N<sup>o<\/sup>113\/CBI\/ICGES\/20). The search of suspected cases and all the diagnostic, treatment and documentation procedures of all malaria cases (detected via active and passive search) were conducted by the NMCP and local health centres\u2019 technical personnel as part of the routine surveillance system for malaria control. Epidemiological information was also obtained from the NMCP databases. The confidentiality of the study subjects with malaria was protected and individual data were not shared.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"265"}}