Despite emerging progress towards eradication of malaria, the 2016 World Malaria Report says that 92% of the estimated 429,000 malaria deaths occur in Africa followed by the South-East Asia Region 6% and the Eastern Mediterranean Region 2%.

The Report by World Health Organization which reviews global progress and disease burden (2010-2015) also adds that 90% of the 212 million new cases of malaria occur in the continent, followed by the South-East Asia Region 7% and the Eastern Mediterranean Region 2%.

The Report also emphasizes despite what remains grim statistics malaria cases and deaths are declining globally including Africa. However, children under 5 are particularly susceptible and in 2015, malaria killed an estimated 303 000 of them globally, including 292 000 in the African Region. Malaria remains a major killer of under-fives, claiming the life of one child every two minutes.

The WHO Report says that controlling the mosquito vector is the main way to prevent and reduce malaria transmission and the two effective methods includes insecticide-treated mosquito nets (ITNs) and indoor residual spraying (IRS). ITNs are the cornerstone of malaria prevention efforts, particularly in sub-Saharan Africa. Over the last 5 years, the use of treated nets in the region has increased significantly: in 2015, an estimated 53% of the population at risk slept under a treated net compared to 30% in 2010. Indoor residual spraying of insecticides (IRS) is used by national malaria programmes in targeted areas.

WHO recommends diagnostic testing for all people with suspected malaria before treatment is administered. Rapid diagnostic testing (RDTs), introduced widely over the past decade, has made it easier to swiftly distinguish between malarial and non-malarial fevers. Artemisinin-based combination therapies (ACTs) are highly effective against P. falciparum, the most prevalent and lethal malaria parasite affecting humans. Malaria infection in pregnancy carries substantial risks for the mother, her fetus and the newborn child. In Africa, the proportion of women who receive intermittent preventive treatment in pregnancy (IPTp) for malaria has been increasing over time, but coverage levels remain below national targets.

IPTp is given to pregnant women at scheduled antenatal care visits after the first trimester. It can prevent maternal death, anaemia and low birth weight, a major cause of infant mortality.

Resistance

Progress in malaria control is threatened by the rapid development and spread of antimalarial drug resistance. To date, parasite resistance to artemisinin – the core compound of the best available antimalarial medicines – has been detected in five countries in Asia’s Greater Mekong sub-region. Mosquito resistance to insecticides is another growing concern. 60 of the 73 countries that monitor insecticide resistance have reported mosquito resistance to at least 1 insecticide class used in nets and indoor spraying; of these, 50 reported resistance to 2 or more insecticide classes.

To address remaining challenges, WHO has developed the Global Technical Strategy for Malaria 2016-2030 (GTS). The Strategy was adopted by the World Health Assembly in May 2015. It provides a technical framework for all endemic countries as they work towards malaria control and elimination.

Milestones for 2020 include:

  • Reducing malaria case incidence by at least 40%;
  • Reducing malaria mortality rates by at least 40%;
  • Eliminating malaria in at least 10 countries;
  • Preventing a resurgence of malaria in all countries that are malaria-free.

Funding

In 2015, malaria funding totalled US$ 2.9 billion, representing only 45% of the GTS funding milestone for 2020. Governments of malaria-endemic countries provided 32% of total funding. The United States of America and the United Kingdom are the largest international funders of malaria control and elimination programmes, contributing 35% and 16% of total funding, respectively. If the 2020 targets of the GTS are to be achieved, total funding must increase substantially. The World Malaria Report is published every year in December, providing the global health community with a comprehensive overview of progress in the fight against malaria. (Source WHO. contact: stewarts@who.int; hartlg@who.int)