Shrinking the Malaria Map

UCSF Global Health Group’s Malaria Elimination Initiative (MEI)

São Tomé and Príncipe

São Tomé and Príncipe has achieved a 97% decrease in reported malaria cases in the past decade and is making great progress toward elimination.

São Tomé and Príncipe is a two-island archipelago located in the Gulf of Guinea off the coast of Gabon in West Africa. A distance of 140 kilometers (87 miles) separates the two islands, with most of the country’s population residing on São Tomé. The population of both islands is concentrated along the coastlines. The country has substantially reduced its malaria burden from a peak of almost 54,000 cases in 2004 to 1,754 in 2014. 100% of malaria cases reported in 2014 were due to Plasmodium falciparum, though P. vivax, P. malariae, and P. ovale infections were more prevalent on the islands in the past.

São Tomé and Príncipe’s entire population is at risk for malaria, but a higher parasite prevalence has historically been recorded on the island of São Tomé. The malaria epidemiological profile of São Tomé is considered low but unstable, whereas transmission on Príncipe, a much smaller island with a very low population, has been low and stable since 2007. Transmission largely occurs along the coastal areas of São Tomé due to high inland elevations that reduce vectorial capacity.

In 2004, the Centro National de Endemias (CNE) of São Tomé and Príncipe launched a malaria control strategy centered on early diagnosis and prompt treatment, high coverage of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs), larval control, and mass screening and treatment. This combination of efforts, along with financial and technical support from global partners, led to a dramatic 96% decline in annual cases to just 2,421 in 2007, placing Príncipe on the brink of elimination and prompting the CNE to shift its overall strategic focus for both islands to pre-elimination. A performance review of the National Program to Fight Malaria (PNLP) in 2011 highlighted the importance of strengthened surveillance and reporting, improved outbreak response preparedness, targeted application of vector control using stratification and mapping, and overall program capacity building. These recommendations were incorporated into São Tomé and Príncipe’s 2012-2016 strategic plan, which sets the country on a path to pre-elimination by 2016.

1,754 # of cases (2014)
2020
Elimination goal
Lower middle
Income level
Reported cases
Reported cases
P falciparum transmission limit (2010)
P falciparum transmission limit (2010)
P vivax transmission limit (2010)
P vivax transmission limit (2010)

Challenges to elimination