Shrinking the Malaria Map

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

Malaria elimination highlights from the World Malaria Report 2016

20 December 2016
By Anne Bulchis

On December 13th, the World Health Organization (WHO) launched the World Malaria Report 2016. Priti Patel, the United Kingdom’s International Development Secretary, spoke at the London launch event alongside Dr. Pedro Alonso (Director, Global Malaria Programme), Jeremy Farrar OBE (Director, Wellcome Trust), and Dr. Winnie Mpanju-Shumbusho (Board Chair, Roll Back Malaria).

The World Malaria Report (WMR), published annually by WHO, tracks progress and trends in malaria control and elimination around the world. It is developed by WHO in collaboration with ministries of health and other partners. The 2016 report draws on 2015 data from 91 countries and territories with ongoing malaria transmission.

Highlights from the WMR include:

1. Globally, malaria endemic countries have seen an overall reduction in malaria cases and deaths.

  • In 2015, malaria cases fell to an estimated 212 million, leading to 490,000 deaths—most of which were in children under five years old in Africa. There were an estimated 214 million malaria cases in 2014 and 262 million cases in 2000.
  • According to the latest estimates, between 2000 and 2015, global malaria case incidence was reduced by 41% and malaria mortality rates declined by 62%.
  • At the beginning of 2016, malaria was considered to be endemic in 91 countries and territories, down from 108 in 2000.
  • The WHO Global Technical Strategy for Malaria (GTS) calls for the elimination of malaria in at least 10 countries by the year 2020. This target is well within reach.
      • Nine countries reported between 150 and 1000 cases.
      • 10 countries and territories reported fewer than 150 locally-acquired cases.

 

2. The region that carries the heaviest malaria burden, sub-Saharan Africa, is also the region that has demonstrated some of the most positive recent trends.

  • It is estimated that 12 countries in sub-Saharan Africa and India accounted for 75% of malaria deaths in 2015. The Democratic Republic of the Congo and Nigeria together accounted for more than 36% of the global total of estimated malaria deaths.
  • WHO recommends diagnostic testing for all people with suspected malaria before treatment is administered. In 22 African countries, the proportion of children with a fever who received a malaria diagnostic test at a public health facility increased by 77% over the last five years—to approximately half.
  • The report notes that vector control is the main way to prevent and reduce malaria transmission. Across sub-Saharan Africa, the proportion of people sleeping under treated nets has nearly doubled over the last five years—to 53% of the population.

Estimated country share of total malaria deaths in 2015. Data and figure from WHO.

 

3. Taken together, the MEI’s eliminating countries have made substantial gains in driving down malaria since 2000 and achieved a marked decrease in reported cases from 2014 to 2015.

  • A growing number of countries are aiming for and achieving elimination.
      • Kyrgyzstan and Sri Lanka received WHO malaria-free certification in 2016.
      • Azerbaijan, Costa Rica, Paraguay, and Turkey maintained zero cases of local transmission in 2015.
      • Tajikistan achieved zero local cases in 2015.
  • Of the remaining 28* malaria-eliminating countries, reported cases fell by an estimated 89% between 2000 and 2015 and by approximately 36% from 2014 to 2015. (This compares with a 7% decline in cases from 2013 to 2014.)
  • Malaria cases declined from 2014 to 2015 in the following 16 malaria-eliminating countries: Belize, Bhutan, Botswana, Cabo Verde, Democratic People’s Republic of Korea, El Salvador, Malaysia, Mexico, Namibia, Nepal, Panama, South Africa, Swaziland, Thailand, Vanuatu, and Vietnam. The six countries in bold are those that had also achieved a decrease from 2013 to 2014.
  • Malaria cases increased from 2014 to 2015 in the following 12 countries: Algeria, China, Dominican Republic, Guatemala, Honduras, Iran, Nicaragua, Philippines, Republic of Korea, Sao Tome & Principe, Saudi Arabia, and the Solomon Islands. The three countries in bold are those that had also experienced an increase from 2013 to 2014.
  • Among the 28 malaria-eliminating countries, there was a remarkable increase in 2015 in the number of countries distinguishing between local versus imported cases. The 12 countries listed below reported imported cases for the first time, indicating improved surveillance. A more sensitive surveillance system could have contributed to increased case numbers for the countries in bold:
      • Africa: Botswana, Namibia, Sao Tome & Principe, South Africa
      • Americas: Dominican Republic, Guatemala, Nicaragua, Panama
      • South-East Asia: DPRK, Nepal, Thailand
      • Western Pacific: Philippines

*Mayotte is not included in the list of 28 countries because it did not report 2015 malaria case data to WHO.

Today’s status of global malaria elimination and control by country. The MEI’s current eliminating countries are shown in purple. Data from WHO and map from the MEI.

 

4. Malaria remains an acute public health problem.

  • The GTS calls for a 40% reduction in malaria case incidence and mortality by 2020. According to the WMR, fewer than half (40) of the 91 countries with malaria transmission are on track to achieve these milestones.
  • In many countries, health systems are under-resourced and poorly accessible to those most at risk of malaria. In 2015, a large proportion (36%) of children with fever were not taken to a health facility for care in 23 African countries.
  • Artemisinin-based combination therapies (ACTs) are highly effective against P. falciparum, the most present and lethal malaria parasite affecting humans. Globally, the number of ACT treatment courses procured from manufacturers increased from 187 million in 2010 to a peak of 393 million in 2013, but subsequently fell to 311 million in 2015.
  • Progress in malaria control in many countries is threatened by the rapid development and spread of antimalarial drug resistance. To date, parasite resistance to artemisinin has been detected in five countries of the Greater Mekong subregion.

Distribution of malarial multidrug resistance in 2016. Data and map from WHO.

 

5. Global financing for malaria increased slightly in 2015, but sustained and sufficient funding for malaria elimination and control is a formidable challenge.

  • In 2015, global financing for malaria totaled US $2.9 billion—a slight increase from US $2.5 billion in 2014 and up from US $960 million in 2005.
      • Governments of malaria endemic countries provided 32% of total funding.
      • The United States and the United Kingdom are the largest international funders of malaria control and elimination programs, contributing 35% and 16% of total malaria funding, respectively.
  • The GTS annual funding target for 2020 is US $6.4 billion, which is more than twice the level of financing available today. If the 2020 targets of the GTS are to be achieved, total funding must increase substantially.