Updates from World Malaria Report 213

This article captures just a tip of the iceberg as the full report detailed all the progresses in various thematic areas. It revealed that since 2000, a tremendous expansion in the financing and coverage of malaria control programmes has led to a wide-scale reduction in malaria incidence and mortality. Based on reported data, 59 out […]

This article captures just a tip of the iceberg as the full report detailed all the progresses in various thematic areas. It revealed that since 2000, a tremendous expansion in the financing and coverage of malaria control programmes has led to a wide-scale reduction in malaria incidence and mortality. Based on reported data, 59 out of 103 countries that had ongoing malaria transmission in 2000 are meeting the Millennium Development Goal (MDG) target of reversing the incidence of malaria.
It also revealed that ‘worldwide, between 2000 and 2012, estimated malaria mortality rates fell by 45% in all age groups and by 51% in children under 5 years of age. If the annual rate of decrease that has occurred over the past 12 years is maintained, then malaria mortality rates are projected to decrease by 56% in all ages, and by 63% in children under 5 years of age by 2015; this represents substantial progress towards the World Health Assembly target of reducing malaria mortality rates by 75% by 2015.’
It reported that an estimated 3.3 million malaria deaths were averted between 2001 and 2012, and that 69% of these lives saved were in the 10 countries with the highest malaria burden in 2000; thus, progress is being made where it matters most. About 3 million (90%) of the deaths averted between 2001 and 2012 are estimated to be in children under 5 years of age in sub-Saharan Africa. Nevertheless, between 2011 and 2012, the pace of decrease in estimated malaria mortality rates slowed.
Financing malaria control
In the area of health financing related to malaria the report documented that the total international and domestic funding committed to malaria control was estimated to be US$ 2.5 billion in 2012 – substantially less than the amount that will be needed to reach the global targets.  International disbursements to malaria-endemic countries have increased markedly, from less than US$ 100 million in 2000 to US$ 1.6 billion in 2011, and an estimated US$ 1.94 billion in 2012 and 1.97 billion in 2013. However, increases in international funding have slowed in recent years, to an average of 4% per year between 2009 and 2013, compared to an average of 43% per year between 2005 and 2009.
It is important to ask the pertinent question of how much each African country allocated, released and expended on Malaria in 2012 and analysed the impact of such expenditure.
Progress on chemoprevention and diagnoses and treatment
It also reported that the median percentage of pregnant women attending antenatal care (ANC) who received at least one dose of intermittent preventive treatment (IPT) during pregnancy in 2012 was 64%, whereas 38% received at least two doses and 23% received at least three doses, indicating that there is considerable scope for improving protection for pregnant women.
In sub-Saharan Africa, an estimated 35 million pregnant women and a large portion of the estimated 26 million infants born each year would benefit from IPT. The numbers of procured rapid diagnostic tests (RDTs) and ACTs are increasing, as is the reported rate of diagnostic testing in the public sector in the African Region, which increased from 37% in 2010 to 61% in 2012. As a result, there has been a decrease in the number of suspected malaria cases treated presumptively with antimalarial drugs. However, millions of people with suspected malaria still do not receive a diagnostic test, and many people with confirmed infections do not receive appropriate treatment with a quality assured antimalarial.
ACTs are recommended as the first-line treatment of malaria caused by P. falciparum, the most dangerous of the Plasmodium parasites that infect humans. By 2012, 79 countries and territories had adopted ACTs as first-line treatment for P. falciparum malaria. P. vivax malaria should be treated with chloroquine where that drug is effective, or by an appropriate ACT in areas where P. vivax is resistant to chloroquine. Treatment of P. vivax should be combined with a 14-day course of primaquine to prevent relapse.
Malaria surveillance, monitoring and evaluation
In 2012, 62 countries of 103 that had ongoing malaria transmission in 2000, reporting was considered to be sufficiently consistent to make a reliable judgement about malaria trends for 2000–2012. In the 41 remaining countries, which account for 80% of estimated cases, it is not possible to reliably assess malaria trends using the data submitted to WHO. Information systems are weakest, and the challenges for strengthening systems are greatest, where the malaria burden is greatest. In 2012, routine health information systems detected only 14% of the cases estimated to occur globally.  
Impact of malaria control
Since 2000, more than half of the countries that had ongoing malaria transmission in 2000 have recorded decreases in the incidence of confirmed malaria, or in reported admissions and deaths (or both). Estimated malaria mortality rates worldwide fell by 45% between 2000 and 2012 in all age groups, and by 51% in children under 5 years of age. If the annual rate of decrease that has occurred over the past 12 years is maintained, then malaria mortality rates are projected to decrease by 56% in all ages, and by 63% in children under 5 years of age, by 2015.
All comments to Dr Aminu Magashi at [email protected]