WHO releases World Malaria Report (29 November 2017)

The World Health Organization (WHO) has released World Malaria Report 2017.

Key Messages:

1. Global Malaria Trends

A. Malaria Cases:

Total cases:

  • 2016: 216 million
  • 2015: 211 million
  • 2010: 237 million

Distribution (2016):

  • WHO African Region (90%),
  • WHO South-East Asia Region (3%) and the
  • WHO Eastern Mediterranean Region (2%).

Indigenous malaria cases were reported from 91 countries. 15 of these carry 80% of the global malaria burden, all of which- except India- are in sub-Saharan Africa.

Incidence Rate (per 1000 population at risk):

  • 2016: 63 cases/ 1000 population at risk
  • 2010: 76 cases/ 1000 population at risk

The WHO South-East Asia Region recorded the largest decline (48%) followed by the WHO Region of the Americas (22%) and the WHO African Region (20%).

Agent

Plasmodium falciparum is the most prevalent malaria parasite in sub-Saharan Africa, accounting for 99% of estimated malaria cases in 2016.
Outside of Africa, P. vivax is the predominant parasite.

B. Malaria Deaths:

Total Deaths:

  • 2016: 445 000
  • 2015: 446 000

Distribution:

  • WHO African Region: 91%
  • WHO South East Asia Region: 6%.

15 countries accounted for 80% of global malaria deaths in 2016; all of these countries are in sub-Saharan Africa, except for India.

wmr2017-square-5

All regions recorded reductions in mortality in 2016 when compared with 2010, with the exception of the WHO Eastern Mediterranean Region, where mortality rates remained virtually unchanged in the period. The largest decline occurred in the WHO regions of South-East Asia (44%), Africa (37%) and the Americas (27%).

2. Diagnostic Testing and Treatment

A. Accessing care:

Prompt diagnosis and treatment is the most effective means of preventing a mild case of malaria from developing into severe disease and death.

Among national-level surveys completed in 18 countries in sub-Saharan Africa between 2014 and 2016 (representing 61% of the population at risk), a median of 47% of children with a fever (febrile) were taken to a trained medical provider for care. This includes public sector hospitals and clinics, formal private sector facilities and community health workers.

B. Diagnosing Malaria:

Among 17 national-level surveys completed in sub-Saharan Africa between 2014 and 2016, the proportion of children with a fever who received a finger or a heel stick – suggesting that a malaria diagnostic test may have been performed – was greater in the public sector than in both the formal and informal private sector.

Testing of suspected cases in the public health system increased in most WHO regions since 2010.
The WHO African Region recorded the biggest rise, with diagnostic testing in the public health sector increasing from 36% of suspected cases in 2010 to 87% in 2016.

C. Treating Malaria:

Among 18 household surveys conducted in sub-Saharan Africa between 2014 and 2016, the proportion of children aged under 5 years with a fever who received any antimalarial drug was 41%.

A majority of patients (70%) who sought treatment for malaria in the public health sector received ACTs, the most effective antimalarial drugs. Children are more likely to be given ACTs if medical care is sought at public health facilities than in the private sector.

To bridge the treatment gap among children, WHO recommends the uptake of integrated community case management (iCCM). This approach promotes integrated management of common life-threatening conditions in children – malaria, pneumonia and diarrhoea – at health facility and community levels.

3. Preventing Malaria

A. Vector Control:

Insecticide Treated mosquito Net (ITN):

Across sub-Saharan Africa, household ownership of at least one Insecticide Treated Net (ITN) increased:

  • 2016: 80%
  • 2010: 50%

However, the proportion of households with sufficient nets (i.e. one net for every two people) remains inadequate, at 43% in 2016.

wmr2017-square-3

More people at risk of malaria in Africa are sleeping under an ITN.

  • 2016: 54% of the population (therefore, 46% of the population are not sleeping under an ITN [infographic above])
  • 2010: 30% of the population

Indoor Residual Spraying (IRS):

Fewer people at risk of malaria are being protected by indoor residual spraying (IRS), a prevention method that involves spraying the inside walls of dwellings with insecticides.

Globally, IRS protection declined

  • 2016: 2.9%
  • 2010: 5.8%,

with decreases seen across all WHO regions. In the WHO African Region, coverage dropped from 80 million people at risk in 2010 to 45 million in 2016.

wmr2017-square-4

The declines in IRS coverage are occurring as countries change or rotate insecticides to more expensive chemicals.

B. Preventive Therapies:

Intermittent Preventive Treatment in pregnancy (IPTp):

To protect women in areas of moderate and high malaria transmission in Africa, WHO recommends “intermittent preventive treatment in pregnancy” (IPTp) with the antimalarial drug sulfadoxine pyrimethamine.

Among 23 African countries that reported on IPTp coverage levels in 2016, an estimated
19% of eligible pregnant women received the recommended three or more doses of IPTp, compared with 18% in 2015 and 13% in 2014.

Seasonal Malaria Chemoprevention (SMC):

In 2016, 15 million children in 12 countries in Africa’s Sahel sub-region were protected through seasonal malaria chemoprevention (SMC) programmes. However, about 13 million children who could have benefited from this intervention were not covered, mainly due to a lack of funding. Since 2012, SMC has been recommended by WHO for children aged 3-59 months living in areas of highly seasonal malaria transmission in this sub-region.

4. Malaria Elimination:

Globally, more countries are moving towards elimination: in 2016, 44 countries reported fewer than 10 000 malaria cases, up from 37 countries in 2010.

Kyrgyzstan and Sri Lanka were certified by WHO as malaria free in 2016.

In 2016, WHO identified 21 countries with the potential to eliminate malaria by the year 2020. WHO is working with the governments in these countries – known as “E-2020 countries” – to support their elimination acceleration goals.

5. Challenges to Achieving a Malaria Free World:

A. Funding

In general, funding has declined, and overall funding per person at risk of malaria is below $2.

B. Histidine-rich Protein 2 Deletions

In some settings, increasing levels of histidine-rich protein 2 gene (HRP2) deletions threaten the ability to diagnose and appropriately treat people infected with falciparum malaria. An absence of the HRP2 gene enables parasites to evade detection by HRP2-based RDTs, resulting in a false-negative test result.

C. Drug Resistance

Multidrug resistance, including artemisinin (partial) resistance and partner drug resistance, has been reported in five countries of the Greater Mekong subregion (GMS).

In Africa, artemisinin (partial) resistance has not been reported to date and first-line ACTs remain efficacious in all malaria endemic settings.

D. Insecticide Resistance

Of the 76 malaria endemic countries that provided data for 2010 to 2016, resistance to at least one insecticide in one malaria vector from one collection site was detected in 61 countries. In 50 countries, resistance to 2 or more insecticide classes was reported.

In 2016, resistance to one or more insecticides was present in all WHO regions, although the extent of monitoring varied.

Useful Links:

Link to the WHO news release:

http://who.int/mediacentre/news/releases/2017/malaria-report-response/en/

Link to the updated WHO fact sheet on malaria:

http://who.int/mediacentre/factsheets/fs094/en/

Link to World Malaria Report 2017:

http://who.int/malaria/publications/world-malaria-report-2017/en/

Link to Infographics based on World Malaria Report 2017:

http://who.int/malaria/media/infographics/en/

Link to Key Messages of the World Malaria Report 2017:

http://who.int/malaria/media/world-malaria-report-2017/en/

 

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