Authors: Martha Powell, Future Science Group
The WHO has published 2019’s World Malaria Report, providing an update on global trends and how progress is going towards the elimination of this disease.
Pregnant women and children in Africa at risk
The World Malaria Report has identified that malaria appears to hit pregnant women and children in Africa the hardest, suggesting that countries prioritize support for these two at-risk groups. In 2018 it is estimated that 11 million pregnant women across 38 countries with moderate-to-high transmission in sub-Saharan Africa were infected. In addition, an estimated 872,000 infants were born with a low birth weight due to malaria in pregnancy.
However, there has been progress – the WHO recommend all children in malaria-affected areas sleep under insecticide-treated nets. In 2018 approximately 62% of children under 5 years old were sleeping under these nets, compared with 26% in 2010. Moreover, based on surveys from 29 sub-Saharan countries, 76% of children with a fever received a diagnostic test in the public health sector between 2015 and 2018, compared with 48% in the previous 4-year period. This is largely due to the availability of cheap and high-quality rapid diagnostics.
“Pregnant women and children are the most vulnerable to malaria, and we cannot make progress without focusing on these two groups,” commented Tedros Adhanom Ghebreyesus, WHO Director-General. “We’re seeing encouraging signs, but the burden of suffering and death caused by malaria is unacceptable, because it is largely preventable. The lack of improvement in the number of cases and deaths from malaria is deeply troubling.”
Previous progress plateauing?
The Report states that exceptional progress was made between 2000 and 2015 in reducing malaria burden, however, the rate of progress has slowed in recent years and critical targets might now be missed.
The global incidence rate of malaria fell from 71 per 1000 population at risk in 2010 to 57 in 2014; however, this has slowed dramatically, remaining at similar levels through 2018. Moreover, the progress in reducing deaths has also slowed. Having fallen from 585,000 in 2010 to 405,000 in 2018 the rate of reduction is reported to be significantly slower between 2016–2018 compared with 2010–2015.
Overall in 2018, an estimated 228 million cases of malaria occurred worldwide, compared with compared with 251 million cases in 2010 and 231 million cases in 2017.
Although in 2018 two countries – Paraguay and Uzbekistan – were certified as malaria-free and two more – Argentina and Algeria – followed in 2019, the progress towards global targets remains off-track. For example, The Global Technical Strategy calls for reductions in case incidence and death rates of 40% by 2020 compared with a 2015 baseline – with recent trends this will be missed.
Resistance – a rising issue
This year’s World Malaria Report also provides an overview on drug- and insecticide-resistance, stating that there is emerging resistance to some antimalarial drugs, particularly in the Greater Mekong Subregion, however, all current first-line drugs used by all malaria-endemic countries remain highly efficacious.
With regards to insecticide resistance, increasing levels of resistance to pyrethroids are being reported across all malaria-endemic countries. From 2010 through 2018, some 81 countries reported data on insecticide resistance monitoring to WHO, with resistance to pyrethroids detected in at least one malaria vector in more than two thirds of the sites tested.
New tools – a solution?
The report suggests that new tools and strategies to combat malaria will be critical to accelerate the pace of progress. It cites tools currently under evaluation for vector control, such as new types of treated nets, vector traps and gene drive approaches, and also points towards the RTS,S pilot program currently being carried out in Ghana, Kenya and Malawi.
Action must be stepped up
In order to get back on track towards global targets the 2019 World Malaria Report states that more action is needed across all endemic countries, specifically those with a high burden. This includes new ‘high burden high impact’ strategies being implemented in several countries, but also stepped-up financing. The report states that in 2018 funding for malaria control and elimination reached approximately US $2.7 billion, falling short of the US $5 billion target in the Global Technical Strategy.
Ultimately, the Report stresses that universal health coverage will be key to success; everyone must have access to the primary care services necessary to prevent, diagnose and treat malaria.
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Source: WHO. World Malaria Report 2019. www.who.int/malaria/publications/world_malaria_report/en/