The World Health Organization (WHO) World Malaria Report 2021 < https://www.who.int/publications/i/item/9789240040496 > estimates that there were 241 million malaria cases, including 627,000 deaths, worldwide in 2020, which represents around 14 million more cases, and 69,000 more deaths, than 2019. Approximately two-thirds of these additional deaths were linked to disruptions in the provision of malaria prevention, diagnosis and treatment during the COVID-19 pandemic. Sub-Saharan Africa continues to carry the heaviest malaria burden, accounting for about 95% of all cases and 96% of all deaths in 2020, with around 80% of deaths in the region among children under five years old. Since 2015, the baseline date for the WHO's global malaria strategy, registered increases in malaria deaths were reported in 24 countries. In the 11 countries that carry the highest burden of malaria worldwide, cases increased from 150 million in 2015 to 163 million cases in 2020, and malaria deaths increased from 390,000 to 444,600 over that same period. As in previous years, the report includes an up-to-date assessment on the burden of malaria at global, regional, and country levels, and tracks investment in malaria programmes and research, as well as detailing progress across the four intervention areas of prevention, diagnosis, treatment and surveillance. There are also dedicated chapters on malaria elimination and key threats, such as insecticide and drug resistance.

World malaria report 2011

https://www.who.int/malaria/mpac/mpac_mar2014_wmr2013.pdf

World Malaria Report 2013

Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990???2013: a systematic analysis for the Global Burden of Disease Study 2013

The burden of malaria in countries in sub-Saharan Africa has declined with scaling up of prevention, diagnosis, and treatment. To assess the contribution of specific malaria interventions and other general factors in bringing about these changes, we reviewed studies that have reported recent changes in the incidence or prevalence of malaria in sub-Saharan Africa. Malaria control in southern Africa (South Africa, Mozambique, and Swaziland) began in the 1980s and has shown substantial, lasting declines linked to scale-up of specific interventions. In The Horn of Africa, Ethiopia and Eritrea have also experienced substantial decreases in the burden of malaria linked to the introduction of malaria control measures. Substantial increases in funding for malaria control and the procurement and distribution of effective means for prevention and treatment are associated with falls in malaria burden. In central Africa, little progress has been documented, possibly because of publication bias. In some countries a decline in malaria incidence began several years before scale-up of malaria control. In other countries, the change from a failing drug (chloroquine) to a more effective drug (sulphadoxine plus pyrimethamine or an artemisinin combination) led to immediate improvements; in others malaria reduction seemed to be associated with the scale-up of insecticide-treated bednets and indoor residual spraying.

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(10)70096-7.pdf

Changes in the burden of malaria in sub-Saharan Africa

An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007. In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT. In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased. Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes.

/pdf/initial-evidence-of-reduction-of-malaria-cases-and-deaths-in-3xjc1qx0rb.pdf

Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment.

To control malaria, the Rwandan government and its partners distributed insecticide-treated nets (ITN) and made artemisinin-based combination therapy (ACT) widely available from 2005 onwards. The impact of these interventions on malaria cases, admissions and deaths was assessed using data from district hospitals and household surveys. District records of ITN and ACT distribution were reviewed. Malaria and non-malaria indictors in 30 district hospitals were ascertained from surveillance records. Trends in cases, admissions and deaths for 2000 to 2010 were assessed by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period, 2000–2005. Changes were estimated by comparing trends in post-intervention (2006–2010) with that of pre-intervention (2000–2005) period. All-cause deaths in children under-five in household surveys of 2005 and 2010 were also reviewed to corroborate with the trends of deaths observed in hospitals. The proportion of the population potentially protected by ITN increased from nearly zero in 2005 to 38% in 2006, and 76% in 2010; no major health facility stock-outs of ACT were recorded following their introduction in 2006. In district hospitals, after falling during 2006–2008, confirmed malaria cases increased in 2009 coinciding with decreased potential ITN coverage and declined again in 2010 following an ITN distribution campaign. For all age groups, from the pre-intervention period, microscopically confirmed cases declined by 72%, (95% Confidence Interval [CI], 12-91%) in 2010, slide positivity rate declined 58%, (CI, 47%–68%), malaria inpatient cases declined 76% (CI, 49%–88%); and malaria deaths declined 47% (CI, 47%–81%). In children below five years of age, malaria inpatients decreased 82% (CI, 61%-92%) and malaria hospital deaths decreased 77% (CI, 40%–91%). Concurrently, outpatient cases, admissions and deaths due to non-malaria diseases in all age groups either increased or remained unchanged. Rainfall and temperature remained favourable for malaria transmission. The annual all-cause mortality in children under-five in household surveys declined from 152 per 1,000 live births during 2001–2005, to 76 per 1,000 live births in 2006–2010 (55% decline). The five-year cumulative number of all-cause deaths in hospital declined 28% (8,051 to 5,801) during the same period. A greater than 50% decline in confirmed malaria cases, admissions and deaths at district hospitals in Rwanda since 2005 followed a marked increase in ITN coverage and use of ACT. The decline occurred among both children under-five and in those five years and above, while hospital utilization increased and suitable conditions for malaria transmission persisted. Declines in malaria indicators in children under 5 years were more striking than in the older age groups. The resurgence in cases associated with decreased ITN coverage in 2009 highlights the need for sustained high levels of anti-malarial interventions in Rwanda and other malaria endemic countries.

https://dash.harvard.edu/bitstream/handle/1/10579222/3502144.pdf?sequence=1

Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial interventions, 2000–2010, Rwanda

Background Namibia is one of the countries among the eight that are targeting malaria elimination in southern Africa. However, the country has encountered malaria epidemics in recent years. The objective of this study was to investigate malaria epidemics and to contribute to strengthening malaria surveillance and control in an effort to move Namibia toward eliminating malaria. Method Malaria epidemiology data for 2014-2015 were collected from the weekly surveillance system. All consenting household members within a 100-m radius of index households were screened in 2016 using a Carestart malaria HRP2/pLDH combined rapid diagnostic test after epidemics. All houses within this radius were sprayed in 2016 with the pyrethroid deltamethrin and K-Othrine WG 250. Anopheles mosquito-positive breeding sites were identified and treated with the organophosphate larvicide temephos. Insecticide susceptibility and bioassay tests were conducted. Results During the epidemic response period in 2016, 56 parasitologically confirmed Plasmodium falciparum malaria cases in the Zambezi region were detected from active screening. The majority of those cases (83%) were asymptomatic infections. In the Kavango region, the malaria epidemic persisted, with 228 P. falciparum malaria cases recorded, but only 97 were investigated. In Namibia, malaria vector susceptibility was detected to 4% dichlorodiphenyltrichloroethane. Indoor residual spraying was conducted in 377 (90%) of the targeted households along with community awareness through health education of 1499 people and distribution of more than 2000 information, education and communication materials. The P. falciparum malaria cases in the Zambezi decreased from 122 in week 9 to 97 after week 15. Conclusions Malaria epidemics along with the persistence of asymptomatic reservoir infections pose a serious challenge in Namibia's elimination effort. The country needs to ensure sustainable interventions to target asymptomatic reservoir infections and prevent epidemics in order to successfully achieve its goal of eliminating malaria.

Khoti Gausi

Papers

Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment.

Trends in malaria cases, hospital admissions and deaths following scale-up of anti-malarial interventions, 2000–2010, Rwanda

An investigation of the Plasmodium falciparum malaria epidemic in Kavango and Zambezi regions of Namibia in 2016.