Citing a rise in global malaria cases last year, World Health Organization (WHO) officials have released the 2017 World Malaria Report with warnings of stalled progress in the fight against the disease and calls for urgent action to shore up gains made in recent years.
The World Malaria Report, published annually, provides a comprehensive update on global and regional progress in the fight against malaria up to the end of 2016. The latest report, released on 29 November 2017, tracks progress in investments in malaria programmes and research, malaria prevention, diagnosis and treatment, surveillance, trends in malaria disease burden, malaria elimination, and threats in tackling malaria and safeguarding the investments made.
Global and regional malaria trends in numbers
In 2016, an estimated 216 million cases of malaria occurred worldwide, compared with 237 million cases in 2010 and 211 million cases in 2015. Most malaria cases in 2016 were in the WHO African Region (90%), followed by the WHO South-East Asia Region (7%) and the WHO Eastern Mediterranean Region (2%).
Of the 91 countries reporting indigenous malaria cases in 2016, 15 countries – all in sub-Saharan Africa, except India – carried 80% of the global malaria burden.
The incidence rate of malaria is estimated to have decreased by 18% globally, from 76 to 63 cases per 1000 population at risk, between 2010 and 2016. 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%).
Despite these reductions, between 2014 and 2016, substantial increases in case incidence occurred in the WHO Region of the Americas, and marginally in the WHO South-East Asia, Western Pacific and African regions.
In 2016, there were an estimated 445,000 deaths from malaria globally, compared to 446 000 estimated deaths in 2015.
The WHO African Region accounted for 91% of all malaria deaths in 2016, followed by the WHO South- East Asia Region (6%).
Fifteen countries accounted for 80% of global malaria deaths in 2016; all of these countries are in sub-Saharan Africa, except for India.
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%).
However, between 2015 and 2016, mortality rates stalled in the WHO regions of South-East Asia, the Western Pacific and Africa, and increased in the Eastern Mediterranean and the Americas.
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.
Although some of E-2020 countries remain on track to achieve their elimination goals, 11 have reported increases in indigenous malaria cases since 2015, and 5 countries reported an increase of more than 100 cases in 2016 compared with 2015.
Challenges to achieving a malaria-free world
Some of the challenges impeding countries’ abilities to stay on track and advance towards elimination include lack of sustainable and predictable international and domestic funding, risks posed by conflict in malaria endemic zones, anomalous climate patterns, the emergence of parasite resistance to antimalarial medicines and mosquito resistance to insecticides.
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.
Resistance to pyrethroids – the only insecticide class currently used in insecticide-treated nets (ITNs) – is widespread. The proportion of malaria endemic countries that monitored and subsequently reported pyrethroid resistance increased from 71% in 2010 to 81% in 2016. The prevalence of confirmed resistance to pyrethroids differed between regions, and was highest in the WHO African and Eastern Mediterranean regions, where it was detected in malaria vectors in over two thirds of all sites monitored.
Nets continue to be an effective tool
According to the report from WHO, ITNs continue to be an effective tool for malaria prevention, even in areas where mosquitoes have developed resistance to pyrethroids. This was evidenced in a large multi-country evaluation coordinated by WHO between 2011 and 2016, which did not find an association between malaria disease burden and pyrethroid resistance across study locations in 5 countries.
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To see the complete key points from the World Malaria Report 2017, click here.
To download the World Malaria Report 2017, click here.