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Malaria deaths for these countries are also estimated from a cause of death fraction for malaria applied to the trends in all-cause mortality in children aged under 5 years, and to which a factor for malaria deaths among those aged over 5 years is applied.
For other countries with stronger surveillance systems, data are used as reported or cases are estimated by adjusting national data for treatment seeking, testing and reporting rates. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Where adjustments are applied to national case data, a species-specific case fatality rate is applied to these data to estimate malaria deaths.
Because these estimates are updated each year, computed malaria cases and deaths change across the period of analysis, and estimates over time may vary in the annual world malaria reports from different years. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Also, partly because of the separate methods used to compute malaria cases and deaths in sub-Saharan Africa, trends in the two measures of burden may be different for a given country; thus, caution should be applied in their comparison.
3.1 GLOBAL ESTIMATES OF MALARIA CASES AND DEATHS, 2000–2019Globally, there were an estimated 229 million malaria cases in 2019 in 87 malaria endemic countries, declining from 238 million in 2000 (Table 3.1) across 108 countries that were malaria endemic in 2000 (Fig.
3.1). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.1).
At the GTS baseline of 2015, there were 218 million estimated malaria cases.
The proportion of cases due to P. vivax reduced from about 7% in 2000 to 3% in 2019.
18FIG.
3.1.Countries with indigenous cases in 2000 and their status by 2019 Countries with zero indigenous cases over at least the past 3 consecutive years are considered to have eliminated malaria. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In 2019, China and El Salvador reported zero indigenous cases for the third consecutive year and have applied for WHO certification of malaria elimination; also, the Islamic Republic of Iran, Malaysia and Timor-Leste reported zero indigenous cases for the second time. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Source: WHO database.■ One or more indigenous cases■ Zero cases in 2018–2019■ Zero cases in 2019■ Zero cases (≥3 years) in 2019■ Certified malaria free after 2000■ No malaria■ Not applicableWHO: World Health Organization.TABLE 3.1.Global estimated malaria cases and deaths, 2000–2019 Estimated cases and deaths are shown with 95% upper and lower confidence intervals. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Source: WHO estimates.Year20002001200220032004200520062007200820092010201120122013201420152016201720182019Number of cases (000)Number of deathsPointLower bound Upper bound% P. vivaxPointLower boundUpper bound 238 000 244 000 239 000 244 000 248 000 247 000 242 000 241 000 240 000 246 000 247 000 239 000 234 000 225 000 217 000 218 000 226 000 231 000 228 000 229 000 222 000 259 000 228 000 265 000 223 000 260 000 226 000 268 000 227 000 277 000 229 000 272 000 223 000 268 000 222 000 265 000 222 000 264 000 226 000 271 000 226 000 273 000 218 000 262 000 213 000 258 000 206 000 248 000 201 000 236 000 203 000 238 000 210 000 247 000 213 000 252 000 211 000 250 000 211 000 252 0006.9%7.4%7.1%7.8%8.0%8.3%7.2%6.8%6.5%6.5%7.0%7.2%6.6%5.3%4.3%3.9%4.0%3.4%3.2%2.8% 736 000 739 000 736 000 723 000 759 000 708 000 716 000 685 000 638 000 620 000 594 000 545 000 517 000 487 000 471 000 453 000 433 000 422 000 411 000 409 000 697 000 700 000 698 000 681 000 708 000 662 000 675 000 644 000 599 000 572 000 546 000 505 000 481 000 451 000 440 000 422 000 403 000 396 000 389 000 387 000 782 000 786 000 783 000 775 000 830 000 765 000 771 000 735 000 685 000 681 000 658 000 596 000 568 000 538 000 511 000 496 000 478 000 467 000 458 000 460 000P. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
vivax: Plasmodium vivax; WHO: World Health Organization.19WORLD MALARIA REPORT 2020WORLD MALARIA REPORT 2020 3Global trends in the burden of malariaMalaria case incidence (i.e.
cases per 1000 population at risk) reduced from 80 in 2000 to 58 in 2015 and 57 in 2019 (Fig.
3.2).
Between 2000 and 2015, malaria case incidence declined by 27% and then by less than 2% in the period 2015–2019, indicating a slowing of the rate of decline since 2015 (Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.2).Malaria deaths have reduced steadily over the period 2000–2019, from 736 000 in 2000 to 409 000 in 2019 (Table 3.1).
The percentage of total malaria deaths among children aged under 5 years was 84% in 2000 and 67% in 2019.
The estimate of deaths in 2015, the GTS baseline, was about 453 000.
The malaria mortality rate (i.e. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The malaria mortality rate (i.e.
deaths per 100 000 population at risk) reduced from about 25 in 2000 to 12 in 2015 and 10 in 2019, with the slowing of the rate of decline in the latter years similar to that seen in number of cases (Fig.
3.2a).Of the 87 countries that were malaria endemic in 2019, 29 accounted for 95% of malaria cases globally (Fig.
3.2b).
Nigeria (27%), the Democratic Republic of the Congo (12%), Uganda (5%), Mozambique (4%) and Niger (3%) accounted for about 51% of all cases globally. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
About 95% of malaria deaths were in 32 countries (Fig.
3.2c).
Nigeria (23%), the Democratic Republic of the Congo (11%), the United Republic of Tanzania (5%), Burkina Faso (4%), Mozambique (4%) and Niger (4%) accounted for about 51% of all malaria deaths globally in 2019 (Fig.
3.2c).FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.2.c)Global trends in a) malaria case incidence rate (cases per 1000 population at risk), b) mortality rate (deaths per 100 000 population at risk), 2000–2019, c) distribution of malaria cases and d) deaths by country, 2019 Source: WHO estimates.80.057.556.8Mali, 3%Angola, 3%Côte d’Ivoire, 3%Burkina Faso, 3%Niger, 3%Mozambique, 4%Uganda, 5%United Republic of Tanzania, 3%Cameroon, 3%India, 2%Ghana, 2%Benin, 2%Rwanda, 2%Malawi, 2%Guinea, 2%Democratic Republic of the Congo, 12%Others, 5%Burundi, 1%Chad, 1%South Sudan, 1%Kenya, 1%Zambia, 1%Sierra Leone, 1%Ethiopia, 1%Sudan, 1%Madagascar, 1%Togo, 1%Liberia, 1%Central African Republic, 1%20002005201020152019Nigeria, 27%24.711.910.120002005201020152019d)Cameroon, 3%Ghana, 3%Mali, 3%Kenya, 3%Côte d’Ivoire, 2%Chad, 2%Uganda, 3%Angola, 3%Burkina Faso, 4%Mozambique, 4%Niger, 4%United Republic of Tanzania, 5%Democratic Republic of the Congo, 11% Guinea, 2%Zambia, 2%India, 2%Benin, 2%Sierra Leone, 2%Malawi, 2%Others, 5%Ethiopia, 1%Sudan, 1%South Sudan, 1%Burundi, 1%Togo, 1%Madagascar, 1%Senegal, 1%Central African Republic, 1%Rwanda, 1%Liberia, 1%Papua New Guinea, 1%Indonesia, 1%20WHO: World Health Organization.21Nigeria, 23%a)100ksirltanoitaupop0001repsesacairaaMlb)ksirltanoitaupop000001repshtaedairaaMl8060402002520151050WORLD MALARIA REPORT 2020 3Global trends in the burden of malaria3.2 ESTIMATED MALARIA CASES AND DEATHS IN THE WHO AFRICAN REGION, 2000–2019With an estimated 215 million malaria cases and 386 000 malaria deaths in 2019 (Table 3.2), the WHO African Region accounted for about 94% of cases and deaths globally. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Although there were fewer malaria cases in 2000 (204 million) than in 2019, malaria case from 363 incidence reduced to 225 cases per 1000 population at risk in this period (Fig.
3.3), reflecting the complexity of interpreting changing disease transmission in a rapidly increasing population.
The population living in sub-Saharan Africa increased from about 665 million in 2000 to 1.1 billion in 2019 (Section 11). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Malaria deaths in the WHO African Region reduced by 44%, from 680 000 in 2000 to 386 000 in 2019, and the malaria mortality rate reduced by 67% over the same period, from 121 to 40 per 100 000 population at risk (Fig.
3.3).
Since 2014, however, the rate of progress in both cases and deaths has slowed, attributed mainly to the stalling of progress in several countries with moderate or high transmission (Fig.
3.3).
Distributions of malaria cases by country are shown in Fig.
3.3. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.3.
It can be seen that 27 of the 29 countries that account for 95% of malaria cases globally (Fig.
3.2c) are in the WHO African Region.TABLE 3.2.Estimated malaria cases and deaths in the WHO African Region, 2000–2019 Estimated cases and deaths are shown with 95% upper and lower confidence intervals.
Source: WHO estimates.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.3.Trends in a) malaria case incidence rate (cases per 1000 population at risk), b) mortality rate (deaths per 100 000 population at risk), 2000–2019 and c) malaria cases by country in the WHO African Region, 2019 Source: WHO estimates.Year20002001200220032004200520062007200820092010201120122013201420152016201720182019Number of cases (000)Number of deathsPointLower bound Upper bound% P. vivaxPointLower boundUpper bound204 000210 000207 000211 000214 000211 000211 000211 000211 000215 000215 000211 000209 000205 000197 000199 000205 000212 000212 000215 000189 000223 000194 000230 000191 000227 000194 000234 000194 000242 000193 000234 000193 000235 000193 000234 000193 000232 000196 000239 000195 000239 000192 000234 000190 000231 000186 000227 000182 000215 000183 000218 000189 000225 000196 000234 000195 000234 000197 000237 0000.9%1.4%1.3%1.7%1.9%1.3%1.5%1.5%1.2%1.4%1.7%2.2%2.2%1.9%1.1%0.9%0.6%0.5%0.2%0.3%680 000686 000686 000672 000706 000653 000667 000638 000591 000569 000542 000502 000478 000454 000436 000418 000395 000390 000386 000386 000657 000713 000662 000720 000661 000721 000644 000717 000671 000771 000624 000703 000637 000713 000610 000678 000567 000625 000538 000618 000509 000597 000474 000544 000449 000522 000424 000500 000414 000469 000397 000453 000376 000430 000369 000428 000367 000429 000365 000433 000P. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
vivax: Plasmodium vivax; WHO: World Health Organization.a)ksirltanoitaupop0001repsesacairaal362.837530022515075233.0225.20M20002005201020152019b)ksirltanoitaupop000001repshtaedairaaMl121.112510075502548.940.3020002005201020152019c))000(sesacairaamlforebmuN75 00050 00025 00012 0009 0006 0003 0000airegNiadnagUognoCehtfocilbupeRcitarcomeDinneBanahGadnawRilwaaMaenuGiidnuruBdahCnooremaCnaduShtuoSayneKiabmaZenoeLarreSiilaMlaognAieuqbmazoMregNiosaFankruBieriovI’detôCianaznaTfocilbupeRdetinUiapohtEiognoClageneSnobaGewbabmZiiabmaGsoromoCaertirEianatiruaMuassiB-aenuGiaenuGilairotauqEogoTairebLiracsagadaMcilbupeRnacirfAlartneCiiabmaN0 0initawsEairegAlanawstoBedreVobaCacirfAhtuoSiepcnirPdnaemoToaS22WHO: World Health Organization.23WORLD MALARIA REPORT 2020 3Global trends in the burden of malaria3.3 ESTIMATED MALARIA CASES AND DEATHS IN THE WHO SOUTH‑EAST ASIA REGION, 2000–2019The WHO South-East Asia Region had nine malaria endemic countries in 2019, and contributed to about 3% of the burden of malaria cases globally. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Malaria cases reduced by 74%, from 23.0 million in 2000 to about 6.3 million in 2019 (Table 3.3).
India contributed to the largest absolute reductions, from about 20 million cases in 2000 to about 5.6 million in 2019.
Malaria case incidence reduced by 78%, from about 18 to 4 per 1000 population at risk in the period 2000–2019 (Fig.
3.4).
Malaria deaths reduced by 74%, from about 35 000 in 2000 to 9 000 in 2019.
India accounted for 88% of malaria cases and 86% of malaria deaths in this region in 2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Sri Lanka was certified malaria free in 2015, and Timor-Leste reported zero malaria cases in 2018 and 2019.TABLE 3.3.Estimated malaria cases and deaths in the WHO South-East Asia Region, 2000–2019 Estimated cases and deaths are shown with 95% upper and lower confidence intervals.
Source: WHO estimates.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.4.Trends in a) malaria case incidence rate (cases per 1000 population at risk), b) mortality rate (deaths per 100 000 population at risk), 2000–2019 and c) malaria cases by country in the WHO South-East Asia Region, 2019 Source: WHO estimates.Year20002001200220032004200520062007200820092010201120122013201420152016201720182019Number of cases (000)Number of deathsPointLower bound Upper bound% P. vivaxPointLower boundUpper bound23 00023 30022 20023 40025 40027 80022 70022 20023 60024 00024 60020 70018 00013 30012 90013 30013 90010 4007 6006 30018 70019 10017 90018 90020 20021 60017 50017 10018 00018 10019 40016 20014 20010 50010 10010 40010 4007 8005 5004 50029 10029 20028 00029 30032 40036 70030 40030 30032 20033 50033 10027 90024 00017 40017 30017 70019 50014 10010 3008 60047.8%50.6%50.0%52.4%52.0%53.8%51.5%49.6%47.5%45.3%46.0%47.7%47.6%46.2%35.2%34.4%34.9%37.3%50.5%51.7%35 00034 00033 00033 00036 00039 00033 00033 00036 00038 00038 00031 00027 00021 00023 00024 00025 00018 00011 0009 0008 0007 0007 0007 0008 0009 0007 0007 0007 0007 0009 0007 0007 0004 0003 0003 0003 0003 0002 0002 00059 00057 00055 00055 00062 00066 00057 00058 00064 00069 00066 00055 00046 00036 00041 00043 00047 00034 00020 00016 000P. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
vivax: Plasmodium vivax; WHO: World Health Organization.a)ksirltanoitaupop0001repsesacairaal252018.1151058.53.90M20002005201020152019b)ksirltanoitaupop000001repshtaedairaaMl5432102.81.50.620002005201020152019c)10 0005 000) 1 500000(sesacairaamlforebmuN1 2009006003000IndiaIndonesiaMyanmarBangladeshThailandNepalBhutanTimor-Leste0Democratic People’sRepublicof Korea24WHO: World Health Organization.25WORLD MALARIA REPORT 2020 3Global trends in the burden of malaria3.4 ESTIMATED MALARIA CASES AND DEATHS IN THE WHO EASTERN MEDITERRANEAN REGION, 2000–2019Malaria cases in the WHO Eastern Mediterranean Region reduced by 26%, from 7 million cases in 2000 to about 5 million in 2019 (Table 3.4). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
About a quarter of the cases in 2019 were due to P. vivax, mainly in Pakistan and Afghanistan.
Malaria deaths also reduced by 16%, from about 12 000 in 2000 to 10 100 in 2019.
Over the period 2000–2019, malaria case incidence declined from 21 to 10 and mortality incidence rate from 4 to 2 (Fig.
3.5).
Sudan is the leading contributor to malaria in this region, accounting for about 46% of cases (Fig.
3.5), followed by Yemen, Somalia, Pakistan, Afghanistan and Djibouti. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Saudi Arabia reported only 38 indigenous malaria cases in 2019, and the Islamic Republic of Iran had no indigenous malaria cases in 2018 and 2019.
Iraq, Oman and Syrian Arab Republic have last reported indigenous malaria cases in 2009, 2011 and 2004, respectively (Annex 3-F).TABLE 3.4.Estimated malaria cases and deaths in the WHO Eastern Mediterranean Region, 2000–2019 Estimated cases and deaths are shown with 95% upper and lower confidence intervals. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Source: WHO estimates.Year20002001200220032004200520062007200820092010201120122013201420152016201720182019Point7 0007 2006 8006 4005 3005 5005 5004 8003 7003 6004 5004 6004 3004 0004 2004 1005 2005 0005 4005 200Number of cases (000)Number of deathsLower bound Upper bound% P. vivaxPointLower boundUpper bound5 5005 6005 3005 0004 1004 3004 1003 7002 9002 7003 4003 5003 3003 2003 3003 2004 2004 0004 2003 90011 50012 00012 30011 0009 0009 80010 3006 6005 2005 3006 5006 6006 1005 5005 7005 5006 7006 6007 2007 30027.3%27.3%28.2%29.3%24.9%21.9%20.2%23.4%27.9%29.5%28.6%39.0%33.1%35.0%36.1%29.6%37.1%30.5%30.3%23.3%12 00012 70011 60010 8009 40010 30010 1009 8007 2006 9008 7007 9008 0007 3007 5007 9009 1009 5009 80010 1004 0004 2004 4003 8002 8003 2003 3003 6002 5002 5003 5003 2003 0002 8002 8002 6003 4003 2003 1002 90022 00022 50020 00018 60016 30017 80017 40017 00012 30012 20014 80012 80012 90011 70012 20013 10015 00016 50017 60019 000P. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
vivax: Plasmodium vivax; WHO: World Health Organization.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.5.Trends in a) malaria case incidence rate (cases per 1000 population at risk), b) mortality rate (deaths per 100 000 population at risk), 2000–2019 and c) malaria cases by country in the WHO Eastern Mediterranean Region, 2019 Source: WHO estimates.b)ksirltanoitaupop000001repshtaedairaaMl5432103.82.01.72000200520102015201921.425201510510.49.020002005201020152019a)ksirltanoitaupop0001repsesacairaal0Mc)2 500)000(sesacairaamlforebmuN2 0001 5001 000500026WHO: World Health Organization.SudanYemenSomaliaPakistanAfghanistanDjiboutiSaudi Arabia0Iran(IslamicRepublic of)27WORLD MALARIA REPORT 2020 3Global trends in the burden of malaria3.5 ESTIMATED MALARIA CASES AND DEATHS IN THE WHO WESTERN PACIFIC REGION, 2000–2019The WHO Western Pacific Region had an estimated 1.7 million cases in 2019, a decrease of 43% from the 3 million cases in 2000 (Table 3.5). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Malaria deaths reduced by 52%, from about 6600 cases in 2000 to 3200 in 2019.
Over the same period, malaria case incidence reduced from 5 to 2 cases per 1000 population at risk (Fig.
3.6), and malaria mortality rate reduced from 1 to 0.4 deaths per 100 000 population at risk.
Papua New Guinea accounted for nearly 80% of all cases in this region in 2019.
China has had no indigenous malaria cases since 2017. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Malaysia had no cases of human malaria in 2018 and 2019, but reported 3212 cases of P. knowlesi, considered to be zoonotic malaria, in 2019.
Three countries had fewer than 10 000 cases in 2019: Republic of Korea (485), Vanuatu (1047) and Viet Nam (9702).TABLE 3.5.Estimated malaria cases and deaths in the WHO Western Pacific Region, 2000–2019 Estimated cases and deaths are shown with 95% upper and lower confidence intervals.
Source: WHO estimates.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.6.Trends in a) malaria case incidence rate (cases per 1000 population at risk), b) mortality rate (deaths per 100 000 population at risk), 2000–2019 and c) malaria cases by country in the WHO Western Pacific Region, 2019 Source: WHO estimates.Year20002001200220032004200520062007200820092010201120122013201420152016201720182019Point2 9902 6312 3342 5262 9362 5092 6592 0181 8452 4361 8391 5761 8881 9642 3211 4311 6761 9611 9811 739Number of cases (000)Number of deathsLower bound Upper bound% P. vivaxPointLower boundUpper bound1 8941 6211 4111 5231 7181 4551 5851 1099641 3411 0589279691 2691 6031 1221 2911 5031 4951 3944 2893 8503 4273 6744 3503 7873 9873 1452 9493 7602 8162 3433 2732 8603 3261 8202 1342 5382 5772 18116.9%19.7%20.0%19.6%21.9%28.5%26.8%23.7%21.5%21.6%23.6%21.7%23.9%14.1%31.7%28.3%25.7%29.0%34.9%33.9%6 6005 6005 0005 4006 1004 9005 3004 1003 9005 1003 8003 3003 8004 4004 3002 8003 3003 8003 6003 2002 2001 8001 6001 7001 8001 5001 6001 10090090080060070060070050050060050050011 80010 3009 30010 00011 7009 5009 8008 4007 90010 2007 5006 7008 8008 8008 2004 8006 0006 7006 6005 600P. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
vivax: Plasmodium vivax; WHO: World Health Organization.a)ksirltanoitaupop0001repsesacairaal4.5543212.31.90M20002005201020152019b)ksirltanoitaupop000001repshtaedairaaMl1.01.00.80.60.40.20.40.4020002005201020152019c)1 500)000(sesacairaamlforebmuN1 000200150100500PapuaNewGuineaSolomonIslandsCambodiaPhilipppinesLaoPeople’sDemocraticRepublicViet NamVanuatuRepublicof Korea00ChinaMalaysia28WHO: World Health Organization.29WORLD MALARIA REPORT 2020 3Global trends in the burden of malaria3.6 ESTIMATED MALARIA CASES AND DEATHS IN THE WHO REGION OF THE AMERICAS, 2000–2019In the WHO Region of the Americas, malaria cases and case incidence reduced by 40% (from 1.5 million to 0.9 million) and 53% (from 14 to 6), respectively (Table 3.6, Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.7).
Over the same period, malaria deaths and mortality rate reduced by 39% (from 909 to 551) and 50% (from 0.8 to 0.4), respectively.
The region’s progress in recent years has suffered from the major increase in malaria in Venezuela (Bolivarian Republic of), which had about 35 500 cases in 2000, rising to over 467 000 by 2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Brazil, Colombia and Venezuela (Bolivarian Republic of) account for 86% of all cases in this region.3.7 ESTIMATED MALARIA CASES AND DEATHS IN THE WHO EUROPEAN REGION, 2000–2019Since 2015, the WHO European Region has been free of malaria.
The last country to report an indigenous malaria case was Tajikistan in 2014.
Also, no indigenous malaria deaths have been reported since 2000. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Throughout the period 2000–2019, no indigenous malaria deaths were reported in the WHO European Region.TABLE 3.6.Estimated malaria cases and deaths in the WHO Region of the Americas, 2000–2019 Estimated cases and deaths are shown with 95% upper and lower confidence intervals.
Source: WHO estimates.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.7.Trends in a) malaria case incidence rate (cases per 1000 population at risk), b) mortality rate (deaths per 100 000 population at risk), 2000–2019 and c) malaria cases by country in the WHO Region of the Americas, 2019 Source: WHO estimates.Year20002001200220032004200520062007200820092010201120122013201420152016201720182019Point1 5401 2971 1831 1591 1461 2831 106994699687821611580562477561677915926889Number of cases (000)Number of deathsLower bound Upper bound% P. vivaxPointLower boundUpper bound1 3921 1711 0781 0671 0671 2111 0429126456347455675425204475256258528618221 7011 4321 2981 2621 2341 3711 1811 0807627519066676276125126027369981 00797071.4%67.6%67.9%68.4%69.4%70.3%68.4%70.4%71.0%70.8%70.9%68.8%69.4%66.1%69.5%71.3%67.5%74.2%75.7%72.3%9098327647257106925865034714635074684164363483985156556025516665935144804604433482972242272502062112271962162522872432201 1681 0901 030992986968852744756740791733622642484551731947880813P. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
vivax: Plasmodium vivax; WHO: World Health Organization.a)ksirltanoitaupop00011514.11296repsesacairaa0M3l6.44.220002005201020152019c)500)000(sesacairaamlforebmuN400200150100500laeuzeneVnairaviloB()focilbupeRlizarBiabmooClurePanayuGitiaHaugaracNiaviiloB)foetatSlanoitaniruP(lb)ksirltanoitaupop000001repshtaedairaaMl0.81.00.80.60.40.20.40.3020002005201020152019amanaPiocxeMsarudnoHiacRatsoCemaniruSianauGhcnerF0ezileB0rodavaSllErodaucElaametauGcilbupeRnacnmoDii30WHO: World Health Organization.WHO: World Health Organization.31WORLD MALARIA REPORT 2020 3Global trends in the burden of malaria3.8 CASES AND DEATHS AVERTED SINCE 2000, GLOBALLY AND BY WHO REGIONCases and deaths averted in the period 2000–2019 were calculated by comparing the current annual estimated burden of malaria to a counterfactual that was computed by holding the 2000 malaria case incidence and mortality rates constant throughout the period 2000–2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The analysis shows that 1.5 billion malaria cases and 7.6 million malaria deaths have been averted globally in the period 2000–2019.
Most of the cases (82%) and deaths (94%) averted were in the WHO African Region, followed by the South-East Asia Region (cases 10% and deaths 3%) (Fig.
3.8, Fig.
3.9). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.8, Fig.
3.9).
In addition to malaria interventions, cases and deaths averted could also be due to other factors that modify malaria transmission or disease, such as improvements in socioeconomic status, malnutrition, infrastructure, housing and urbanization.FIG.
3.8.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.9.Cumulative number of cases and deaths averted globally and by WHO region, 2000–2019 Source: WHO estimates.Cases (million)Deaths (000)Percentage of a) cases and b) deaths averted by WHO region, 2000–2019 Source: WHO estimates.WorldAFRSEAR-1.2EMRWPRAMREURWorldAFRSEAREMRWPRAMR150012009006003000125010007505002500150120906030010080604020030241812602016128400.750.600.450.300.15010 0008000600040002000010 000800060004000200002502001501005001501209060300756045301501086420a)SEAR, 10.1%EMR, 4.9%WPR, 2.0%AMR, 1.1%EUR, 0%AFR, 81.8%b)AFR, 94.1%AMR, 0.1%WPR, 0.9%EMR, 1.8%SEAR, 3.0%000210022002300240025002600270028002900201021102210231024102510261027102810291020002100220023002400250026002700280029002010211022102310241025102610271028102910232AFR: WHO African Region; AMR: WHO Region of the Americas; EMR: WHO Eastern Mediterranean Region; EUR: WHO European Region; SEAR: WHO South-East Asia Region; WHO: World Health Organization; WPR: WHO Western Pacific Region.AFR: WHO African Region; AMR: WHO Region of the Americas; EMR: WHO Eastern Mediterranean Region; EUR: WHO European Region;SEAR: WHO South-East Asia Region; WHO: World Health Organization; WPR: WHO Western Pacific Region.33WORLD MALARIA REPORT 2020 3Global trends in the burden of malaria3.9 BURDEN OF MALARIA IN PREGNANCYMalaria infection during pregnancy has substantial risks for the pregnant woman, her fetus and the newborn child. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
For the pregnant woman, malaria infection can lead to severe disease and death, and placental sequestration of the parasite which can lead to maternal anaemia; it also puts the mother at increased risk of death before and after childbirth, and is an important contributor to stillbirth and preterm birth. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Placental infection can also lead to poor fetal growth and low birthweight, which in turn can lead to child growth retardation and poor cognitive outcomes, as well as being a major risk factor for perinatal, neonatal and infant mortality (118–120).antenatal care (ANC) (Section 7.4) in areas of moderate to high transmission in sub-Saharan Africa. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The World malaria report 2019 presented, for the first time, an analysis of the prevalence of malaria in pregnancy and the resulting burden of low birthweight (77).
This section presents a follow-up analysis of the exposure to malaria infections during pregnancy and the prevalence of low birthweight. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
It also presents an analysis of the number of low birthweights averted if coverage of the first dose of IPTp was optimized, by ensuring that all women attending ANC clinics for the first time received the first dose. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
To avert the consequences to women and children of malaria infections, WHO recommends – in combin ation with vector control, and prompt diagnosis and effective treatment of malaria – the use of IPTp with SP as part of The analysis in this section is restricted to moderate to high transmission countries in the WHO African Region (Annex 1), where the burden of malaria in pregnancy is most pronounced.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.10.Estimated prevalence of exposure to malaria infection during pregnancy, overall and by subregion in 2019, in moderate to high transmission countries in the WHO African Region Source: Imperial College and WHO estimates.3.9.1 Prevalence of exposure to malaria infections during pregnancy and contribution to low birthweight newbornMalaria infection exposure during pregnancy (measured as cumulative prevalence over 40 weeks) was estimated from mathematical models (121) that relate estimates of the geographical distribution of P. falciparum exposure by age across Africa in 2019 with patterns of infections in placental histology by age and parity (122) (Annex 1). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Country-specific age- and gravidity-specific fertility rates, stratified by urban or rural status, were obtained from DHS and malaria indicator surveys (MIS) (55), where such surveys had been carried out since 2014 and were available from the DHS programme website (56).
For countries where surveys were not available, fertility patterns were allocated based on survey data from a different country, matched on the basis of total fertility rate (123) and proximity. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The exposure prevalence and the expected number of pregnant women who would have been exposed to infection were computed by country and subregion.In 2019, in 33 moderate to high transmission countries1 in the WHO African Region, there were an estimated 33.2 million pregnancies, of which 35% (11.6 million) were exposed to malaria infection (Fig.
3.10). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
By WHO subregion, Central Africa had the highest prevalence of exposure to malaria during pregnancy (40%) closely followed by West Africa (39%), while prevalence was 24% in East and Southern Africa.1 Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Equatorial Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Senegal, Sierra Leone, South Sudan, Togo, Uganda, United Republic of Tanzania, Zambia and Zimbabwe.■ Pregnancies with malaria infection ■ Pregnancies without malaria infection■ Pregnancies with malaria infection ■ Pregnancies without malaria infectionCentral AfricaEast and Southern AfricaWest Africa3 551 07240%2 414 43024%5 625 79239%5 218 92160%7 608 57376%8 805 83461%Sub-Saharan Africa (moderate to high transmission)11 591 29335%21 633 32965%34WHO: World Health Organization.35WORLD MALARIA REPORT 2020 3Global trends in the burden of malariaIt is estimated that malaria infection during pregnancy in these 33 countries resulted in 822 000 children with low birthweight (Table 3.8) with almost half of these children (49%) being in the subregion of West Africa (Table 3.8, Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
3.11).In the 33 countries, on average, 80% of all pregnant women visited ANC clinics at least once during their pregnancy, 62% received at least one dose of IPTp, 49% received at least two doses of IPTp and 34% received at least three doses of IPTp (Section 7.4).
At current levels of IPTp coverage across all doses, an estimated 426 000 low birthweights were averted in 2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
If the 80% of pregnant women visiting ANC clinics at least once during pregnancy received a single dose of IPTp, assuming they were all eligible, an additional 56 000 low birthweights would be averted, representing a significant missed opportunity under current levels of ANC use (Fig.
3.12).
Urgent attention is clearly needed to optimize these missed opportunities while at the same time ensuring high coverage of subsequent doses of IPTp. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
It is hoped that the recent call from the RBM Partnership to End Malaria to leaders and health policy-makers to increase protection of mothers and newborn children will result in an accelerated increase in IPTp coverage (124).FIG.
3.11.FIG.
3.12.Estimated number of low birthweights due to exposure to malaria infection during pregnancy, overall and by subregion in 2019, in moderate to high transmission countries in sub-Saharan Africa Sources: Imperial College and WHO estimates. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Estimated number of low birthweights averted if current levels of IPTp coverage are maintained and the additional number averted if coverage of first dose of IPTp was optimized to match levels of coverage of first ANC visit in 2019, in moderate to high transmission countries in the WHO African Region Sources: Imperial College and WHO estimates. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
500 000■ Additional low birthweights averted if IPTp1 matches ANC1 coverage ■ Low birthweights averted with current level of IPTp coverage822 018ithgewhtribwolhtiwnerdlihcforebmundetamitsE1 000 000800 000600 000400 000200 0000406 702226 937188 379Central AfricaEast and Southern AfricaWest AfricaTotalithgewhtribwolhtiwnerdlihcforebmundetamitsE400 000300 000200 000100 000055 586426 39526 645194 79312 462127 12916 479104 473Central AfricaEast and Southern AfricaWest AfricaTotalWHO: World Health Organization.ANC: antenatal care; ANC1: first ANC visit; IPTp: intermittent preventive treatment in pregnancy; IPTp1: first dose of IPTp; WHO: World Health Organization.3637WORLD MALARIA REPORT 2020 Elimination4 Globally, the number of countries that were malaria endemic in 2000 and that reported fewer than 10 000 malaria cases increased from 26 in 2000 to 46 in 2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In the same period, the number of countries with fewer than 100 indigenous cases increased from 6 to 27.
Between 2015 and 2019, the number of countries with fewer than 10 indigenous cases increased from 20 to 24 (Fig.
4.1).s s s4.1 MALARIA ELIMINATION CERTIFICATIONBetween 2000 and 2019, 21 countries had achieved 3 consecutive years of zero indigenous malaria cases; 10 of these countries were certified malaria free by WHO (Table 4.1). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Algeria is the first country in the WHO African Region to be certified malaria free since 1973.
The process to certify El Salvador is underway and would probably have been completed had the COVID-19 pandemic not disrupted the evaluation process.4.2 E‑2020 INITIATIVEProgress in the reduction of malaria cases since 2010 in the 21 countries that are part of the E-2020 initiative is shown in Table 4.2.
In the period 2010–2019, total malaria cases in the 21 countries reduced by 79%.
FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
FIG.
4.1.No indigenous cases were reported in Paraguay and Algeria, which were certified malaria free by WHO in 2018 and 2019, respectively. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Number of countries that were malaria endemic in 2000, with fewer than 10, 100, 1000 and 10 000 indigenous malaria cases between 2000 and 2019 Sources: NMP reports and WHO estimates.■ Fewer than 10 000 ■ Fewer than 1000 ■ Fewer than 100 ■ Fewer than 10 351796402617114636242046342724seirtnuocforebmuN504030201002614632000TABLE 4.1.Countries eliminating malaria since 2000 Countries are shown by the year that they attained 3 consecutive years of zero indigenous cases; countries that have been certified as malaria free are shown in green (with the year of certification in parentheses). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Sources: Country reports and WHO.20002001200220032004200520062007200820092010201120122013201420152016201720182019EgyptUnited Arab Emirates (2007)KazakhstanMorocco (2010)Syrian Arab RepublicTurkmenistan (2010)Armenia (2011)IraqGeorgiaTurkeyArgentina (2019)Kyrgyzstan (2016)OmanUzbekistan (2018)Paraguay (2018)AzerbaijanSri Lanka (2016)Algeria (2019)TajikistanChinaEl SalvadorWHO: World Health Organization.Note: Although Maldives was certified in 2015, it was already malaria free before 2000.TABLE 4.2.Number of indigenous malaria cases in E-2020 countries, 2010–2019 Source: NMP reports.CountryAlgeriaBelizeBhutanBotswanaCabo VerdeChinaComorosCosta RicaEcuadorEl SalvadorEswatiniIran (Islamic Republic of)MalaysiaMexicoNepalParaguayRepublic of KoreaSaudi ArabiaSouth AfricaSurinameTimor-LesteTotal201020112012201320142015201620172018201911504361 0464717219443274 9901 308553382193124482015019194561 346228326530934284739041565948107110360021 8475341694230200036 53824 85649 84053 1562 2031 8841 4673 89615 61317 599110101 8881 218654413409756036867284792 0501 0928334953 2301 97403948203833402426389358604656832055730041270956181 1911 2751 6531 80353181672425175910627831225081266551507060227204405785736623043617706860080349305016102390061812704853873791 6324 1641 1243 4141505699 8666 6218 64511 7054 9594 32323 3819 5403 09679556972948 13719 7395 5181 223401411818076811916290950116 934 69 79371 47369 91619 85710 54510 41033 44129 99424 366172681 8475 1941 2263 894181 267298 0601 77138NMP: national malaria programme; WHO: World Health Organization.E-2020: eliminating countries for 2020; NMP: national malaria programme.392005201020152019WORLD MALARIA REPORT 2020WORLD MALARIA REPORT 2020 4 EliminationChina and El Salvador had no indigenous malaria cases for a third consecutive year and have made a formal request for certification. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Iran (Islamic Republic of), Malaysia and Timor-Leste reported zero indigenous malaria cases in 2018 and 2019.
In 2019, Belize and Cabo Verde reported zero indigenous malaria cases for the first time since 2000.
There were more cases in 2019 than in 2018 in Comoros, Costa Rica, Ecuador and Suriname, which reported 1986, 25, 150 and 66 additional cases, respectively. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
A malaria outbreak in Timor-Leste in 2020 is under investigation to determine whether any cases should be classified as indigenous.4.3 THE GREATER MEKONG SUBREGIONThe six countries of the GMS – Cambodia, China (Yunnan Province), Lao People’s Democratic Republic, Myanmar, Thailand and Viet Nam – have made huge gains against malaria as they aim for P. falciparum malaria elimination by 2025 (Fig.
4.2, Fig.
4.3) and elimination of all malaria by 2030. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
4.3) and elimination of all malaria by 2030.
Between 2000 and 2019, the reported number of P. falciparum malaria cases fell by 97%, while all malaria cases fell by 90%.
Of the 239 000 malaria cases reported in 2019, 65 000 were P. falciparum cases.
Overall, Cambodia (58%) and Myanmar (31%) accounted for most cases of malaria in the GMS.The rate of decline has been fastest since 2012, when the MME programme was launched. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
During this period, malaria cases reduced sixfold, while P. falciparum cases reduced by a factor of nearly 14. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This accelerated decrease in P. falciparum is especially critical because of the increasing drug resistance; in the GMS, P. falciparum parasites have developed partial resistance to artemisinin, the core compound of the best available antimalarial drugs.4.4 PREVENTION OF RE‑ESTABLISHMENT Once countries have eliminated malaria, re- establishment of transmission must be prevented through continued preventive measures in areas with malariogenic potential (risk of importation in areas receptive to transmission), vigilance to identify suspected malaria cases in the health system, quality-assured diagnosis and treatment, and follow-up to ensure complete cure and no onward transmission. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
After elimination, imported cases of malaria are expected, while any introduced or indigenous cases signify local transmission and warn of deficiencies with prevention and surveillance strategies that must be addressed.
Transmission of malaria may be considered re-established when at least three indigenous cases of malaria of the same species are found in the same transmission focus for 3 consecutive years. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Between 2000 and 2019, no country that was certified malaria free has been found to have malaria transmission re-established.FIG.
4.2.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
4.3.Total malaria and P. falciparum cases in the GMS, 2000–2019 Sources: MME programme database and NMP reports.■ Total malaria cases ■ P. falciparum malaria casesRegional map of malaria incidence in the GMS by area, 2012–2019 Source: NMP reports.Incidence per 1000 population■ 0 ■ 0–0.1 ■ 0.1–1 ■ 1–5 ■ 5–10 ■ 10–20 ■ 20–50 ■ >50 ■ Not available)000(sesacairaamlforebmuN3 0002 5002 0001 5001 00050002000200120022003200420052006200720082009201020112012201320142015201620172018 20192012201320142015201620172018201940GMS: Greater Mekong subregion; MME: Mekong Malaria Elimination; NMP: national malaria programme; P. falciparum: Plasmodium falciparum.GMS: Greater Mekong subregion; NMP: national malaria programme.41WORLD MALARIA REPORT 2020 high impact approach5High burden to In November 2018, WHO and the RBM Partnership to End Malaria launched the high burden to high impact (HBHI) country-led approach (108), as a mechanism to support the 11 highest burden countries to get back on track to achieve the GTS 2025 milestones (4). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The approach includes the four key response elements shown in Fig.
5.1.
These 11 countries (Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and the United Republic of Tanzania) account for 70% of the global estimated case burden and 71% of global estimated deaths from malaria. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Several countries with a smaller population but with high malaria incidence have also adopted the HBHI approach.Since November 2018, the HBHI response has been launched in 10 of the 11 countries (it has not yet been launched in Mali owing to disruptions due to the COVID-19 pandemic).
However, all 11 countries have implemented HBHI-related activities across the four response elements. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This section presents a summary of key activities and case studies for each of the first three response elements: political will, strategic information and better guidance.s s s5.1 GALVANIZING POLITICAL WILL, MOBILIZING RESOURCES AND MOBILIZING COMMUNITY RESPONSEIn each HBHI country initiation, there has been high-level political engagement and support. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Several countries have begun adapting the RBM Partnership to End Malaria campaign, ‘Zero Malaria Starts with Me’ (125), through high-level national committees and councils, community mobilization and engagement activities, including the private sector.Following the sixth replenishment of the Global Fund in October 2019, the global malaria allocation for the period 2020–2022 was US$ 4.8 billion, an increase of about US$ 1 billion from the previous allocation period. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Of this, US$ 2.1 billion was allocated to the 11 HBHI countries, an increase of about US$ 500 million from the previous allocation in the period 2017–2019 (126).I II III IV In 2020, all HBHI countries except Mali submitted funding requests to the Global Fund, based on the analysis of subnational tailoring of interventions described in Section 5.2. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
At the same time, PMI increased its overall allocation to malaria in 2020 to about US$ 770 million (from about US$ 755 million in 2019), with most of the funds allocated to HBHI countries (52).FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
5.1.This section presents the Mass Action Against Malaria (MAAM) initiative in Uganda as an example of a country-led process of political engagement at all levels, and of multisectoral and community mobilization (Box 5.1 on next page).HBHI: a targeted malaria response to get countries back on track to achieve the GTS 2025 milestones Sources: WHO GMP and RBM Partnership to End Malaria.ImpactReduction in mortality & morbidityOutcomeEffective and equitable delivery of evidence-informed mix of interventionsOutputOutputOutputOutputlliwlacitiloPInoitamrofniicgetartSecnadugiretteBidetandrooCesnopserIIIIIIVEffective health systemMultisectoral response42GMP: Global Malaria Programme; GTS: Global technical strategy for malaria 2016–2030; HBHI: high burden to high impact; WHO: World Health Organization.43WORLD MALARIA REPORT 2020WORLD MALARIA REPORT 2020 5High burden to high impact approachBOX 5.1.Uganda’s MAAM Source: Uganda NMP.ChaseMalariaBackgroundWith a slogan of “Am I free of malaria today?” MAAM was launched in April 2018 in Kampala by the President of Uganda, His Excellency President Yoweri Museveni. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
To address the high malaria burden in the country, and its impact on individual and community development, MAAM was targeted at high-level state leadership, parliamentarians, government civil servants, religious and cultural leaders, media personnel, private sector, district health teams, health facilities, schoolteachers, community leaders, and households and the public at large. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
A handbook to guide MAAM has been developed, detailing the roles and responsibilities of all key stakeholders (127).Key stakeholders ■ The cabinet ■ Parliamentarians ■ Government ministries, parastatals and departments ■ National and regional leaders (religious and cultural) ■ Private sector ■ Media ■ Regional health directors and administrators ■ District leaders ■ Health care facility service providers ■ Community leaders ■ School administrators, teachers and other staff ■ HouseholdsExpectations from stakeholders at all levels ■ To have a re-orientation of one’s own values, to think about malaria prevention as a public health action to save lives ■ To acknowledge that one’s actions or inaction affects others ■ To have full commitment to and accountability for the fight against malaria ■ To support the scaling up of interventions against malaria ■ To have a sense of urgency, acknowledging that each minute delayed or wasted costs lives, with negative consequences for the individual, the community and the economyAchievements ■ High-level launch and widespread media dissemination ■ Development of MAAM handbook ■ Incorporation of malaria agenda into the 2021–2025 National Development Plan III, Health Sector Development Plan III ■ Establishment of Uganda Parliamentary Forum for Malaria (UPFM), supported by government ■ Establishment of the UPFM scorecard for periodic rating of performance at constituency level ■ Malaria agenda included in the political party manifesto for the 2021 national election ■ Establishment of district task forces, and support for malaria operational interventions and local dissemination through music, dance and drama ■ Increase in domestic malaria financing, through institutions such as the Ministry of Finance, Planning and Economic Development, with a budget call circular to all sectors to prioritize the malaria agenda ■ Establishment of Malaria Free Uganda Initiative – a private mechanism to drive the malaria agenda ■ Establishment of Rotary Malaria PartnershipChallenges ■ Sustained funding for MAAM is required to ensure high impact ■ Domestic financing is increasing but is not yet optimal ■ Accountability at subnational level requires capacity-building ■ Operationalization of initiatives is often delayed and slow pacedI II III IV 5.2 USING STRATEGIC INFORMATION TO DRIVE IMPACTThe HBHI Response Element 2 set out to implement work under five main areas in two phases (Table 5.1), with Phase 1 to be achieved by the end of 2020 and Phase 2 by the end of 2021. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The HBHI countries have successfully implemented all the Phase 1 activities, with support from a collaborative partnership coordinated by WHO.TABLE 5.1.HBHI Response Element 2: work areas and status update Source: WHO.Work areaStatusPhase 1 (by end of 2020)Progress review: Country-level malaria situation analysis, and review of malaria programmes to understand progress and bottlenecksAnalysis of stratification, intervention mixes and prioritization: Data analysis for stratification, optimal intervention mixes and prioritization for NMSP development and implementationPhase 2 (by end of 2021)National malaria data repositories: Functioning national malaria data repositories, with programme tracking dashboardsSubnational operational plans: Subnational operational plans linked to subnational health plansMonitoring and evaluation: Ongoing national and subnational monitoring and evaluation of programmatic activities (including data systems) and impactMalaria programme reviews have been completed in all countries except Mali, where a review is in progressSubnational tailoring of interventions has been completed in all countries except Mali, where tailoring is in progress. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The example of Nigeria is shown in Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
5.3New NMSPs have been developed in all countries using analysis for subnational tailoring of interventions, and is in progress in MaliNew NMSP have been used to develop funding requests to the Global Fund and other funders; these requests have been submitted for review and are in the grant-making processWHO has developed a master indicators list for national integrated malaria databasesWHO has developed a generic DHIS2 national repository platform that can be linked directly with HMIS DHIS2 instancesAn integrated malaria database repository has been launched repositories are under development in Ghana, Mozambique, Uganda and the United Republic of Tanzaniain Nigeria, and Other countries have not yet started repositories, but discussions among countries and partners are ongoingNew NMSP have 5-year workplans Specific workplans will be developed once discussions with the Global Fund and other donors are completeWHO and partners will work with countries to develop annual workplansDiscussions are ongoing between WHO and each country and partners on enhanced monitoring and evaluation processesLearning from experience in Benin and Nigeria, countries will be encouraged to digitalize their ITN, IRS and SMC campaigns, to ensure efficient micro planning and distribution, with real-time data availabilityComprehensive surveillance assessments are planned in Burkina Faso, the Democratic Republic of the Congo and Ghana; rapid surveillance system assessments are planned in other countriesDHIS2: District Health Information Software 2; Global Fund: Global Fund to Fight AIDS, Tuberculosis and Malaria; HBHI: high burden to high impact; HMIS: health management information system; IRS: indoor residual spraying; ITN: insecticide-treated mosquito net; NMSP: national malaria strategic plan; SMC: seasonal malaria chemoprevention; WHO: World Health Organization.4445WORLD MALARIA REPORT 2020 5High burden to high impact approachThe process for analysing subnational tailoring of malaria interventions in the HBHI countries starts with the identification and mapping of operational units in each HBHI country. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Demographic, epidemiological, entomological, climatic, health system and other contextual information is assembled for the operational units.
Using flexible, context-specific criteria for the targeting of each WHO-approved intervention (4), countries then identify operational units that meet the criteria for each intervention.
At the end of the process, each unit will have a mix of interventions tailored to its context. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
At various stages of the process, mathematical models are used to help countries understand the impact on malaria of the scenarios with different combinations of interventions.
This information is then used to review and refine the goals of the NMSP, and to help with costing and prioritization of resources during funding requests to the government, the Global Fund, PMI and other donors. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
WHO coordinates this process; WHO also led the analysis support to countries and collaborated with several mapping and modelling groups to support the HBHI countries.1The example of intervention mixes for each local government authority in Nigeria is presented in Fig.
5.2.
This intervention-mix map was used to inform Nigeria’s new NMSP, and funding requests to the Global Fund and PMI. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
It also helped with anticipating interventions that would be implemented if a joint malaria loan from the World Bank and Islamic Development Bank is approved, to target states that do not receive support from the Global Fund, PMI or other donors.The main highlights of the analysis of subnational tailoring of intervention mixes in Nigeria were an increase in SMC-targeted states, from 114 to 395 local government authorities (LGAs), with actual planned implementation increasing from 114 to 305 LGAs based on available funding, increasing the number of children targeted for SMC from about 4 million to 16 million; funding for new-generation piperonyl butoxide (PBO) nets to cover more than 160 million people; and a recognition that, before the next ITN campaign, a comprehensive exercise of urban microstratification to better target interventions and improve efficiencies will be implemented by the National Malaria Elimination Programme (NMEP), with support from WHO and partners, given that just over half of the 215 million people in Nigeria live in urban areas.A modelling analysis of the impact of four intervention scenarios was implemented: business as usual (BAU), which is the pre-HBHI approach; a fully funded NMSP updated using the HBHI approach, where 80% or more of coverage of core interventions is achieved in areas where they are targeted; a funding request based on updated NMSPs that limits SMC to five states; and one that increases SMC to an additional five states (Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
5.2).
The analysis shows that the BAU approach will lead to very small reductions in malaria prevalence in Nigeria, whereas full implementation of the subnationally tailored NMSP will lead to substantial reductions in malaria prevalence – by 2023, infection prevalence in children aged under 5 years will be about 16%, a reduction from the estimated prevalence of 28% in 2020. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
For the period 2020–2023, preliminary analysis by the NMEP of Nigeria shows that US$ 2.75 billion is needed to achieve high coverage of interventions in targeted areas, and full availability of diagnosis and treatment in public health facilities.
Additional funding is required to cover all SMC eligible populations as well as major improvements in treatment seeking behaviour, access to care, compliance with SMC and use of LLINs. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Currently, available funding for LLINs, RDTs and ACTs for the period 2020–2023 is about US$ 1.75 billion.
If the current gap in funding is filled through to 2023, it is projected that, compared with BAU, about 73 million malaria cases and 66 000 deaths will be averted.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
5.2.Example of subnational tailoring of malaria intervention mixes and their projected impacts implemented as part of the HBHI response (in Nigeria) Sources: NMEP, WHO, Northwestern University, IDM.Cases per 1000 population at riskParasite prevalence (2–10 years old)All-cause U5 mortality rateSMC-eligible areasI II III IV Pyrethroid insecticide resistanceUrban areas (>1 million people)Mean distance to public health facilitiesPopulation not seeking care for fever (%)Subnationally tailored national malaria strategic planImpact of new subnational targeting of interventionssegalla,RPfP0.300.250.200.150.100.050201520162017201820192020202120222023Relative change in PfPR (all ages): 2023 compared to 2020 BAU0.20.0-0.2-0.4-0.6-0.8Scenarios:■ Business as usual■ NMSP with 80% effective coverage■ Funded scenario with PAAR SMC LGAs■ Funded scenario without PAAR SMC LGAsCases and deaths averted compared to a business as usual scenario, 2020–2023Cases: all agesCases: U5Deaths: all agesDeaths: U5LLIN distributionsUrban microstratificationIPTiNoNoEligibleEligibleSMCNoYesNoNoPyrethroid onlyPyrethroid onlyPyrethroid onlyPyrethroid+PBONoYesPyrethroid+PBOYesYesYesNoNoNo. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
of LGAsIPTp51943322385YesYesYesYesYesScenario1 The Swiss Tropical and Public Health Institute supported five countries (Cameroon, Ghana, Mozambique, Uganda and the United Republic of Tanzania), PATH supported three countries (the Democratic Republic of the Congo, Mali and Niger), and Northwestern University and the Institute for Disease Modeling supported two countries (Burkina Faso and Nigeria). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Subnational maps of parasite prevalence and all-cause mortality in children aged under 5 years were received from the Malaria Atlas Project (MAP) and the Institute for Health Metrics and Evaluations, respectively.46Full implementation of NMSP103 000 00032 000 000Funded scenario with prioritized above allocation request (PAAR) SMC LGAs 73 000 00024 000 000Funded scenario without PAAR SMC LGAs71 000 00023 000 00090 00066 00064 00075 00054 00053 000BAU: business as usual; HBHI: high burden to high impact; IDM: Institute for Disease Modeling; IPTi: intermittent preventive treatment in infants; IPTp: intermittent preventive treatment in pregnancy; LGA: local government authority; LLIN: long-lasting insecticidal net; NMEP: National Malaria Elimination Programme; NMSP: national malaria strategic plan; PAAR: prioritized above allocation request; PBO: piperonyl butoxide; PfPR: Plasmodium falciparum parasite rate; SMC: seasonal malaria chemoprevention; U5: aged under 5 years; WHO: World Health Organization.47WORLD MALARIA REPORT 2020 5High burden to high impact approachI II III IV 5.3 IMPROVING WHO’S MALARIA POLICY‑MAKING AND DISSEMINATION PROCESSESBefore the launch of HBHI, the GMP had already begun an extensive review of the WHO process for developing and disseminating policy guidance on malaria (128). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The overall aim was to improve the transparency, consistency, efficiency and predictability of the policy-making process, to make policies timely and more readily adaptable by countries.
The resulting pathway was structured as a three-tier process: better anticipate, develop policy and optimize uptake.
The HBHI response has added further urgency to this process (128).
other resources, to guide readers on how these global recommendations can best be implemented. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In the same year, WHO updated its technical brief to countries, to support them in the development of robust funding proposals that are tailored to their context (110).
The document provided information on the process of stratification, which guides tailoring of interventions to the local context and the prioritization of resources, while adhering to the evidence-based recommendations that have been developed through WHO’s standard, stringent processes. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In 2019, WHO created a compendium of its malaria guidance (109), to list all WHO recommendations and associated guidance on malaria in a single resource, and to inform programme managers, and national and international stakeholders.
The compendium also references relevant WHO handbooks, manuals and Based on the new WHO policy pathway, in 2020, the GMP established several guideline development groups focusing on vector control, case management, chemoprevention and elimination strategies. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The results from the deliberations of these groups are expected in early 2021.5.4 COORDINATED RESPONSESeveral areas of focus were identified for the HBHI fourth response element: stakeholder landscaping; identification of in-country processes requiring coordination; strengthening coordination structures; and aligning partner support around the national strategic and implementation plans.Although countries have undertaken some assessment of the status of coordination during the initiation phase, most have not formally evaluated their needs. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Early feedback from some countries shows that, although they are grateful for the support they receive from partners and WHO, gaps remain; for example: ■ weak NMP organizational and staff capacities; ■ weak cross-partner coordination structures; ■ weak subnational coordination structures; ■ potential risks of partner misalignment with NMSPs and operational research priorities; ■ issues around the sustainability of project-driven interventions and activities; ■ challenges of complex emergencies, including the COVID-19 pandemic.5.5 MALARIA IN HBHI COUNTRIES SINCE 2018Comparisons of malaria cases, case incidence, deaths and mortality rates in 2018 (the year HBHI was launched) and 2019 are presented in Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
5.3.
Overall, there have been no major changes in the burden of malaria in these countries since 2018.
Although cases in India reduced by 1.2 million and Mali by 0.8 million, increases were estimated in Nigeria (2.4 million) and the Democratic Republic of the Congo (1.2 million).
Overall, cases increased slightly from 155 million to 156 million between the two years, and deaths reduced from 263 000 to 226 000. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In 2015, at GTS baseline, there were 148 million estimated malaria cases in the 11 HBHI countries.5.6 REPORTED MALARIA CASES IN HBHI COUNTRIES SINCE 2018 AND COMPARISONS WITH ESTIMATED CASESThe methods used in this report to estimate the burden of malaria cases and deaths have several limitations.
These methods are elaborated in Annex 1.
The implications of the limitations become stark in the HBHI countries because they account for 70% or more of the burden of malaria morbidity and mortality. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In moderate to high malaria transmission countries in Africa, including the HBHI countries in this region, WHO uses a parasite rate-to-incidence model to estimate malaria cases (Annex 1, Section 3).
The process of estimation relies on community parasite surveys, interventions and climatic data to quantify parasite prevalence, which is then transformed to incidence using epidemiological methods (93). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The estimates are often different from cases reported by countries, and this difference has been an important 48FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
5.3.Estimated malaria a) cases, b) cases per 1000 population at risk, c) deaths and d) deaths per 100 000 population at risk, 2018 and 2019, in HBHI countries Source: WHO estimates.■ 2018 ■ 2019BurkinaFasoCameroonDemocraticRepublic ofthe CongoGhanaIndiaMaliMozambiqueNigerNigeriaUgandaUnitedRepublic ofTanzania■ 2018 ■ 2019BurkinaFasoCameroonDemocraticRepublic ofthe CongoGhanaIndiaMaliMozambiqueNigerNigeriaUgandaUnitedRepublic ofTanzania■ 2018 ■ 2019BurkinaFasoCameroonDemocraticRepublic ofthe CongoGhanaIndiaMaliMozambiqueNigerNigeriaUgandaUnitedRepublic ofTanzania■ 2018 ■ 2019a)forebmundetamitsE)noillim(sesacairaaml75604530150b)airaamlforebmundetamitsEksirltanoitaupop0001repsesac5004003002001000c)100forebmundetamitsE)000(shtaedairaamld)airaamlforebmundetamitsEksirltanoitaupop000001repshtaed806040200100806040200BurkinaFasoCameroonDemocraticRepublic ofthe CongoGhanaIndiaMaliMozambiqueNigerNigeriaUgandaUnitedRepublic ofTanzania49HBHI: high burden to high impact; WHO: World Health Organization.WORLD MALARIA REPORT 2020 5High burden to high impact approachI II III IV source of unease among NMPs. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Another method used for Southern African countries and those outside Africa where malaria transmission is low is the adjustment of reported data, mainly from the public health sector, for reporting, testing and treatment seeking rates (Annex 1).
Table 5.2 compares the results of two methods used to estimate burden: the parasite-rate-to-incidence method (107) used by WHO and the approach based on adjustment of routine data. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The WHO method estimates about 150 million cases in 2019 but the method based on adjustment of routine data estimates about 265 million cases.
Previous analysis showed that similar differences (i.e.
with the routine data method generally resulting in more cases) are seen in most of the 20 sub-Saharan countries that use the parasite rate-to-incidence method.
These discrepancies could be explained by data quality, epidemiological and methodological issues (129). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
However, improving national data systems (e.g. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |