December 14, 2016
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Malaria control improves in vulnerable populations; more progress needed

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New data from WHO’s 2016 Malaria Report revealed that malaria control efforts increased among children and pregnant women in sub-Saharan Africa, where 90% of infections occurred in 2015. However, WHO officials warn that gaps in funding and weak health care systems could threaten recent improvements.

“We are definitely seeing progress,” Pedro Alonso, MD, PhD, director of the WHO Global Malaria Program, said in a news release. “But the world is still struggling to achieve the high levels of program coverage that are needed to beat this disease.”

According to the report, there has been a substantial increase in testing among children and prevention treatment in pregnant women in sub-Saharan Africa. Half of children with a fever who sought care at a public health facility in 22 African countries were tested for malaria — an increase from 29% in 2010. Based on available data, there was a fivefold increase in the percentage of women who received at least three doses of intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy. WHO recommends that pregnant women with moderate and high risk for malaria receive the treatment at each scheduled antenatal care visit during the second and third trimesters to prevent maternal and infant mortality, anemia and other adverse events. WHO estimated that 31% of pregnant women received the treatment in 2015.

The report also demonstrated an increase in the percentage of people using insecticide-treated nets from 30% in 2010 to 53% in 2015. Results from a 5-year evaluation of the efficacy of insecticidal nets (LLINs) released last month showed that people who slept under LLINs had significantly lower rates of malaria infection than those who did not use a net, even in areas where mosquitoes had developed resistance to pyrethroids.

Margaret Chan
Margaret Chan

“We have made excellent progress, but our work is incomplete,” WHO Director-General Margaret Chan, MD, said in the report. “Last year alone, the global tally of malaria reached 212 million cases and 429,000 deaths. Across Africa, millions of people still lack access to the tools they need to prevent and treat the disease.”

According to WHO, 43% of the population in sub-Saharan Africa did not have access to LLINs or indoor spraying with insecticides. In many countries, health care systems are poorly accessible and often lack adequate resources.

To help contain the worldwide malaria epidemic, member states adopted goals from the “Global Technical Strategy for Malaria” during the 2015 World Health Assembly. One global target that aims to eliminate malaria in at least 10 countries by 2020 appears to be on track, according to WHO. In 2015, 10 countries and territories had fewer than 150 malaria cases, and an additional nine countries only reported 150 to 1,000 cases. Recently, WHO announced that Kyrgyzstan and Sri Lanka had eliminated indigenous cases of malaria. However, more progress is needed to advance other targets, including a 40% reduction in malaria incidence from 2015 to 2020. WHO estimates that less than half (n = 40) of the 91 endemic countries and territories will meet this goal.

“To speed progress towards our global malaria goals, WHO is calling for new and improved malaria-fighting tools,” Chan said. “Greater investments are needed in the development of new vector control interventions, improved diagnostics and more effective medicines.”

Although global malaria investments increased between 2000 and 2010, funding has since flatlined, WHO reported. Approximately $2.9 billion was available for malaria control efforts in 2015, which is less than half of the $6.4 billion funding milestone for 2020. Most funds came from the United States (35%), followed by the United Kingdom and Northern Ireland (16%).

“The challenges we face are sizable but not insurmountable,” Chan said. “Recent experience has shown that with robust funding, effective programs and country leadership, progress in combatting malaria can be sustained and accelerated. The potential returns are well worth the effort. With all partners united, we can defeat malaria and improve the health of millions of people around the world." by Stephanie Viguers

Disclosures: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.