India: WHO Launches Country-Led Response To Put Stalled Malaria Control Efforts Back On Track

India, the only country out of 11 highest burden countries worldwide, has recorded a substantial decline in malaria cases in 2017

On November 19, 2018, World Health Organization (WHO) released the World Malaria Report 20181 which provides a comprehensive update on global and regional malaria data and trends. The latest report, tracks investments in malaria programmes and research as well as progress across all intervention areas - prevention, diagnosis, treatment and surveillance.

Highlights of the World Malaria Report 2018

According to the new World Malaria Report 2018, the reductions in malaria cases have stalled globally after several years of decline. For the second consecutive year, the annual report produced by WHO reveals a plateauing in numbers of people affected by malaria.

Malaria Cases: In 2017, there were an estimated 219 million cases of malaria, compared to 217 million the year before. But in the years prior, the number of people contracting malaria globally had been steadily falling, from 239 million in 2010 to 214 million in 2015.

The incidence rate of malaria declined globally between 2010 and 2017, from 72 to 59 cases per 1000 population at risk. India with fifteen countries in sub-Saharan Africa carried almost 80% of the global malaria burden. Five countries accounting for nearly half of all malaria cases worldwide include Nigeria (25%), Democratic Republic of the Congo (11%), Mozambique (5%), India (4%) and Uganda (4%).

The 10 highest burden countries in Africa reported increase in cases of malaria in 2017 compared to 2016. Of these, Nigeria, Madagascar and the Democratic Republic of the Congo had the highest estimated increases, all greater than half a million cases. In contrast, India reported 3 million fewer cases in the same period, a 24% decrease compared with 2016.

Malaria deaths: In 2017, there were an estimated 4,35,000 deaths from malaria globally, compared to 4,51,000 estimated malaria deaths in 2016, and 6,07,000 in 2010. The WHO African Region accounted for 93% of all malaria deaths in 2017. All WHO regions except the WHO Region of the Americas recorded reductions in mortality in 2017 compared with 2010. The largest declines occurred in the WHO regions of South-East Asia (54%), Africa (40%) and the Eastern Mediterranean (10%).

Malaria-related anaemia: This year's report includes a section on malaria-related anaemia, a condition that, if left untreated, can result in death, especially among vulnerable populations such as pregnant women and children aged under 5 years. Data from household surveys conducted in 16 high-burden African countries between 2015 and 2017 show that, the prevalence of any anaemia was 18% higher in children who tested positive for malaria compared to children who tested negative for malaria.

Positive findings in Malaria Report 2018

Despite a levelling off in progress since 2015, the global malaria response is in a much better position for some countries that carry a high burden of malaria, such as India, Rwanda, Ethiopia and Pakistan.

For example - India, a country that accounted for 4% of global malaria cases in 2017 is making significant progress in bringing down its malaria burden. As reflected in this year's World Malaria Report, the country registered a 24% reduction in cases over 2016, largely due to substantial declines of the disease in the high burden state like Odisha, home to approximately 40% of all malaria cases in the country.

Success factors include rejuvenated political commitment, strengthened technical leadership, which focused on prioritizing the right mix of vector control measures, and increased levels of domestic funding to back efforts. A notable aspect of Odisha's approach is its network of Accredited Social Health Activists, or ASHAs, who serve as front-line workers to deliver essential malaria services across the state, particularly in rural and remote areas.

The report also reveals that, in a subset of countries that are nearing elimination, the pace of progress is quickening. For example, 46 countries reported fewer than 10,000 indigenous malaria cases in 2017, up from 37 countries in 2010.

WHO's country-led response "High burden to high impact"

WHO and partners have launched a new country-led response "High burden to high impact" to get the reduction in malaria deaths and disease back on track, to scale up prevention and treatment, and increased investment, to protect vulnerable people from the deadly disease.

According to this, the approach will be driven by the 11 countries that carry the highest burden of the disease. Key elements of the new approach include:

  • Political will to reduce the toll of malaria;
  • Strategic information to drive impact;
  • Better guidance, policies and strategies; and
  • A coordinated national malaria response.

Note – The current report also highlights that the immediate barriers to achieving the fast-approaching Global Technical Strategy milestones for 2020 and 2025 are malaria's continued rise in countries with the highest burden of the disease and inadequate international and domestic funding. At the same time, the continued emergence of parasite resistance to antimalarial medicines and mosquito resistance to insecticides pose threats to progress.

Footnotes

1 http://www.who.int/malaria/publications/world-malaria-report-2018/report/en/

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