By Keffyalew Gebremedhin, The Ethiopia Observatory (TEO)
About 313 million people in the 12 countries of Sub-Saharan Africa are at some risk for malaria. Of these, 254 million are at high risk, according to a newly-issued report by the World Health Organization (WHO).
The 2015 World Malaria Report, indicates that between 2000 and 2014, malaria admission rates declined by at least 75% in the Comoros, Eritrea, Rwanda, and Zanzibar in the United Republic of Tanzania, similar to rates in other studies. A 50–75 percent decrease in malaria admission rates by 2015 is projected for Zambia.
In this same report, WHO estimates that a cumulative 1.2 billion fewer malaria cases and 6.2 million fewer malaria deaths occurred globally between 2001 and 2015 than would have been the case had incidence and mortality rates remained unchanged since 2000.
In Africa, the WHO study shows that Algeria, Botswana, Cape Verde, Eritrea, Namibia, Rwanda, Sao Tome and Principe, South Africa and Swaziland have been reported to have achieved 75 percent decrease in reported malaria case incidence between 2000-2015. Decreases in malaria admissions also occurred in Mozambique between 2007 and 2012, but there were small increases in subsequent years; no comparable data from earlier than 2007 are available.
For the remaining six countries (Ethiopia, Kenya, Malawi, South Sudan, Uganda and the United Republic of Tanzania), it was not possible to assess trends between 2000 and 2014 because of inconsistent reporting, or changes in health service accessibility or diagnostic testing, according to the the WHO report. In the case of Ethiopia, Zambia and Zimbabwe, the projected rate of decrease was 50-75 percent.
It is reported that about 25 precent of the population of Ethiopia and Kenya live in areas that are free of malaria. P. falciparum is the predominant species, except in Eritrea and Ethiopia, where P. vivax accounts for about 31 percent and 26 percent of reported cases, respectively.
P. vivax malaria is a significant public health issue in many parts of the world. This form of malaria caused an estimated 13.8 million cases globally in 2015, and accounted for about half of all malaria cases outside Africa. Most cases of P. vivax malaria occurred in the WHO South-East Asia Region (74 percent), followed by the
WHO Eastern Mediterranean Region (11 percent) and the WHO African Region (10 percent).
Most cases of P. vivax malaria occur in the WHO South-East Asian Region (74 percent), followed by the WHO Eastern Mediterranean Region (11 percent) and the WHO African Region (10 percent). More than 80 percent of P. vivax malaria cases are estimated to occur in three countries of Ethiopia, India and Pakistan.
In 2015, WHO estimates that 15 countries accounted for 80 percent of cases, and 15 countries accounted for 78 percent of deaths. The global burden of mortality is dominated by countries in sub-Saharan Africa, with the Democratic Republic of the Congo and Nigeria together accounting for more than 35 percent of the global total of estimated malaria deaths. Decreases in case incidence and mortality rates were slowest in countries that had the largest numbers of malaria cases and deaths in 2000. Reductions in incidence need to be greatly accelerated in these countries if global progress is to improve.
WHO indicates that millions of people still do not receive the services they need for economic or policy failures. For instance, an estimated 269 million of the 834 million people at risk of malaria in sub-Saharan Africa in 2014 lived in households without any ITNs or IRS; 15 million of the 28 million pregnant women at risk did not receive a dose of IPTp; and between 68 and 80 million of the 92 million children with malaria did not receive ACT.
In sub-Saharan Africa, WHO estimates that malaria control interventions accounted for 70 percent of the 943 million fewer malaria cases occurring between 2001 and
2015, averting 663 million malaria cases (range: 542–753 million). Of the 663 million cases averted due to malaria control interventions, it is estimated that 69% were averted due to use of insecticide-treated mosquito nets (ITNs – insecticide-treated nets) (UI: 63–73 percent), 21 percent due to artemisinin-based combination therapy (ACT) (UI: 17–29 percent) and 10 percent due to indoor residual spraying (IRS) (UI: 6–14 percent).