Progress
Major increases in funding and attention given to malaria control
Attention and funding to combat malaria have significantly increased in recent years. Resources for malaria control have increased by more than tenfold since 2000 with the majority of the increase occurring since 2005. This has been achieved thanks in large part to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank’s Malaria Control Booster Programme, the United States President’s Malaria Initiative (PMI), UNICEF and the Bill & Melinda Gates Foundation, among others. Funding increases have resulted in marked achievements in programme coverage and considerable health impact. However, this success is fragile and closely tied to sustained funding. In areas where financing has not been maintained gains have been quickly lost.
New and more effective tools to fight malaria have been developed during the past decade, including long-lasting insecticide-treated nets (LLINs) and artemisinin combination therapies (ACTs). Reduction of bottlenecks in the production, procurement and distribution of these interventions has also contributed greatly to achieving results. Countries have also been quicker to adopt more effective strategies that would have been out of reach with less funding available, such as changing national drug policies to include more effective – but more expensive – treatment courses, as well as expanding the use of diagnostics. Together, these activities have led to significant increases in coverage with insecticide-treated mosquito nets (ITNs), and many other key malaria control interventions are also now beginning to reach the people most in need. Most countries achieved key malaria control intervention scale-up in a highly equitable fashion, reaching rural and poor households where the malaria burden has always been the worst.
Major progress in scaling up insecticide-treated net (ITN) coverage
UNICEF, one of the largest net procurers globally, purchased 164 million nets between 2000 and 2010. The vast majority of nets (79 per cent) were purchased since 2006, further highlighting the recent global scale-up of malaria control since around the middle of the decade.
Cumulative numbers of ITNs procured by UNICEF (in millions) 2000-2010
Source: UNICEF Supply Division 2011, published in A Decade of Partnership and Results, RBM Progress & Impact Series, Report No. 7, 2011.
Delivery of Long lasting insecticide treated nets (LLINs) in Africa
290 million LLINs have been delivered to African countries since 2008, satisfying nearly 80% of reported need across
Number of LLINs delivered and available for use during 2008–2010 as a percentage of reported need to cover one net for every two people living in an area with malaria transmission
Household ownership of ITNs
Household ownership is a precondition for use. There is still high variability in household ITN ownership across the African continent (from about 42 per cent to more than 80 per cent –from surveys available in 2010) but some countries have made considerable progress in recent years in scaling up home ownership of ITNs.
Household ownership of ITNs is relatively high, but some countries still have low coverage
Percentage of households owning at least one ITN, African countries with at least two data points, 2000-2010
Source: UNICEF global malaria databases 2011, from Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and Malaria Indicator Surveys (MIS), published in A Decade of Partnership and Results, RBM Progress & Impact Series, Report No. 7, 2011.
Children sleeping under ITNs
Much progress has been made across sub-Saharan Africa in quickly scaling up ITN use among children (MDG indicator 6.7). All 33 countries with trend data have shown major increases in ITN use by children. Despite this progress, though, overall ITN use still falls short of global targets of universal coverage.
Rapid progress in scaling up use of insecticide-treated nets across sub-Saharan Africa
Proportion of children under five years of age sleeping under an ITN, African countries with two or more data points, 2000-2010
Source: UNICEF global malaria databases 2011, from MICS, DHS and MIS, published in A Decade of Partnership and Results, RBM Progress & Impact Series, Report No. 7, 2011.
Most countries in Africa increased coverage for ITN use among children in an equitable way, often favouring the rural areas and the poor. This was largely due to nationwide free distribution campaigns that emphasized reaching poor and rural areas.
Intervention scale-up has been done in a highly equitable fashion, reaching rural and poor households where the malaria burden has always been the worst
Proportion of children under five years of age sleeping under an ITN, by residential setting 2008-2010
Case management across sub-Saharan Africa
Treatment of malaria among children varies greatly across sub-Saharan Africa. In 2010 the World Health Organization (WHO) started recommending universal use of diagnostic testing to confirm malaria infection and apply appropriate treatment based on the results. According to the new guidelines, treatment solely on the basis of clinical suspicion should only be considered when a parasitological diagnosis is not accessible.
Many countries are now greatly expanding the use of diagnostics to focus treatment on only those children with malaria. Thus, it is increasingly challenging to track trends in antimalarial treatment among febrile children as lower levels of coverage may indicate that antimalarials are being provided only to confirmed malaria cases. However, this may also indicate that children who are ill with malaria are not receiving needed treatment.
By 2008, most African countries had adopted a malaria treatment policy of using artemisinin combination therapy (ACT) as the first-line drug. However, in surveys since 2007, only a relatively low proportion of children treated for malaria were actually receiving ACT. Although practice is changing, other less effective antimalarial drugs are still commonly used for malaria treatment.
Despite moderately high treatment rates, many African children are still given less effective medicines
The proportion of children receiving ACT of all children who received an antimalarial drug, African countries, 2007–2010
Note: Dates of national surveys are indicated next to the country.
Source: UNICEF global malaria databases 2011, from MICS, DHS and MIS, published in A Decade of Partnership and Results, RBM Progress & Impact Series, Report No. 7, 2011.
ACT is the most effective antimalarial therapy for P. falciparum, the most lethal malaria parasite and the most pervasive in sub-Saharan Africa. ACT is also the first-line drug treatment in most countries in the region. Global procurement of ACTs has risen sharply since around 2005.
Recent and rapid scale-up in the global procurement of artemisinin combination therapies
Number of doses of artemisinin combination therapy (ACT) cumulatively procured worldwide, in millions, 2001–2010
Source: UNICEF global malaria databases 2011, from MICS, DHS and MIS, published in A Decade of Partnership and Results, RBM Progress & Impact Series, Report No. 7, 2011.
Prevention and control of malaria during pregnancy
Use of insecticide-treated mosquito nets by pregnant women
Although some progress has been made, across sub-Saharan Africa the proportion of pregnant women aged 15–49 sleeping under ITNs remains too low. Some countries have achieved higher coverage rates, such as Niger (over 70 per cent in 2010), Rwanda (60 per cent in 2007–2008) and the United Republic of Tanzania (57 per cent in 2010).
Across sub-Saharan Africa the proportion of pregnant women sleeping under insecticide-treated nets remains low
Proportion of pregnant women sleeping under an ITN, African countries, countries with two data points, 2000-2010
Source: UNICEF global malaria databases 2011, from MICS, DHS and MIS, published in A Decade of Partnership and Results, RBM Progress & Impact Series, No. 7 (2011).
Intermittent preventive treatment for pregnant women
Nearly every sub-Saharan African country with a high malaria burden has adopted intermittent preventive treatment for pregnant women (IPTp) as part of its national malaria control strategy. Some countries have already achieved relatively high coverage, including Zambia and Malawi (69 and 60 per cent in 2010, respectively), whereas others are still in the process of scaling up this relatively recent intervention.
Too many pregnant women in sub-Saharan Africa lack appropriate preventive treatment against malaria
Proportion of women aged 15–49 who received intermittent preventive treatment during pregnancy before their last live birth, African countries with at least two data points, 2003-2010
Note: Intermittent preventive treatment is defined as receiving two or more doses of sulfadoxine-pyrimethamine during an antenatal care visit; in some country surveys the site of treatment (e.g. “during antenatal care visit”) is not specified. Dates of national surveys are indicated next to the country.
Source: UNICEF global malaria databases 2011, from MICS, DHS and MIS, published in A Decade of Partnership and Results, RBM Progress & Impact Series, Report No. 7, 2011.
References
Roll Back Malaria Partnership, A Decade of Partnership and Results, Progress & Impact Series, Report number 7, Geneva, September 2011.
WHO, UNICEF and PATH, Malaria Funding & Resource Utilization: The first decade of Roll Back Malaria, Progress & Impact Series, Report number 1, Geneva, March 2010.
UNICEF (on behalf of the RBM Partnership Secretariat) and PATH, World Malaria Day 2010: Africa update, Progress & Impact Series, Report number 2, 2010.
WHO, Guidelines for the Treatment of Malaria: Second edition, WHO, Geneva, 2010.
WHO, World Malaria Report 2010, WHO, Geneva, 2010.