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London School of Hygiene & Tropical Medicine Malaria Centre

World Malaria Report 2013: Major progress against disease 'still fragile'

 
Image: World Malaria Report 2013. Picture courtesy of WHO
 

Image: World Malaria Report 2013. Picture courtesy of WHO

11 December 2013
Malaria Centre members contribute to this year's World Malaria Report from the WHO

Read the original story on the ACT Consortium web site.

Read the World Malaria Report 2013.

Malaria deaths have declined by 45% globally since 2000 – thanks to prevention and control measures, political commitment and expanded funding. But improving access to diagnosis and treatment is still needed, according to this year’s World Malaria Report.

Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, states the WHO analysis of data from 102 countries. The incidence of malaria has reduced by 31% in Africa, where most cases occur. The majority of the lives saved were in the ten countries with the highest malaria burden, and among children under five years old – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%. However, “this remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, Director-General of the World Health Organization. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.” In 2012, there were an estimated 207 million cases of malaria, which caused approximately 627,000 malaria deaths.

Access to malaria diagnosis and treatment improved, but is still poor

Malaria diagnostic testing continued to expand in this period. The proportion of people with suspected malaria who received a test in the public sector increased from 44% to 64% globally. Most of the increase in Africa is attributable to the use of rapid diagnostic tests (RDTs). Access to artemisinin-based combination therapies (ACTs) – the antimalarial treatment recommended by the WHO – has also increased, with the number of ACTs delivered to countries rising from 76 million in 2006 to 331 million in 2012. Despite this progress, millions of people with suspected malaria still do not receive a diagnostic test, and many people with confirmed infections do not receive appropriate treatment with a quality assured antimalarial. It has been difficult to track the extent to which patients with confirmed malaria received antimalarials, the report states. This is because information linking diagnostic testing and treatment is limited. In order to ensure that all patients with malaria receive prompt and effective treatment, there needs to be an increased access to care for fever, as well as appropriate diagnostic testing and therapeutic management. The director of the ACT Consortium, Prof David Schellenberg, describes the improvements as “tremendously encouraging”, but highlights that “increased access to reliable diagnosis, and reporting of test results, will help target valuable malaria treatments to people who really have got malaria, and allow us to count cases with confidence”. Malaria prevention suffered a slowdown in recent years, particularly in providing access to insecticide-treated bed nets, which this year remained well under 50% due to a decrease in funding for malaria control.

WHO calls for sustained funding to meet malaria control targets

The World Malaria Report 2013 shows that there is an urgent need to increase funding for malaria control and to expand programme coverage, in order to meet the Millennium Development Goal target of reversing the incidence of malaria. The total international and domestic funding committed to malaria control was estimated to be US$ 2.5 billion in 2012 – substantially less than the amount that will be needed to reach the global targets. Without adequate and predictable funding, the progress against malaria is also threatened by emerging cases of parasite resistance to Artemisinin – the core component of ACTs – and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries. “The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

Read the World Malaria Report 2013.