World Malaria Report 2018

Malaria header image
We have just had the opportunity to digest the latest World Health Organisations report on Malaria, and it makes for some interesting reading.
In 2017 there were a reported 219 million cases of malaria worldwide compared with 239 million cases in 2010.

Whilst it is great news that we have seen a reduction, it is a stark reminder that malaria is present and the global disease burden is still present. Despite significant amounts of money being invested (upwards of $3.1 billion) in the eradication of malaria, significant progress has not been made.

Malaria burden around the globe is distributed as follows:

Worldwide Malaria Burden 2017 - Pie Chart

Africa 92%; South East Asia region 5%; WHO Eastern Med Region 2%; WHO all other regions 1%.

Significantly looking at countries contributing the most to malaria transmission we see the following:

Malaria Burden by Country 2017 - Pie Chart

Nigeria 25%; Democratic Republic of Congo 11%; Mozambique 5%; India 4%; Uganda 4%

Importantly though we have seen decreases in malaria transmission in the WHO South East Asia region, with only 7 cases per 1000 people being reported.

Malaria Deaths:

In 2017 nearly 80% of the total global deaths were reported from just 7 countries.

Malaria Deaths by Country 2017 - Pie Chart

Nigeria 19%; DRC 11%; Burkina Faso 6%; Tanzania 5%; Sierra Leone 4%; Niger 4%; India 4%

All regions worldwide with the exception of WHO Americas recorded reductions in Malaria deaths which is great news but there were still an estimated 435000 deaths with 61% of deaths being in the most vulnerable group the under 5’s.

What are VFR travellers?

In the UK malaria is primarily bought by individuals who are Visiting Friends and Relatives (the VFR). Traditionally these groups are hard to reach and data acquired by Travelpharm via freedom of information requests have seen a 16% increase in cases between 2015 and 2016. With nearly all the overwhelming majority arising from sub-SaharanEast and West Africa. It is massively important that UK VFR’s heading to sub-Saharan Africa use all available measures to prevent malaria.

What’s being done to prevent malaria?

In 2017 a total of 624 million treated nets were deployed with 83% of these being delivered to sub-Saharan Africa with 8% of these nets being distributed via ante-natal care. Which is a great way to ensure newborns are not exposed in their early years! Households with 1 net per 2 people have increased but reported use of insecticide knockdown sprays has declined, probably due to targeted campaigns on mosquito breeding sites.

Rapid testing using WHO prequalified test like the CareStart malaria test kit. Over 245million rapid test kits were distributed to countries in need. Access to prompt testing and treatment with an artemesian combination product is the best way to prevent unnecessary deaths.

Elimination

Worldwide more and more countries are moving towards elimination of locally acquired cases with Paraguay joining the list in 2018. Algeria, Argentina, Uzbekistan are applying to join the list.
Unfortunately, of the high burden countries listed earlier, only India has made significant headway in reducing numbers of cases.

Drug Resistance

Thankfully our primary treatment drug Artemesian outside of the Mekong regions of Vietnam, Cambodia and Laos is still about 95% effective in treating cases. It is troubling though that the gold standard has for many years had pockets of resistance around South East Asia.

Travellers

I believe the message to travellers has not changed.

  • Check reliable guidance from CDC, TravelhealthPro or Fit For Travel
  • If required use an appropriate antimalarial for the region
  • Prevent bites by using nets, repellents and appropriate clothing
  • Sleep in air-conditioned rooms where possible with windows and doors shut
  • Use environmental products like smoke coils outside or plug-in mosquito killers inside.

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