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Measuring Progress in Malaria Control

Summary and Comment |
February 24, 2014

Measuring Progress in Malaria Control

  1. Mary E. Wilson, MD

In Africa, malaria transmission intensity decreased substantially between 2000 and 2010, but 57% of the people in malaria-endemic countries still live in areas with moderate-to-high transmission.

  1. Mary E. Wilson, MD

Investment in malaria control has increased dramatically since the Roll Back Malaria initiative was launched in 1998. To assess progress, investigators examined the change in malaria transmission intensity between 2000 and 2010 in Africa.

The researchers assembled data from Plasmodium falciparum prevalence surveys in malaria-endemic countries. They used these data together with spatially matched covariates in a Bayesian hierarchical space-time model to estimate the proportion of children aged 2 to 10 years with various parasitemia levels, indicated as the standardized P. falciparum parasite rate (PfPR2–10). They then derived estimates for 2000 and 2010 at a 1 × 1 km resolution and computed the number of individuals at each level of endemicity.

Between 2000 and 2010, across 44 malaria-endemic countries and territories, the number of people living in holoendemic (>75% PfPR2–10) or hyperendemic (>50%–75% PfPR2–10) areas decreased from 218.6 million to 183.5 million; the proportion of the population in such areas decreased from 34% to 23%. However, the number of people living in mesoendemic (>10%–50% PfPR2–10) areas increased from 178.6 to 280.1 million, and the number of those in areas where transmission was unstable or <1% PfPR2–10 increased from 78.2 to 128.2 million. Although 40 of 44 countries showed a fall in parasite prevalence, and 27% of people in endemic countries lived in a lower endemicity class in 2010 than in 2000, 57% still lived in areas with >10% PfPR2–10 in 2010. Ten countries accounted for 87% of people in the highest transmission areas (>50% PfPR2–10).

Comment

This study delivers good news and bad: Excellent progress has been achieved, but the malaria burden in Africa remains substantial. Sustained funding will be essential to maintain control. Editorialists cite threats to control, including mosquito resistance to pyrethroid insecticides and the potential spread of artemisinin-resistant parasites. Because of rapid population growth, almost 200 million people were added to malaria-endemic areas between 2000 and 2010, decreasing some of the proportional gains in reducing transmission. The authors note the need to tailor malaria-control strategies to transmission intensity before and after interventions.

  • Disclosures for Mary E. Wilson, MD at time of publication Editorial boards Clinical Infectious Diseases; Infectious Diseases in Clinical Practice; RSTMH International Health; UpToDate Leadership positions in professional societies International Society of Travel Medicine (Chair, Scientific Program Committee for 2013 Meeting)

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