Africa Continues to Shoulder Heaviest Malaria Burden – WHO Report

Each year, the World Health Organization, WHO’s World malaria report provides a comprehensive and up-to-date assessment of trends in malaria control and elimination across the globe.

Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Symptoms, including fever, headache, and chills usually appear 10-15 days after a bite and may be mild and difficult to recognize as malaria. Left untreated, malaria can progress to severe illness and death. It is preventable and curable.

WHO has released new data that shows that countries around the world largely held the line against further setbacks to malaria prevention, testing, and treatment services in 2021. According to WHO’s latest report, there were an estimated 619,000 malaria deaths globally in 2021 compared to 625,000 in the first year of the pandemic. In 2019, before the pandemic struck, the number of deaths stood at 568,000.

In 2020, there were an estimated 241 million cases of malaria worldwide and the estimated number of malaria deaths stood at 627,000 in 2020. In the past two decades, the annual death rate from malaria has dropped by nearly half, making it one of humanity’s greatest public health successes.

The African region continues to shoulder the heaviest burden of malaria. In 2021, the region accounted for 95% of all malaria cases (234 million cases) and 96% of all malaria deaths (593 000 deaths). Children under 5 years of age accounted for about 80% of all malaria deaths.

Four countries also accounted for just over half of all malaria deaths globally: Nigeria (31.3%), the Democratic Republic of the Congo (12.6%), the United Republic of Tanzania (4.1%), and Niger (3.9%). Nigeria accounted for an estimated 38.4% of global malaria deaths in children aged under 5 years.  Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa.  Africa is struggling to eliminate the disease.

Progress varied, however, and some individual countries beat the overall regional trend. Between 2015 and 2021, Cabo Verde, Ethiopia, the Gambia, Ghana, Mauritania, Rwanda, South Africa, and Zimbabwe met the target of a reduction in malaria case incidence of 40% or more.

Although not on track to reach the GTS milestones, 15 countries achieved reductions in malaria case incidence, Burkina Faso, Cameroon, Equatorial Guinea, Eswatini,  Guinea, Kenya, Malawi, Mali, Mozambique, Niger, Senegal, Sierra Leone, Togo, Tanzania, and Zambia. Cabo Verde and Eswatini had zero estimated malaria deaths in 2021, while Ethiopia, South Africa, and Zimbabwe achieved reductions in their mortality rates of 40% or more. Algeria was certified malaria-free by WHO in 2019.

Matshidiso Moeti, WHO Regional Director for Africa, said “despite progress, the African region continues to be hardest hit by this deadly disease … new tools – and the funding to deploy these – are urgently needed to help us defeat malaria”.

Disruptions during the pandemic and converging humanitarian crises, health system challenges, restricted funding, rising biological threats and a decline in the effectiveness of core disease-cutting tools threaten the global response to malaria, the report added.

The report also found that malaria progress is being hampered by the declining effectiveness of core malaria control tools, such as ITNs. Threats to this key prevention tool include insecticide resistance; insufficient access; loss of ITNs due to the stresses of day-to-day use outpacing replacement; and changing behaviour of mosquitoes, which appear to be biting early before people go to bed and resting outdoors, thereby evading exposure to insecticides.

Other risks are also rising, including parasite mutations affecting the performance of rapid diagnostic tests; growing parasite resistance to the drugs used to treat malaria, and the invasion in Africa of an urban-adapted mosquito that is resistant to many of the insecticides used today.

The latest World Malaria Report shows that U.S.$7.3 billion is required globally to stay on track to defeat malaria.

WHO recently launched two strategies to support countries in the African continent as they work to build a more resilient response to malaria: a strategy to curb antimalarial drug resistance and an initiative to stop the spread of the Anopheles stephensi malaria vector. Additionally, a new global framework to respond to malaria in urban areas, developed jointly by WHO and UN-Habitat, provides guidance for city leaders and malaria stakeholders.

Malawi and WHO recently rolled out a new malaria vaccine for young children that backers say will reduce deaths from the mosquito-borne disease. Malawi begun vaccinating children as part of a world-first, large-scale campaign against malaria using the  RTS,S vaccine which was tested in Ghana, Kenya, and Malawi. It has taken more than 30 years to develop the vaccine. Malaria remains a huge public health problem in Malawi, with about one-third of its 20 million people getting infected each year. In 2021, the government launched a nationwide anti-malaria initiative known as Zero Malaria Starts with Me, aimed at eliminating the disease by 2030.

In August 2022, Nigeria’s President Buhari inaugurated the 16-member committee, which will oversee an effort to eliminate malaria in Nigeria within the next eight years. He appointed Aliko Dangote, Africa’s richest man, to lead a committee commissioned with eliminating malaria in the West African nation as the mosquito-borne infection has made a comeback across the continent amid disruptions related to the coronavirus pandemic. The World Health Organization says Nigeria alone accounts for about 27% of all malaria cases and 31.3% of malaria deaths globally.

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