By Sharon Atieno

Despite the African region bearing the biggest brunt of the global malaria cases, progress in the fight against malaria in the region has stalled, the recent World Health Organization (WHO) World Malaria report reveals.

With an estimated 215 million malaria cases and 384 000 malaria deaths in 2019, the WHO African Region accounted for about 94% of cases and deaths globally. Though there has been reduction in incidences and mortalities; since 2014, the rate of progress in both cases and deaths has slowed, attributed mainly to the stalling of progress in several countries with moderate or high transmission, the report says.

Of the 29 countries that account for 95% of malaria cases globally, 27 are in the WHO African region.

In addition, the region is off track for achieving the malaria morbidity and mortality milestones in the 2020 Global technical strategy (GTS) for malaria. The report finds that while the GTS target to reduce malaria incidence and mortality rate is by at least 40%, the African region stands at 37% and 27% respectively.

Only Botswana, Cabo Verde, Ethiopia, the Gambia, Ghana, Namibia and South Africa are on track to achieve the GTS 2020 target of a 40% reduction in malaria case incidence, and Algeria has already been certified malaria free.

Although not on track, 17 countries (Equatorial Guinea, Gabon, Guinea, Guinea-Bissau, Kenya, Malawi, Mali, Mauritania, Mozambique, Niger, Senegal, Sierra Leone, South Africa, Togo, United Republic of Tanzania, Zambia and Zimbabwe) were estimated to have achieved reductions in malaria case incidence by 2020 compared with 2015, the report says.

There was no difference (less than 5% increase or decrease) in case incidence in 2020 compared with 2015 in Benin, Burkina Faso, Cameroon, Central African Republic, Liberia, Madagascar, Nigeria, South Sudan and Uganda. Case incidence was higher in 2020 than in 2015 by less than 25% in Angola, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Rwanda, and Sao Tome and Principe, and increased by 40% or more in Burundi, Comoros, Eritrea and Eswatini.

The WHO report notes that Botswana, Cabo Verde, Eswatini, and Sao Tome and Principe zero malaria deaths in 2019 and were projected to maintain this in 2020. Ethiopia and Namibia were estimated to have achieved a reduction in mortality rate of more than 40%.

Also, although not on track for the GTS 2020 mortality milestones, 30 countries (Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Kenya, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Senegal, Sierra Leone, South Africa, Togo, Uganda, United Republic of Tanzania, Zambia and Zimbabwe) had achieved mortality rate reductions of less than 40%.

Guinea-Bissau, Liberia, Madagascar, Rwanda and South Sudan showed no change in levels of mortality rate (less than 5% decrease or increase) in 2020 compared with 2015, whereas increases in mortality rate of more than 40% were reported in Comoros, Eritrea and Sudan, the report notes.

COVID-19 disrupting malaria response

The emergence of COVID-19 pandemic has brought disruptions to malaria responses globally, the report finds. Prevention interventions like insecticide-treated mosquito nets (ITN), indoor residual spraying (IRS) and seasonal malaria chemoprevention (SMC) were among those affected.

“All 31 countries (25 in sub-Saharan Africa) that had ITN campaigns planned in 2020 aimed to complete them by the end of the year. As of 23 November 2020, five countries had completed on time (within the planned period before the pandemic), seven had completed with moderate delays (within the second quarter of the original planned period), 12 had ongoing campaigns with moderate delays, and another seven had campaigns in progress but with major delays (beyond the second quarter of the original planned period),” the report reads.

“Of the 222 million ITNs expected to be distributed in 2020, 105 million had been distributed by 23 November 2020. Of the 47 countries that planned IRS campaigns in 2020, 23 had completed them, with eight of those countries doing so with delays.”

Thirteen countries are on track to complete their IRS campaigns, six of them with delays, the report adds. Eleven countries, eight of them in sub-Saharan Africa, were either off track or at risk of not completing their IRS campaigns.

By the third week of November 2020, all countries that had planned SMC campaigns were on track to complete them, despite moderate delays in some areas.