World Malaria Report 2010 1.

The World Malaria Report 2010 summarizes information received from 106 malaria-endemic countries and other partners and updates the analyses presented in the 2009 Report. It highlights continued progress made to ards meeting international targets for malaria control to !e achieved !y 2010 and 201". 2. The report outlines the evolving situation of financing for malaria control# ho these gro ing resources have resulted in increased coverage of $%&recommended malaria control interventions# and the association !et een this rapid scale-up and su!stantial reductions in malaria !urden. '. International funding for malaria control has risen steeply in the past decade. (is!ursements reached their highest ever levels in 2009 at )*+ 1." !illion# !ut ne commitments for malaria control appear to have stagnated in 2010# at )*+ 1., !illion. -ountries ith smaller populations at ris. continue to receive more funding per person at ris. than more populous countries. /. The amounts committed to malaria# hile su!stantial# still fall short of the resources re0uired for malaria control# estimated at more than )*+ 6 !illion for the year 2010.The increased financing has resulted in tremendous progress in increasing access to insecticide-treated mos0uito nets 1IT2s3 in the past ' years. ". 4y the end of 2010# appro5imately 2,9 million IT2s ill have !een delivered to su!-*aharan 6frica# enough to cover 768 of the 76" million persons at ris. of malaria. It is estimated that /28 of households in 6frica o ned at least one IT2 in mid-2010# and that '"8 of children slept under a IT2. 6. The percentage of children using IT2s is still !elo the $%6 target of ,08 partly !ecause up to the end of 2009# IT2 o nership remained lo in some of the largest 6frican countries. 9o rates of use reported in some surveys are primarily due to a lac. of sufficient nets to cover all household mem!ers: household survey results suggest that most 1,083 of the availa!le IT2s are used. 7. $hile the rapid scale-up of IT2 distri!ution in 6frica represents an enormous pu!lic health achievement# it also represents a formida!le challenge for the future in ensuring that the high levels of coverage are maintained. The lifespan of a long-lasting IT2 is currently estimated to !e ' years. ,. 2ets delivered in 2006 and 2007 are therefore already due for replacement# and those delivered !et een 200, and 2010 soon ill !e. ;ailure to replace these nets could lead to a resurgence of malaria cases and deaths.

9. IR* programmes have also e5panded considera!ly in recent years# ith the num!er of people protected in su!-*aharan 6frica increasing from 1' million in 200" to 7" million in 2009# corresponding to protection for appro5imately 108 of the population at ris. in 2009. 10. -urrent methods of malaria vector control are highly dependent on a single class of insecticides# the pyrethroids# hich are the most commonly used compounds for IR* and the only insecticide class used for IT2s. The idespread use of a single class of insecticide increases the ris. that mos0uitoes ill develop resistance# hich could rapidly lead to a ma<or pu!lic health pro!lem.

11. The ris. is of particular concern in 6frica# here insecticidal vector control is !eing deployed ith unprecedented levels of coverage and here the !urden of malaria is greatest.$%& no recommends that all cases of suspected malaria !e confirmed ith a diagnostic test prior to treatment. 6s the incidence of malaria decreases through much of su!-*aharan 6frica# the need to differentiate malaria from non-malarial fevers !ecomes more pressing. 12. The proportion of reported cases in 6frica confirmed ith a diagnostic test has risen su!stantially from less than "8 at the !eginning of the decade to appro5imately '"8 in 2009# !ut lo rates persist in the ma<ority of 6frican countries and in a minority of countries in other regions. 6 small num!er of countries have sho n that it is possi!le to scale up rapidly the availa!ility of malaria diagnostic testing on a national scale# 1'. provided that attention is given to ade0uate preparation# training# monitoring# supervision and 0uality control. *uch e5periences have !een lin.ed ith large savings in the use of artemisinin-!ased com!ination therapies 16-Ts3 and ith improved malaria surveillance.Information from manufacturers indicates that the num!er of 6-Ts procured has increased in every year since 200". 1/. 4y the end of 2009# 11 6frican countries ere providing sufficient courses of 6-Ts to cover more than 1008 of malaria cases seen in the pu!lic sector: a further , 6frican countries delivered sufficient courses to treat "08=1008 of cases. These figures represent a su!stantial increase since 200"# hen only " countries ere providing sufficient courses of 6-T to cover more than "08 of patients treated in the pu!lic sector. 1". %o ever# information on access to treatment is generally incomplete# particularly for the significant proportion of patients treated in the private sector. The use of oral artemisinin-!ased monotherapies threatens the therapeutic life of 6-Ts !y fostering the spread of resistance to artemisinins. 16. 4y 2ovem!er 2010# 2" countries ere still allo ing the mar.eting of these products and '9 pharmaceutical companies ere manufacturing them. >ost of the countries that still allo the mar.eting of monotherapies are located in the 6frican Region and most of the manufacturers are in India. 17. The spread of resistance to antimalarial medicines over the past fe decades has led to an intensification of efficacy monitoring to allo early detection of resistance. (espite the o!served changes in parasite sensitivity to artemisinins# the clinical and parasitological efficacy of 6-Ts has not yet !een compromised# even in the ?reater >e.ong su!-region. 1,. 2onetheless# !oth components of the drug com!ination are currently at ris. and using an 6-T ith an ineffective partner medicine can increase the ris. of development or spread of artemisinin resistance.6 total of 11 countries and one area in the $%& 6frican Region sho ed a reduction of more than "08 in either confirmed malaria cases or malaria admissions and deaths in recent years. 19. 6 decrease of more than "08 in the num!er of confirmed cases of malaria !et een 2000 and 2009 as found in '2 of the "6 malaria-endemic countries outside 6frica# hile do n ard trends of 2"8="08 ere seen in , other countries. >orocco and Tur.menistan ere certified !y the (irector-?eneral of $%& in 2009 as having eliminated malaria.

20. In 2009# the @uropean Region reported no cases of P. falciparum malaria for the first time. It is estimated that the num!er of cases of malaria rose from 2'' million in 2000 to 2// million in 200" !ut decreased to 22" million in 2009. 21. The num!er of deaths due to malaria is estimated to have decreased from 9," 000 in 2000 to 7,1 000 in 2009. (ecreases in malaria !urden have !een o!served in all $%& Regions# ith the largest proportional decreases noted in the @uropean Region# follo ed !y the Region of 6mericas. 22. The largest a!solute decreases in deaths ere o!served in 6frica.$hile progress in reducing the malaria !urden has !een remar.a!le# there as evidence of an increase in malaria cases in ' countries in 2009 1R anda# *ao Tome and Arincipe# and Bam!ia3. The reasons for the resurgences are not .no n ith certainty. 2'. The increases in malaria cases highlight the fragility of malaria control and the need to maintain control programmes even if num!ers of cases have !een reduced su!stantially. The e5periences in R anda and Bam!ia also indicate that monthly monitoring of disease surveillance data# !oth nationally and su!nationally# is essential. 2/. *ince many countries in su!-*aharan 6frica had inade0uate data to monitor disease trends# it is apparent that greater efforts need to !e made to strengthen routine surveillance systems. >a<or epidemiological events could !e occurring in additional countries ithout !eing detected and investigated