Malaria deaths in young children have dropped by 45 per cent since 2000, but additional funding is needed to sustain fragile gains
Source: UNICEF analysis based on United Nations Inter-agency Group for Child Mortality Estimation (IGME) 2013, the World Health Organization (WHO) and the Child Health Epidemiology Reference Group (CHERG) 2013.
Every day in 2012, malaria killed more than 1,200 children under age 5—a total of 450,000 children a year. Most of these deaths occurred in sub-Saharan Africa.
Despite this heavy toll, major inroads have been made against the disease as a result of stepped-up funding and programming. Coverage of key prevention and treatment interventions has risen dramatically over the past decade. Adequate funding is now needed to sustain these gains. In areas where financing has not been maintained, gains have quickly eroded.
International disbursements on malaria control increased 20-fold between 2000 and 2013 – from US$100 million to $1.97 billion. Yet that is still far below what is required to reach universal coverage of malaria-control interventions. In 2012, the global total of international and domestic funding for this purpose was $2.5 billion – less than half of the $5.1 billion needed. Funding increases have resulted in major advances against malaria. However, success is fragile and closely tied to sustained support.
Regular use of insecticide-treated mosquito nets (ITNs) is one of the most effective ways to prevent malaria transmission and reduce deaths among children. Since 2000, production, procurement and delivery of ITNs have accelerated, resulting in increased household ownership and use. Household ownership of ITNs is uneven across sub-Saharan Africa – ranging from less than 30 per cent to more than 90 per cent, but most countries have made considerable progress in this area.
Note: The light blue bars represent data from surveys conducted between 2010 and 2012.
Source: UNICEF global malaria databases, 2014, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and Malaria Indicator Surveys (MIS).
Over the last decade, the proportion of children sleeping under ITNs in sub-Saharan Africa increased from less than 5 per cent to almost 40 per cent, with large country and regional variations. For instance, while the percentage in sub-Saharan Africa as a whole was 36 per cent in 2012, coverage in Eastern and Southern Africa was 46 per cent and in West and Central Africa, 28 per cent.
All countries with trend data have shown major increases in ITN use by children. Despite this progress, overall use of treated mosquito nets falls short of the global target of universal coverage, and many children are not benefiting from this potentially life-saving intervention.
Most countries in Africa increased ITN use among children in an equitable way. This was largely due to free distribution campaigns that emphasized poor and rural areas. The success of this strategy has been reflected in an increased use of ITNs by vulnerable populations.
Source: UNICEF global malaria databases, 2014, based on MICS, DHS and MIS.
The US President’s Malaria Initiative, along with the World Health Organization (WHO) and other partners, has made major efforts to scale up indoor residual spraying for mosquitoes. In 2012, about 30 million people were protected through spraying operations in 16 countries.
Until recently, the ‘Proportion of children under 5 with fever who are treated with appropriate antimalarial drugs’ was the standard indicator for monitoring antimalarial treatment. However, it has become increasingly challenging to track trends following a 2010 WHO recommendation that advised universal use of diagnostic testing to confirm malaria infection before applying any treatment. As a follow up to this recommendation, many countries are now expanding the use of testing to focus treatment on only those children diagnosed with malaria. The current lower levels of antimalarial treatment, therefore, may indicate that antimalarials are being provided only to confirmed cases. For more information on this issue, see the 2013 edition of the Household Survey Indicators for Malaria Control.
Artemisinin combination therapy (ACT) is the most effective antimalarial therapy for P. falciparum, the most lethal malaria parasite and the one most pervasive in sub-Saharan Africa. ACT is also the first-line drug treatment in most countries in the region. By 2008, most African countries had adopted a malaria treatment policy of using ACT as the first-line drug. However, in surveys since 2010, only a relatively small proportion of children treated for malaria were actually receiving ACT. Although the practice is changing, other less effective antimalarial drugs are still commonly used to treat malaria.
MALARIA DURING PREGNANCY
In malaria-endemic African countries, pregnant women are highly vulnerable to malaria infection due to reduced immunity. When infected with malaria during pregnancy, they are more likely to become anaemic and give birth to low-birthweight or stillborn babies. Regular use of ITNs by pregnant women as well as intermittent preventive treatment during pregnancy are vital interventions in the prevention of malaria among pregnant women.
Although some progress has been made, the proportion of pregnant women aged 15 to 49 in sub-Saharan Africa who sleep under an ITN is too low. Some countries, however, including Benin, Niger and Rwanda, have managed to achieve coverage rates over 70 per cent in 2010─2012.
Preventing malaria in pregnant women through intermittent treatment with sulfadoxine-pyrimethamine is an effective way of reducing maternal anaemia and low birthweight. Nearly every country in sub-Saharan Africa with a high malaria burden has adopted intermittent preventive treatment for pregnant women as part of its national malaria control strategy. Such treatment has been advised for all pregnant women in malaria-endemic areas during antenatal care visits. However, gaps in antenatal visits in many countries limits the chances for administering this treatment. In October 2012, WHO issued a new recommendation that extended treatment at every antenatal visit to all pregnant women in areas of moderate-to-high malaria transmission. Many countries are still in the process of scaling up this recommendation. However, according to the data for the previous recommendation (of at least two doses of sulfadoxine-pyrimethamine during antenatal care), some countries have achieved relatively high coverage.
Notes: In this chart, intermittent preventive treatment is defined as receiving two or more doses of sulfadoxine-pyrimethamine during an antenatal care visit. In some country surveys, the site of treatment (for example, ‘during antenatal care visit’) is not specified.
Source: UNICEF global malaria databases, 2014, based on MICS, DHS and MIS.
Measure Evaluation, Measure DHS, President’s Malaria Initiative, Roll Back Malaria Partnership, UNICEF and WHO, 2013 Household Survey Indicators for Malaria Control.
Roll Back Malaria Partnership, A Decade of Partnership and Results, Progress & Impact Series, Report no. 7, WHO, Geneva, September 2011.
UNICEF, The State of the World’s Children 2014, UNICEF, New York, 2014.
WHO, Guidelines for the Treatment of Malaria: Second edition, WHO, Geneva, 2010.
WHO, World Malaria Report 2013, WHO, Geneva, 2013.
Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. The “UN Decade to Roll Back Malaria” was proclaimed soon after all UN Member States made a commitment to tackle the disease in their landmark 2001 General Assembly resolution. This report documents the remarkable progress that has been made.
The purpose of this manual is to provide detailed specifications for the indicators that can be measured through household surveys and the data that is required for their construction, as well as the issues related to their interpretation.
The following are official Millennium Development Goal indicators for the monitoring of MDG 6: Combat HIV/AIDS, malaria and other diseases:
Millennium Development Goal
6.7 Children under 5 sleeping under insecticide-treated bed nets, percentage
Goal 6. Combat HIV/AIDS, malaria and other diseases
Target 6.C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
6.8 Proportion of children under 5 with fever who are treated with appropriate antimalarial drugs*
* This indicator refers to antimalarial treatment among all children with fevers, rather than among confirmed malaria cases, and thus should be interpreted with caution.
For additional information, visit the updated Household Survey Indicators for Malaria Control manual.