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UNICEF STATISTICS
Current Status + Progress
Malaria deaths in young children have dropped by 40 per cent since 2000, but additional funding is needed to sustain fragile gains

In 2013, malaria led to 584,000 deaths of which 78 per cent were children under five years of age. This translates into a daily toll of more than 1,200 children under age 5—a total of over 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. Funding increases have resulted in major advances against malaria. However, success is fragile and closely tied to sustained support.

In 2013, the global total of international and domestic funding for malaria control and elimination was $2.7 billion. This represented a three-fold increase since 2005, however, it is just over half of the $5.1 billion required to achieve global targets for malaria control and elimination. 

PREVENTION

Sleeping under insecticide-treated mosquito nets (ITNs) on a regular basis is one of the most effective ways to prevent malaria transmission and reduce malaria related deaths. Since 2000, production, procurement and delivery of ITNs, particularly Long Lasting Insecticide Treated Nets (LLINs) have accelerated, resulting in increased household ownership and use.

Household ownership of ITNs/LLINs is uneven across countries in the region. With an average coverage of  over 50 per cent in sub-Saharan Africa – ranging from less than 30 per cent to more than 90 per cent – but most countries have made considerable progress in the past decade.

Household ownership of insecticide-treated mosquito nets has increased dramatically, but coverage in some countries remains low
Percentage of households owning at least one insecticide-treated mosquito net, in African countries with more than 75 per cent of their population at risk of malaria and at least two data points, around 2000 and around 2013

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 2013, coverage in Eastern and Southern Africa was 45 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.

Despite major gains, sub-Saharan African countries are falling short of the global target of universal use of treated mosquito nets by children
Percentage of children under five sleeping under insecticide-treated mosquito nets, African continent, around 2000 and 2013

Source: UNICEF global malaria databases, 2014, based on MICS, DHS and Malaria Indicator Surveys (MIS).

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.

Free distribution of mosquito nets has succeeded in reaching poor, rural households, where the burden of malaria has always been heaviest
Percentage of children under age 5 sleeping under an insecticide-treated mosquito net, in African countries with more than 75 per cent of their population at risk of malaria, by urban or rural residence, 2011─2012

Source: UNICEF global malaria databases, 2014, based on MICS, DHS and MIS. 

In Africa, 58 million people, or 8 per cent of the population at risk were protected from malaria through the use of indoor residual spraying in 2013. The global total for protected population was 123 million. However there has been some decrease since 2010 due to a withdrawal or downsizing of spraying programs in some regions. 

CASE MANAGEMENT

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 diagnostic testing to focus treatment on only those diagnosed with malaria. The current lower levels of antimalarial treatment in febrile children, 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.

FIRST-LINE TREATMENT

Artemisinin-based 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. By the end of 2013, most African countries, where Plasmodium (P.) falciparum is endemic, had adopted ACTs as national policy for first-line treatment. 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.

Despite moderately high treatment rates for malaria, many African children are still not receiving the most effective medication
Percentage of children receiving ACT of all children who received an antimalarial drug, African countries with more than 75% of their population at risk of malaria, 20112013

Source: UNICEF global malaria databases, 2014, based on MICS, DHS and MIS. 

MALARIA DURING PREGNANCY

In African countries with high malaria transmission, 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 in sub-Saharan Africa who sleep under an ITN is too low. Some countries, however, including Benin, Rwanda and United Republic of Tanzania, have managed to achieve coverage rates over 70 per cent in 2012─2013.

Preventing malaria in pregnant women through intermittent treatment (IPTp) with sulfadoxine-pyrimethamine, which is administered during antenatal care visits, 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. In most countries coverage of antenatal care services is much higher than current levels of IPTp administration, suggesting that there are missed opportunities to expand access to this life-saving intervention for mothers and newborns.  

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 new recommendation. However, according to the data for the previous recommendation (of at least two doses of sulfadoxine-pyrimethamine during antenatal care), very few countries have achieved relatively high coverage level (50 to 70 per cent).

Too many pregnant women in sub-Saharan Africa are not receiving preventive treatment against malaria
Percentage of women aged 15─49 who received intermittent preventive treatment of malaria during their last pregnancy (two doses of sulfadoxine-pyrimethamine during antenatal care), in African countries with more than 75 per cent of their population

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.

REFERENCES

Measure Evaluation, Measure DHS, President’s Malaria Initiative, Roll Back Malaria Partnership, UNICEF and WHO, 2013 Household Survey Indicators for Malaria Control.

President’s Malaria Initiative, 2014, Eighth Annual Report to Congress, Washington DC, April 2014.

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 2015, UNICEF, New York, 2015.

WHO, Guidelines for the Treatment of Malaria: Second edition, WHO, Geneva, 2010.

WHO, World Malaria Report 2014, WHO, Geneva, 2013.

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Publication

Progress and impact series: Number 7 - September 2011 - A Decade of Partnership and Results

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.

 

Publication

Household Survey Indicators for Malaria Control 2013 edition

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. 

 

Notes on the Data

The following are official Millennium Development Goal indicators for the monitoring of MDG 6: Combat HIV/AIDS, malaria and other diseases:

MDG indicator

Millennium Development Goal

MDG target

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.