Current Status + Progress
Malaria mortality among children under five is concentrated in sub-Saharan Africa

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In 2015, there were 214 million malaria cases that led to 438,000 deaths. Of these about 80 per cent were children under five years of age. This translates into a daily toll of more than 800 children under age 5. Most of these deaths occurred in sub-Saharan Africa. However, progress in reducing malaria mortality among children has been encouraging. Since 2000, mortality rates among children under-five have fallen by 65 per cent. An estimated 5.9 million child deaths have been averted.

Malaria is an urgent public health priority. Malaria and the costs of treatment trap families in a cycle of illness, suffering and poverty. Today, 3.2 billion (almost half of the world population) are at risk.  Since 2000 malaria has cost sub-Saharan Africa US$ 300 million each year for case management alone and it is estimated to cost up to 1.3 per cent of GDP in Africa.

Despite this heavy toll, major inroads have been made against the disease as a result of stepped-up funding and programming. Since 2000, global investment for malaria control has had a 20-fold increase.  Domestic investments have also increased year on year. Funding increases have resulted in major advances against malaria. However, success is fragile and closely tied to sustained support.

In 2015, the global total of international and domestic funding for malaria control and elimination was $2.7 billion – less than half of what is needed.  In order to achieve the goals of a malaria-free world, annual spending requirement needs to triple from the current level to $8.7 billion by 2030.

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. Since 2000, an estimated 1-billion ITNs have been distributed in Africa.

Household ownership of ITNs/LLINs is uneven across countries in the region. With an average coverage of over 60 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
African countries with more than 75 per cent of their population at risk of malaria and at least two data points between 2000 and 2014

Source: UNICEF global malaria databases, 2016, 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 just over 40 per cent, with large country and regional variations. For instance, while the percentage in sub-Saharan Africa as a whole was 44 per cent in 2015, coverage in Eastern and Southern Africa was 49 per cent and in West and Central Africa, 39 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, 1999-2015

Source: UNICEF global malaria databases, 2016, 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 sub-Saharan Africa, around 2000 and around 2015

Notes: Regional estimates are based on a subset of 38 countries, covering 87% of population under five in sub Saharan Africa in 2015. Sub-regional estimates represent data from countries covering at least 50% of regional population under five.

Source: UNICEF global databases 2016 based on from MICS, MIS and DHS.


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 2014, 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.

Treatment of malaria in children with ACT is low in sub-Saharan Africa with just over one third of children treated with antimalarial drugs receiving the first-line drug. Lowest proportions – 21 per cent – are observed in West and Central Africa.

Despite moderately high treatment rates for malaria, many African children are still not receiving the most effective medication
Percentage of febrile children under five receiving first line treatment (ACT) among children who received any antimalarial, 2010-2014

Note: Regional estimates are based on a subset of 38 countries, covering 94% of population under five in sub Saharan Africa in 2014. Sub-regional estimates represent data from countries covering at least 50% of regional population under five.

Source: UNICEF global malaria databases, 2015, 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.

  • Pregnant women sleeping under ITNs – 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, Guinea Bissau, Madagascar, Niger, Rwanda and United Republic of Tanzania, have managed to achieve coverage rates over 70 per cent since 2010.
  • Intermittent preventive treatment during pregnancy (IPTp) – Preventing malaria in pregnant women through 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).

More than three fourths of pregnant women in sub-Saharan Africa don’t receive IPTp. This translates into about 28 million live births not protected against malaria in the region. Wealth is a major factor behind inequity in coverage of this important preventive treatment for pregnant women: 17% of women in the lowest wealth quintile receive IPTp as compared to 27% in the highest wealth quintile.

Coverage of IPTp (2 doses) is below 50% in most malaria endemic countries in sub-Saharan Africa
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).

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, 2015, based on MICS, DHS and MICS.

Download our latest infographic on “Investing in Malaria in Pregnancy in Sub-Saharan Africa: Saving Women’s and Children’s Lives“.

REFERENCES

UNICEF, Progress for Children Beyond Averages: Learning from the MDGs, New York, 2015

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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Access The Data
Children sleeping under an ITN (Dec 2016) Download Data
ITN ownership by households (Dec 2016) Download Data
Vector control (1 ITN per 2 people and IRS spraying) (Dec 2016)Download Data
Pregnant women sleeping under an ITN (Dec 2016)Download Data
Malaria preventive treatment for pregnant women 3+ doses IPTP 3+ (Dec 2016)Download Data
Care seeking for children under 5 with fever (Dec 2016)Download Data
Malaria diagnostics use among children under 5 (Dec 2016)Download Data
Malaria 1st line treatment ACT (Dec 2016)Download Data
Malaria mortality among children under 5 (2015)Download Data
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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.