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WORLD MALARIA REPORT


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WORLD MALARIA REPORT 2016


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Contents
Foreword iv
Acknowledgements vii
Abbreviations xi
Key points xii

1. Global targets, milestones and indicators 2


2. Investments in malaria programmes and research 7
2.1 Total expenditure for malaria control and elimination 8
2.2 Funding for malaria-related research 11
2.3 Malaria expenditure per capita for malaria control and elimination 12
2.4 Commodity procurement trends 13
3. Preventing malaria 17
3.1 Population at risk sleeping under an insecticide-treated mosquito net 20
3.2 Targeted risk group receiving ITNs 20
3.3 Population at risk protected by indoor residual spraying 20
3.4 Population at risk sleeping under an insecticide-treated mosquito net or protected by indoor
residual spraying 22
3.5 Vector insecticide resistance 24
3.6 Pregnant women receiving three or more doses of intermittent preventive therapy 25
4. Diagnostic testing and treatment 27
4.1 Children aged under 5 years with fever for whom advice or treatment was sought from a trained
provider 28
4.2 Suspected malaria cases receiving a parasitological test 29
4.3 Suspected malaria cases attending public health facilities and receiving a parasitological test 30
4.4 Malaria cases receiving first-line antimalarial treatment according to national policy 31
4.5 ACT treatments among all malaria treatments 32
4.6 Parasite resistance 32
5. Malaria surveillance systems 35
5.1 Health facility reports received at national level 36
5.2 Malaria cases detected by surveillance systems 37
6. Impact 39
6.1 Estimated number of malaria cases by WHO region, 20002015 40
6.2 Estimated number of malaria deaths by WHO region, 20002015 42
6.3 Parasite prevalence 45
6.4 Malaria case incidence rate 46
6.5 Malaria mortality rate 47
6.6 Malaria elimination and prevention of re-establishment 48
6.7 Malaria cases and deaths averted since 2000 and change in life expectancy 50
6.8 Economic value of reduced malaria mortality risk, estimated by full income approach 50

Conclusions 52
References 54
Annexes 57

WORLD MALARIA REPORT 2016 iii


Foreword

Dr Margaret Chan
Director-General
World Health Organization

The World Malaria Report, published annually by WHO, provides an in-depth


analysis of progress and trends in the malaria response at global, regional and
country levels. It is the result of a collaborative effort with ministries of health in
affected countries and many partners around the world.
Our 2016 report spotlights a number of positive trends, particularly in sub-Saharan
Africa, the region that carries the heaviest malaria burden. It shows that, in many
countries, access to disease-cutting tools is expanding at a rapid rate for those
most in need.
Children are especially vulnerable, accounting for more than two thirds of global
malaria deaths. In 22 African countries, the proportion of children with a fever who
received a malaria diagnostic test at a public health facility increased by 77% over
the last 5 years. This test helps health providers swiftly distinguish between malarial
and non-malarial fevers, enabling appropriate treatment.
Malaria in pregnancy can lead to maternal mortality, anaemia and low birth
weight, a major cause of infant mortality. WHO recommends intermittent
preventive treatment in pregnancy, known as IPTp, for all pregnant women in
sub-Saharan Africa living in areas of moderate-to-high transmission of malaria.
The last 5 years have seen a five-fold increase in the delivery of three or more
doses of IPTp in 20 African countries.
Long-lasting insecticidal nets are the mainstay of malaria prevention. WHO
recommends their use for all people at risk of malaria. Across sub-Saharan Africa,
the proportion of people sleeping under treated nets has nearly doubled over the
last 5 years.
We have made excellent progress, but our work is incomplete. Last year alone,
the global tally of malaria reached 212 million cases and 429 000 deaths. Across

iv WORLD MALARIA REPORT 2016


Africa, millions of people still lack access to the tools they need to prevent and
treat the disease.
In many countries, progress is threatened by the rapid development and spread
of mosquito resistance to insecticides. Antimalarial drug resistance could also
jeopardize recent gains.
In 2015, the World Health Assembly endorsed the WHO Global Technical Strategy
for Malaria, a 15-year malaria framework for all countries working to control and
eliminate malaria. It sets ambitious but attainable goals for 2030, with milestones
along the way to track progress.
The Strategy calls for the elimination of malaria in at least 10 countries by the
year 2020 a target well within reach. According to this report, 10 countries and
territories reported fewer than 150 locally-acquired cases of malaria. A further
nine countries reported between 150 and 1000 cases.
But progress towards other global targets must be accelerated. The report finds
that less than half of the 91 malaria-affected countries are on track to achieve the
2020 milestones of a 40% reduction in case incidence and mortality.
To speed progress towards our global malaria goals, WHO is calling for new
and improved malaria-fighting tools. Greater investments are needed in the
development of new vector control interventions, improved diagnostics and more
effective medicines.
WHO announced that the worlds first malaria vaccine would be piloted in three
countries in sub-Saharan Africa. The vaccine, known as RTS,S, has been shown to
provide partial protection against malaria in young children. It will be evaluated as
a potential complement to the existing package of WHO-recommended malaria
preventive, diagnostic and treatment measures.
The need for more funding is an urgent priority. In 2015, malaria financing totalled
US$ 2.9 billion. To achieve our global targets, contributions from both domestic
and international sources must increase substantially, reaching US$ 6.4 billion
annually by 2020.
The challenges we face are sizeable but not insurmountable. Recent experience
has shown that with robust funding, effective programmes and country leadership,
progress in combatting malaria can be sustained and accelerated.
The potential returns are well worth the effort. With all partners united, we can
defeat malaria and improve the health of millions of people around the world.

WORLD MALARIA REPORT 2016 v


vi WORLD MALARIA REPORT 2016
Acknowledgements
We are very grateful to the numerous people who contributed to the production
of the World Malaria Report 2016. The following people collected and reviewed
data from malaria endemic countries:
Ahmad Mureed and Fraidon Sediqi (Afghanistan); Lammali Karima (Algeria); Pedro
Rafael Dimbu and Yava Luvundo Ricardo (Angola); Giovanini Coelho and Mario
Zaidenberg (Argentina); Suleyman Mammadov (Azerbaijan); Anjan Kumar Saha
(Bangladesh); Carlos Ayala and Kim Bautista (Belize); Dos Santos Hounkpe Bella
(Benin); Tenzin Wangdi (Bhutan); Percy Halkyer and Ral Marcelo Manjn Tellera
(Bolivia [Plurinational State of]); Tjantilili Mosweunyane (Botswana); Oscar Mesones
Lapouble and Cassio Roberto Leonel Peterka (Brazil); Yacouba Savadogo (Burkina
Faso); Ndayizeye Flicien (Burundi); Antnio Lima Moreira (Cabo Verde); Tol Bunkea
(Cambodia); Kouambeng Celestin (Cameroon); Christophe Ndoua (Central African
Republic); Mahamat Idriss Djaskano (Chad); Li Zhang (China); Gabriela Rey and
Sandra Lorena Giron Vargas (Colombia); Astafieva Marina (Comoros); Youndouka
Jean Mermoz (Congo); Liliana Jimnez Gutirrez and Enrique Prez-Flores (Costa
Rica); Ehui Anicet and Parfait Katche (Cte dIvoire); Kim Yun Chol (Democratic
Peoples Republic of Korea); Joris Losimba Likwela (Democratic Republic of the
Congo); Luz A. Mercedes and Hans Salas (Dominican Republic); Csar Daz and
Adriana Estefana Echeverra Matute (Ecuador); Ahmed El-Taher Khater (Egypt);
Jaime Enrique Alemn Escobar and Franklin Hernandez (El Salvador); Matilde
Riloha (Equatorial Guinea); Selam Mihreteab and Selam Mihreteab (Eritrea);
Hiwot Solomon Taffese (Ethiopia); Laure Garancher (French Guiana); Okome Nze
Gyslaine (Gabon); Momodou Kalleh (Gambia); Constance Bart-Plange (Ghana);
Jaime Jurez and Erica Chvez Vsquez (Guatemala); Nouman Diakite (Guinea);
Jean Seme Fils Alexandre and Quacy Grant (Guyana); Darlie Antoine and Moussa
Thior (Haiti); Engels Ilich Banegas Medina and Rosa Elena Meja (Honduras);
A.C. Dhariwal (India); M. Epid and Elvieda Sariwati (Indonesia); Leyla Faraji and
Ahmad Raeisi (Iran [Islamic Republic of]); Muthana Ibrahim Abdul Kareem (Iraq);
Khalil Kanani (Jordan); James Kiarie (Kenya); Almunther Alhasawi (Kuwait); Bouasy
Hongvanthong (Lao Peoples Democratic Republic); Najib Achi (Lebanon); Oliver J.
Pratt (Liberia); Abdunnaser Ali El-Buni (Libya); Rakotorahalahy Andry Joeliarijaona
(Madagascar); Austin Albert Gumbo (Malawi); Mohd Hafizi Bin Abdul Hamid
(Malaysia); Diakalia Kone (Mali); Mohamed Lemine Ould Khairy (Mauritania);
Anita Bahena, Ezequiel Daz Prez, Rosario Garca Surez and Hctor Olgun
Bernal (Mexico); Souad Bouhout (Morocco); Guidion Mathe (Mozambique); Aung
Thi (Myanmar); Mwalenga Nghipumbwa (Namibia); Rajendra Mishra and Uttam
Raj Pyakurel (Nepal); Martha Reyes and Ada Mercedes Soto Bravo (Nicaragua);
Djermakoye Hadiza Jackou (Niger); Audu Bala Mohammed (Nigeria); Majed
Al-Zadjali (Oman); Muhammad Suleman Memon (Pakistan); Margarita Ana Botello,
Jos Lasso, Carlos Victoria and Fernando Vizcano (Panama); John Deli (Papua New
Guinea); Miguel Angel Aragn and Cynthia Viveros (Paraguay); Mnica Guardo
and Victor Alberto Laguna Torres (Peru); Raffy Deray (Philippines); Maha Hammam
Alshamali (Qatar); Park Kyeongeun (Republic of Korea); Murindahabi Ruyange
Monique (Rwanda); Jessica Da Veiga Soares (Sao Tome and Principe); Mohammed

WORLD MALARIA REPORT 2016 vii


Hassan Al-Zahrani (Saudi Arabia); Medoune Ndiop (Senegal); Samuel Juana
Smith (Sierra Leone); John Leaburi (Solomon Islands); Abdi Abdillahi Ali, Abdikarim
Hussein Hassan, Ali Abdirahman Osman and Fahmi Essa Yusuf (Somalia); Bridget
Shandukani (South Africa); H.D.B. Herath (Sri Lanka); Abd Alla Ahmed Ibrahim
Mohammed (Sudan); Beatrix Jubithana and Juanita Malmberg (Suriname); Zulisile
Zulu (Swaziland); Nipon Chinanonwait (Thailand); Maria do Rosiro de Fatima Mota
(Timor-Leste); Tchadjobo Tchassama (Togo); Dhikrayet Gamara (Tunisia); Damian
Rutazaana (Uganda); Mary John (United Arab Emirates); Anna Mahendeka (United
Republic of Tanzania, [Mainland]); Abdul-wahid H. Al-mafazy (United Republic
of Tanzania [Zanzibar]); Esau Nackett (Vanuatu); Angel Manuel Alvarez and Jesus
Toro Landaeta (Venezuela [Bolivarian Republic of]); Nguyen Quy Anh (Viet Nam);
Moamer Badi (Yemen); Mercy Mwanza Ingwe (Zambia); Busisani Dube and
Wonder Sithole (Zimbabwe).
The following WHO staff in regional and subregional offices assisted in the design
of data collection forms; the collection and validation of data; and the review of
epidemiological estimates, country profiles, regional profiles and sections:
Birkinesh Amenshewa, Magaran Bagayoko, Steve Banza Kubenga and Issa Sanou
(WHO Regional Office for Africa [AFRO]); Spes Ntabangana (AFRO/Inter-country
Support Team [IST] Central Africa); Khoti Gausi (AFRO/IST East and Southern Africa);
Abderrahmane Kharchi Tfeil (AFRO/IST West Africa); Maria Paz Ade, Janina Chavez,
Rainier Escalada, Valerie Mize, Roberto Montoya, Eric Ndofor and Prabhjot Singh
(WHO Regional Office for the Americas [AMRO]); Caroline Barwa and Ghasem
Zamani (WHO Regional Office for the Eastern Mediterranean [EMRO]); Adel
Al-Jasari (Yemen), Jamal Amran (Somalia), Qutbuddin Kakar (Pakistan) and Naeem
Safi (Afghanistan); Elkhan Gasimov and Karen Taksoe-Vester (WHO Regional Office
for Europe [EURO]); Eva-Maria Christophel (WHO Regional Office for South-East
Asia [SEARO]); Rabindra Abeyasinghe, James Kelley, Steven Mellor and Raymond
Mendoza (WHO Regional Office for the Western Pacific [WPRO]).
Carol DSouza and Jurate Juskaite (Global Fund to Fight AIDS, Tuberculosis and
Malaria [Global Fund]) supplied information on financial disbursements from
the Global Fund. Adam Wexler (Kaiser Family Foundation) provided information
on financial contributions for malaria control from the United States of America.
Julie Wallace (United States Agency for International Development) and Iain Jones
(United Kingdom Department for International Development) reviewed financing
data from their respective agencies. Jeremy Lauer (WHO Department of Health
Systems Governance and Financing) edited the narrative on the economic
valuation of malaria mortality reduction. John Milliner (Milliner Global Associates)
provided information on long-lasting insecticidal nets delivered by manufacturers.
Peter Gething (University of Oxford), Samir Bhatt (Imperial College, University
of London) and the Malaria Atlas Project (MAP, www.map.ox.ac.uk) team, with
the support of the Bill & Melinda Gates Foundation and the Medical Research
Council (United Kingdom of Great Britain and Northern Ireland [United Kingdom]),
produced estimates of insecticide-treated mosquito net (ITN) coverage for African
countries using data from household surveys, ITN deliveries by manufacturers, ITNs
distributed by national malaria control programmes (NMCPs), and ITN coverage
indicators. They also produced estimates of Plasmodium falciparum parasite
prevalence in sub-Saharan Africa. Catherine Moyes and Antoinette Wiebe (MAP)
and Christen Fornadel (United States Presidents Malaria Initiative) provided data
on insecticide resistance and Anna Trett assisted with data compilation. Liliana
Carvajal and Valentina Buj (United Nations Childrens Fund [UNICEF]) reviewed
data and texts and made suggestions for improvement.

viii WORLD MALARIA REPORT 2016


Acknowledgements

Michael Lynch, John Painter and Nelli Westercamp (United States Centers for
Disease Control and Prevention) and Cristin Fergus (London School of Economics,
University of London) provided data analysis and interpretation for sections
on chemoprevention, diagnostic testing and treatment. Adam Bennett (Global
Health Group), Donal Bisanzio and Peter Gething (MAP) and Thom Eisele (Tulane
University) produced analysis of malaria treatment from household surveys. Li Liu
(Johns Hopkins Bloomberg School of Public Health), Dan Hogan and Colin Mathers
(WHO Department of Health Statistics and Information Systems) prepared estimates
of malaria mortality in children aged under 5 years, on behalf of the Child Health
Epidemiology Reference Group, and undertook calculations on life expectancy.
The maps for country and regional profiles were produced by MAPs ROAD-
MAPII team; led by Mike Thorn, the team comprised Harry Gibson, Naomi Gray,
Joe Harris, Andy Henry, Annie Kingsbury, Daniel Pfeffer and Jen Rozier. MAP is
supported by the Bill & Melinda Gates Foundation and the Medical Research
Council (United Kingdom).
We are also grateful to:
Melanie Renshaw (African Leaders Malaria Alliance [ALMA]), Trenton Ruebush
(independent consultant) and Larry Slutsker (Program for Appropriate
Technology in Health [PATH]), who graciously reviewed all sections and
provided substantial comments for their improvement;
Claudia Nannini (WHO) for legal review;
Carlota Gui (WHO consultant) and Laurent Bergeron (WHO Global Malaria
Programme) for the translation into Spanish and French, respectively, of the
foreword and key points;
Claude Cardot and the Designisgood team for the design and layout of the
report;
Paprika (Annecy, France) for generating Annex 4;
Alex Williamson for the report cover; and
Hilary Cadman and the Cadman Editing Services team for technical editing of
the report.
The production of the World Malaria Report 2016 was coordinated by Richard
Cibulskis (WHO Global Malaria Programme). Laurent Bergeron (WHO Global
Malaria Programme) provided programmatic support for overall management of
the project. The World Malaria Report 2016 was produced by John Aponte (WHO
consultant), Maru Aregawi, Laurent Bergeron, Richard Cibulskis, Jane Cunningham,
Tessa Knox, Edith Patouillard, Pascal Ringwald, Silvia Schwarte, Saira Stewart and
Ryan Williams, on behalf of the WHO Global Malaria Programme. We are grateful
to our colleagues in the Global Malaria Programme who reviewed sections of the
report and provided helpful comments: Pedro Alonso, Amy Barrette, Andrea Bosman,
Gawrie Loku Galappaththy, Abdisalan Noor, Peter Olumese, Leonard Ortega, Camille
Pillon, Charlotte Rasmussen, Vasee Sathiyamoorthy and David Schellenberg. We also
thank Hiwot Taffese Negash and Simone Colairo-Valerio for administrative support.
Funding for the production of this report was gratefully received from the Bill
& Melinda Gates Foundation; Luxembourgs Ministry of Foreign and European
Affairs Directorate for Development Cooperation and Humanitarian Affairs; the
Spanish Agency for International Development Cooperation; the Swiss Agency for
Development and Cooperation through a grant to the Swiss Tropical and Public
Health Institute; and the United States Agency for International Development.

WORLD MALARIA REPORT 2016 ix


x WORLD MALARIA REPORT 2016
Abbreviations
ACT artemisinin-based combination P. Plasmodium
therapy PMI Presidents Malaria Initiative
AIDS acquired immunodeficiency PPP purchasing power parity
syndrome
RDT rapid diagnostic test
AIM Action and investment to defeat
malaria 20162030 SDG Sustainable Development Goal

AMFm Affordable Medicine Facility SMC seasonal malaria chemoprevention


malaria SP sulfadoxine-pyrimethamine
ANC antenatal care UI uncertainty interval
AQ amodiaquine UN United Nations
CDC Centers for Disease Control and UNICEF United Nations Childrens Fund
Prevention USA United States of America
CI confidence interval USAID United States Agency for
cITN conventional insecticide-treated net International Development
CRS creditor reporting system VSL value of a statistical life
DAC Development Assistance Committee WHO World Health Organization
DDT dichloro-diphenyl-trichloroethane WTA willingness to accept
GDP gross domestic product
Global Fund Global Fund to Fight AIDS,
Tuberculosis and Malaria
GTS Global Technical Strategy for Abbreviations of WHO regions andoffices
Malaria 20162030 AFR WHO African Region
HIV human immunodeficiency virus AFRO WHO Regional Office for Africa
HRP2 histidine rich protein 2 AMR WHO Region of the Americas
IPTi intermittent preventive treatment in AMRO WHO Regional Office for the
infants Americas
IPTp intermittent preventive treatment in EMR WHO Eastern Mediterranean Region
pregnancy
EMRO WHO Regional Office for the Eastern
IQR interquartile range Mediterranean
IRS indoor residual spraying EUR WHO European Region
ITN insecticide-treated mosquito net EURO WHO Regional Office for Europe
LLIN long-lasting insecticidal net SEAR WHO South-East Asia Region
M&E monitoring and evaluation SEARO WHO Regional Office for South-East
NMCP national malaria control Asia
programme WPR WHO Western Pacific Region
OECD Organisation for Economic WPRO WHO Regional Office for the
Co-operation and Development Western Pacific

WORLD MALARIA REPORT 2016 xi


Key points

1. Global targets, milestones and indicators


The targets of the Global Technical Strategy for Malaria 20162030 (GTS) are,
by 2030: to reduce malaria incidence and mortality rates globally by at least
90% compared with 2015 levels; to eliminate malaria from at least 35 countries
in which malaria was transmitted in 2015; and to prevent re-establishment of
malaria in all countries that are malaria free.
For malaria, Target 3.3 of the Sustainable Development Goals (SDGs) to end
the epidemics of AIDS, TB, malaria and neglected tropical diseases (NTDs) by
2030 is interpreted by WHO as the attainment of the GTS targets.
To track progress of the GTS, the World Malaria Report 2016 presents
information on 26 indicators.
The World Malaria Report is produced by the WHO Global Malaria Programme,
with the help of WHO regional and country offices, ministries of health in
endemic countries and a broad range of other partners.
The primary sources of information are reports from 91 endemic countries. This
information is supplemented by data from nationally representative household
surveys and databases held by other organizations.

2. Investments in malaria programmes and research


Total funding for malaria control and elimination in 2015 is estimated at
US$2.9billion, having increased by US$ 0.06 billion since 2010. This total
represents just 46% of the GTS 2020 milestone of US$ 6.4 billion.
Governments of endemic countries provided 32% of total funding in 2015, of
which US$ 612 million was direct expenditures through national malaria control
programmes (NMCPs) and US$ 332 million was expenditures on malaria patient
care.
The United States of America is the largest single international funder of malaria
control activities, accounting for an estimated 35% of global funding in 2015,
followed by the United Kingdom of Great Britain and Northern Ireland (16%),
France (3.2%), Germany (2.4%), Japan (2.3%), Canada (1.7%), the Bill & Melinda
Gates Foundation (1.2%) and European Union institutions (1.1%). About one half
of this international funding (45%) is channelled through the Global Fund to Fight
AIDS, Tuberculosis and Malaria (Global Fund).
Spending on research and development for malaria was estimated at
US$611million in 2014 (the latest year for which data are available), increasing
from US$ 607 million in 2010, and representing more than 90% of the GTS
annual investment target of US$ 673 million.

xii WORLD MALARIA REPORT 2016


Countries with the highest number of malaria cases are furthest from the per
capita spending milestones for 2020 set in the GTS.

3. Preventing malaria
Vector control
The proportion of the population at risk in sub-Saharan Africa sleeping under
an insecticide-treated mosquito net (ITN) or protected by indoor residual
spraying (IRS) is estimated to have risen from 37% in 2010 (uncertainty interval
[UI]: 2548%) to 57% in 2015 (UI: 4470%).
In sub-Saharan Africa, 53% of the population at risk slept under an ITN in 2015
(95% confidence interval [CI]: 5057%), increasing from 30% in 2010 (95% CI:
2832%),
The rise in the proportion of people at risk sleeping under an ITN has been
driven by an increase in the proportion of the population with access to an ITN
(60% in 2015, 95% CI: 5764%; 34% in 2010, 95% CI: 3235%).
The proportion of households with at least one ITN increased to 79% in 2015
(95% CI: 7683); thus, a fifth of households where ITNs are the main method of
vector control do not have access to a net.
The proportion of households with sufficient ITNs for all household members
was 42% (95% CI: 3945%).
IRS is generally used by NMCPs only in particular areas. The proportion of the
population at risk protected by IRS declined from a peak of 5.7% globally in 2010
to 3.1% in 2015, and from 10.5% to 5.7% in sub-Saharan Africa.
Reductions in IRS coverage may be attributed to cessation of spraying with
pyrethroids, particularly in the WHO African Region.
Of 73 malaria endemic countries that provided monitoring data for 2010
onwards, 60 reported resistance to at least one insecticide, and 50 reported
resistance to two or more insecticide classes.
Resistance to pyrethroids the only class currently used in ITNs is the most
commonly reported. A WHO-coordinated five-country evaluation showed that
ITNs still remained effective but there is still a need for new vector control tools.
Intermittent preventive therapy in pregnancy
In 2015, 31% of eligible pregnant women received three or more doses of
intermittent preventive treatment in pregnancy (IPTp) among 20 countries with
sufficient data, a major increase from 6% in 2010.

4. Diagnostic testing and treatment


Access to care
Among 23 nationally representative surveys completed in sub-Saharan Africa
between 2013 and 2015 (representing 61% of the population at risk), a median of
54% of febrile children aged under 5 years (interquartile range [IQR]: 4159%)
were taken to a trained provider.

WORLD MALARIA REPORT 2016 xiii


A higher proportion of febrile children sought care in the public sector (median:
42%, IQR: 3150%) than in the private sector (median: 20%, IQR: 1228%).
A large proportion of febrile children were not brought for care (median: 36%,
IQR: 2642%).
Diagnostic testing
The proportion of febrile children who received a malaria diagnostic test was
greater if they sought care in the public sector (median: 51%, IQR: 3560%)
than if the children sought care in the formal private sector (median: 40%,
IQR: 2857%) or in the informal private sector (median: 9%, IQR: 412%). The
proportion receiving a test in the public sector has increased from 29% in 2010
(IQR: 1946%).
Data reported by NMCPs indicate that the proportion of suspected malaria
cases receiving a parasitological test in the public sector increased from 40% of
suspected cases in the WHO African Region in 2010 to 76% in 2015. This increase
was primarily due to an increase in the use of rapid diagnostic tests (RDTs),
which accounted for 74% of diagnostic testing among suspected cases in 2015.
HRP2 deletions, which allow malaria parasites to evade detection by common
RDTs, have been reported from more than 10 countries.
Treatment
Among 11 nationally representative household surveys conducted in sub-Saharan
Africa from 2013 to 2015, the median proportion of children aged under 5 years
with evidence of recent or current Plasmodium falciparum infection and a
history of fever, who received any antimalarial drug, was 30% (IQR: 2051%).
The median proportion receiving an artemisinin-based combination therapy
(ACT) was 14% (IQR: 545%). However, no clear conclusions can be drawn
from these findings because the ranges associated with the medians are wide,
indicating large variation among countries; in addition, the household surveys
cover only a third of the population at risk in sub-Saharan Africa.
Further investments are needed to better track malaria treatment at health
facilities (through routine reporting systems and health facility surveys) and
at community level to better understand the extent of barriers to accessing
malaria treatment.
The proportion of antimalarial treatments that are ACTs given to children with
both a fever in the previous 2 weeks and a positive RDT at the time of survey
increased from a median of 29% in 20102012 (IQR: 1755%) to 80% in 20132015
(IQR: 2995%).
Antimalarial treatments were more likely to be ACTs if children sought treatment
at public health facilities or via community health workers than if they sought
treatment in the private sector.
Plasmodium falciparum resistance to artemisinin has been detected in five
countries in the Greater Mekong subregion. In Cambodia, high failure rates
after treatment with an ACT have been detected for four different ACTs.

xiv WORLD MALARIA REPORT 2016


Key points

5. Malaria surveillance systems


The proportion of health facility reports received at national level exceeded
80% in 40 of the 47 countries that reported on this indicator.
This indicator could not be calculated for 43 countries, either because the
number of health facilities that were expected to report was not specified
(two countries) or because the number of reports submitted was not stated
(17countries), or both (24 countries).
A total of 23 countries received reports from private health facilities, but these
comprised a minority of all reports received in these countries (median: 2.1%,
IQR: 0.613%).
In 2015, it is estimated that malaria surveillance systems detected 19% of cases
that occur globally (UI: 1621%).
The bottlenecks in case detection vary by country and WHO region. In four WHO
regions a large proportion of patients seek treatment in the private sector and
these cases are not captured by existing surveillance systems. In three WHO
regions a relatively low proportion of patients attending public health facilities
also receive a diagnostic test.
Case detection rates have improved since 2010 (10%), with most of the
improvement being due to increased diagnostic testing in sub-Saharan Africa.

6. Impact
Parasite prevalence
The proportion of the population at risk in sub-Saharan Africa who are infected
with malaria parasites is estimated to have declined from 17% in 2010 to 13% in
2015 (UI: 1115%).
The number of people infected with malaria parasites in sub-Saharan Africa
is estimated to have decreased from 131 million in 2010 (UI: 126136 million) to
114 million in 2015 (UI: 99130 million).
Infection rates are higher in children aged 210 years, but most infected people
are in other age groups.
Case incidence
In 2015, an estimated 212 million cases of malaria occurred worldwide (UI:
148304 million).
Most of the cases in 2015 were in the WHO African Region (90%), followed by
the WHO South-East Asia Region (7%) and the WHO Eastern Mediterranean
Region (2%).
About 4% of estimated cases globally are due to P. vivax, but outside the African
continent the proportion of P. vivax infections is 41%.
The incidence rate of malaria is estimated to have decreased by 41% globally
between 2000 and 2015, and by 21% between 2010 and 2015.

WORLD MALARIA REPORT 2016 xv


Of 91 countries and territories with malaria transmission in 2015, 40 are
estimated to have achieved a reduction in incidence rates of 40% or more
between 2010 and 2015, and can be considered on track to achieve the GTS
milestone of a further reduction of 40% by 2020.
Reductions in case incidence rates need to be accelerated in countries with high
case numbers if the GTS milestone of a 40% reduction in case incidence rates
by 2020 is to be achieved.
Mortality
In 2015, it was estimated that there were 429 000 deaths from malaria globally
(UI: 235 000639 000).
Most deaths in 2015 are estimated to have occurred in the WHO African Region
(92%), followed by the WHO South-East Asia Region (6%) and the WHO Eastern
Mediterranean Region (2%).
The vast majority of deaths (99%) are due to P. falciparum malaria. Plasmodium
vivax is estimated to have been responsible for 3100 deaths in 2015 (range:
18004900), with 86% occurring outside Africa.
In 2015, 303 000 malaria deaths (range: 165 000450 000) are estimated to
have occurred in children aged under 5 years, which is equivalent to 70% of
the global total. The number of malaria deaths in children is estimated to have
decreased by 29% since 2010, but malaria remains a major killer of children,
taking the life of a child every 2 minutes.
Malaria mortality rates are estimated to have declined by 62% globally between
2000 and 2015 and by 29% between 2010 and 2015. In children aged under
5years, they are estimated to have fallen by 69% between 2000 and 2015 and
by 35% between 2010 and 2015.
Of 91 countries and territories with malaria transmission in 2015, 39 are estimated
to have achieved a reduction of 40% or more in mortality rates between 2010
and 2015. A further 10 countries had zero indigenous deaths in 2015.
If the GTS milestone of a 40% reduction in mortality rates is to be achieved by
2020, rates of mortality reduction must increase in countries with high numbers
of deaths.
Elimination
Between 2000 and 2015, 17 countries eliminated malaria (i.e. attained zero
indigenous cases for 3 years or more); six of these countries have been certified
as malaria free by WHO.
In progressing to malaria elimination, the 17 countries reported a median of
184 indigenous cases 5 years before attaining zero cases (IQR: 78728) and
a median of 1748 cases 10 years before attaining zero cases (IQR: 4235731).
In 2015, 10 countries and territories reported fewer than 150 indigenous cases
and a further nine countries reported between 150 and 1000 indigenous cases.
Thus, there appears to be a good prospect of attaining the GTS milestone of
eliminating malaria from 10 countries by 2020.

xvi WORLD MALARIA REPORT 2016


Key points

Malaria has not been re-established in any of the countries that eliminated
malaria between 2000 and 2015.
Reduced malaria mortality, increased life expectancy and economic valuation
Between 2001 and 2015, it is estimated that a cumulative 6.8 million fewer
malaria deaths have occurred globally than would have occurred had incidence
and mortality rates remained unchanged since 2000.
The highest proportion of deaths was averted in the WHO African Region (94%).
Of the estimated 6.8 million fewer malaria deaths between 2001 and 2015,
about 6.6 million (97%) were for children aged under 5 years.
Not all of the deaths averted can be attributed to malaria control efforts. Some
progress is probably related to increased urbanization and overall economic
development, which has led to improved housing and nutrition.
As a consequence of reduced malaria mortality rates, particularly among
children aged under 5 years, it is estimated that life expectancy at birth has
increased by 1.2 years in the WHO African Region. This increase represents 12%
of the total increase in life expectancy of 9.4 years seen in sub-Saharan Africa,
from 50.6 years in 2000 to 60 years in 2015.
Globally, reductions in malaria mortality have led to an increase in life
expectancy of 0.26 years in malaria endemic countries, representing 5% of the
overall gain of 5.1 years.
Current methodologies suggest that the increased life-expectancy resulting
from malaria mortality reductions observed between 2000 and 2015 can be
valued at US$ 1810 billion in the WHO African Region (UI: US$13302480billion),
which is equivalent to 44% of the gross domestic product (GDP) of the affected
countries in 2015.
Globally, the malaria mortality reductions are valued at US$ 2040 billion (UI:
US$ 15602700 billion), which is 3.6% of the total GDP of malaria affected
countries.
The economic value of longer life is expressed as a percentage of GDP to provide
a convenient and well-known comparison, but is not meant to suggest that the
value of longevity is itself a component of domestic output, or that the value
of these gains enter directly into the national income accounts. Nonetheless,
the comparison suggests that the value of the gains in life expectancy due to
reductions in malaria mortality are substantial.

WORLD MALARIA REPORT 2016 xvii


Avant-propos

Dr Margaret Chan
Directeur gnral
de lOrganisation mondiale de la Sant
(OMS)

Le Rapport sur le paludisme dans le monde, publi chaque anne par lOMS,
fournit une analyse dtaille des progrs et des tendances de la lutte contre le
paludisme au niveau mondial, rgional et national. Il sagit l du produit dun
effort collaboratif entre les ministres de la Sant des pays endmiques et de
nombreuses organisations partenaires dans le monde.
Notre rapport 2016 met en lumire plusieurs tendances positives, notamment
en Afrique subsaharienne o la maladie svit le plus. Il indique que laccs aux
interventions prventives et thrapeutiques augmente rapidement parmi les
populations qui en ont le plus besoin et ce, dans nombre de pays.
Les enfants sont particulirement vulnrables; ils reprsentent plus des deux
tiers des dcs dus au paludisme dans le monde. Des enqutes ralises dans
22 pays africains montrent que le pourcentage denfants ayant t soumis
un test de diagnostic du paludisme au sein dtablissements de soins publics a
augment de 77 % ces cinq dernires annes. Ce test permet aux prestataires de
sant de rapidement diffrencier les fivres palustres des autres, ce qui garantit
ladministration dun traitement appropri.
Le paludisme pendant la grossesse peut avoir des consquences dramatiques:
mortalit maternelle, anmie et enfants prsentant un poids insuffisant la
naissance, une cause principale de mortalit nonatale. LOMS recommande le
traitement prventif intermittent pendant la grossesse (TPIp) toutes les femmes
enceintes dAfrique subsaharienne vivant dans des zones de transmission modre
leve. Au cours des cinq dernires annes, le taux dadministration dau moins
trois doses de TPIp a t multipli par cinq dans 20 pays africains au total.
Les moustiquaires imprgnes dinsecticide longue dure sont essentielles la
prvention du paludisme et lOMS en recommande lutilisation lensemble de la
population risque. En Afrique subsaharienne, le pourcentage de la population
dormant sous moustiquaire a quasiment doubl ces cinq dernires annes.

xviii WORLD MALARIA REPORT 2016


Les progrs raliss sont excellents, mais il reste beaucoup faire. Pour la seule
anne 2015, les estimations font tat de 212millions de cas de paludisme et de
429000 dcs associs. En Afrique, la population nayant toujours pas accs aux
outils ncessaires pour prvenir et traiter la maladie se compte par millions.
Dans de nombreux pays, les progrs sont menacs par le dveloppement et
la propagation rapides de la rsistance des moustiques aux insecticides. La
rsistance aux antipaludiques pourrait aussi mettre en pril les avances rcentes.
En 2015, lAssemble mondiale de la Sant a approuv la Stratgie technique
mondiale de lutte contre le paludisme, un cadre oprationnel dune dure de
15ans pour tous les pays engags dans le contrle et llimination du paludisme.
Cette stratgie dfinit des cibles ambitieuses et nanmoins ralisables pour 2030,
avec des objectifs intermdiaires permettant un suivi des progrs.
Cette stratgie vise liminer le paludisme dans au moins 10 pays dici 2020, ce
qui semble ralisable. Le prsent rapport indique en effet que 10 pays et territoires
ont rapport moins de 150 cas de paludisme transmis localement, et que 9 autres
en ont recens entre 150 et 1000.
Nanmoins les progrs relatifs aux autres cibles mondiales doivent sacclrer.
Daprs ce rapport, plus de la moiti des 91 pays endmiques ne sont pas en voie
datteindre les objectifs de 40% de rduction de lincidence du paludisme et de
la mortalit associe dici 2020.
Pour acclrer les progrs vers les cibles mondiales lies au paludisme, lOMS
demande expressment le dveloppement de nouveaux outils antipaludiques
et lamlioration de larsenal existant. Des investissements plus importants sont
ncessaires pour mettre au point de nouvelles interventions de lutte antivectorielle,
des outils de diagnostic amliors et des mdicaments plus efficaces.
LOMS a annonc la mise en place de projets pilotes dans trois pays dAfrique
subsaharienne concernant le premier vaccin antipaludique. Ce vaccin, RTS, S, a
dmontr une protection partielle contre le paludisme chez les jeunes enfants; il
sera valu en tant quoutil complmentaire larsenal de mesures recommandes
par lOMS en matire de prvention, de diagnostic et de traitement du paludisme.
Il est prioritaire et urgent daugmenter le financement de la lutte contre le
paludisme, estim US$ 2,9milliards en 2015. Pour atteindre les cibles mondiales,
les investissements nationaux et internationaux doivent en effet atteindre
US$6,4milliards par an dici 2020.
Les obstacles face nous ne sont ni ngligeables ni insurmontables. Lexprience
rcente a dmontr quavec des financements solides, des programmes efficaces
et un leadership national fort, les progrs en matire de lutte contre le paludisme
peuvent tre maintenus et acclrs.
Les perspectives de retour sur investissement sont sduisantes. Avec lensemble
des partenaires runis, nous pouvons vaincre le paludisme et amliorer la sant
de millions de personnes dans le monde.

WORLD MALARIA REPORT 2016 xix


Points essentiels

1. Cibles, objectifs intermdiaires et indicateurs au niveau


mondial
Les cibles dfinies par la Stratgie technique mondiale de lutte contre le
paludisme 2016-2030 (le GTS) pour 2030 sont les suivantes: rduire, au
plan mondial, lincidence du paludisme et la mortalit associe dau moins
90% par rapport 2015, liminer le paludisme dans au moins 35 pays o il
y avait transmission en 2015 et empcher la rapparition du paludisme dans
tous les pays exempts.
Concernant le paludisme, la cible 3.3 des Objectifs de dveloppement durable,
savoir mettre fin lpidmie de sida, la tuberculose, au paludisme et aux
maladies tropicales ngliges dici 2030, est interprte par lOrganisation
mondiale de la Sant (OMS) comme latteinte des cibles du GTS.
Pour suivre les progrs raliss par rapport au GTS, le Rapport sur le paludisme
dans le monde dcrit les avances ralises par rapport 26 indicateurs.
Le Rapport sur le paludisme dans le monde est produit par le Programme
mondial de lutte antipaludique cr par lOMS, en collaboration avec les
bureaux nationaux et rgionaux de lOMS, les ministres de la Sant des pays
endmiques et de nombreuses organisations partenaires.
Les principales sources de donnes sont les rapports manant de 91 pays et
territoires endmiques, compltes par des informations issues des enqutes
nationales ralises auprs des mnages et des bases de donnes provenant
dautres organisations.

2. Investissements dans les programmes et la recherche


antipaludiques
En 2015, le financement mondial pour le contrle et llimination du paludisme
a t estim US$ 2,9milliards, soit US$ 60millions de plus quen 2010.
Cemontant ne reprsente que 46% de lobjectif intermdiaire fix par le GTS
US$ 6,4milliards pour 2020.
Les gouvernements des pays endmiques ont contribu hauteur de 32% du
total des financements en 2015, dont US$ 612millions de dpenses directes
par le biais des programmes nationaux de lutte contre le paludisme (PNLP) et
US$332millions en prise en charge des patients souffrant dinfections palustres.
Avec une contribution estime 35% du financement mondial de la lutte contre
le paludisme en 2015, les tats-Unis arrivent en tte des bailleurs de fonds
individuels, suivis par le Royaume-Uni de Grande-Bretagne et dIrlande du

xx WORLD MALARIA REPORT 2016


Nord (16%), la France (3,2%), lAllemagne (2,4%), le Japon (2,3%), le Canada
(1,7 %), la Fondation Bill & Melinda Gates (1,2%) et les institutions de lUnion
Europenne(1,1%). Environ la moiti de ce financement international (45%)
transite par le Fonds mondial de lutte contre le sida, la tuberculose et le
paludisme (Fonds mondial).
Les dpenses en matire de recherche et de dveloppement pour lutter contre
le paludisme ont t estimes US$ 611millions en 2014 (lanne la plus rcente
pour laquelle des donnes sont disponibles), contre US$ 607millions en 2010,
ce qui reprsente plus de 90% de lobjectif dinvestissements annuels fix
US$673millions par le GTS.
Les pays ayant le plus de cas de paludisme sont aussi ceux o les dpenses
nationales (rapportes au nombre dhabitants) sont les plus loignes de
lobjectif dfini par le GTS pour 2020.

3. Prvention du paludisme
Lutte antivectorielle
En Afrique subsaharienne, le pourcentage de la population risque dormant
sous moustiquaire imprgne dinsecticide (MII) ou ayant bnfici de la
pulvrisation intradomiciliaire dinsecticides effet rmanent (PID) aurait
augment de 37% en 2010 (incertitude comprise entre 25% et 48%) 57% en
2015 (incertitude: 44%-70%).
En Afrique subsaharienne, 53% de la population risque dort sous moustiquaire
en 2015 (intervalle de confiance [IC] de 95%: 50%-57%), contre 30% en 2010
(IC de 95%: 28%-32%).
Laugmentation du pourcentage de la population risque dormant sous MII est
due un accs accru aux moustiquaires (60% en 2015, IC de 95%: 57%-64%;
34% en 2010, IC de 95%: 32%-35%).
Le pourcentage des mnages possdant au moins une MII a augment,
pour atteindre 79% en 2015 (IC de 95%: 76%-83%); en dautres termes, un
cinquime des mnages pour lesquels les MII sont le principal moyen de lutte
antivectorielle nont pas accs une moustiquaire.
Le pourcentage des mnages avec un nombre de MII suffisant pour couvrir
tous les membres du foyer slve 42% (IC de 95%: 39%-45%).
La PID est gnralement utilise par les PNLP dans des zones spcifiques
uniquement. Le pourcentage de la population risque protge par PID a
baiss, passant dun pic de 5,7% au niveau mondial en 2010 3,1% en 2015, et
de 10,5% 5,7% en Afrique subsaharienne.
La baisse de la couverture en PID peut tre attribue larrt de la pulvrisation
base de pyrthodes, en particulier dans la rgion Afrique de lOMS.
Sur 73 pays endmiques ayant communiqu des donnes de suivi partir de
2010, 60 ont signal une rsistance au moins une classe dinsecticides, et 50
deux classes au moins.
La rsistance aux pyrthodes, la seule classe dinsecticides actuellement
utilise pour les MII, est la plus frquente. Quand bien mme une valuation
coordonne par lOMS dans cinq pays a montr que les moustiquaires taient
toujours efficaces, de nouveaux outils de lutte antivectorielle sont ncessaires.

WORLD MALARIA REPORT 2016 xxi


Traitement prventif intermittent pendant la grossesse
Dans 20 pays disposant de donnes suffisantes, 31% des femmes enceintes
ligibles ont reu au moins trois doses de traitement prventif intermittent
pendant la grossesse (TPIp) en 2015, contre 6% en 2010.

4. Diagnostic et traitement
Accs aux soins
Sur 23 enqutes reprsentatives au niveau national et ralises en Afrique
subsaharienne entre2013 et2015 (reprsentant 61% de la population risque),
une mdiane de 54% des enfants de moins de 5 ans ayant eu de la fivre (cart
interquartile [I]: 41%-59%) ont t orients vers un prestataire de sant form.
Le pourcentage des enfants fivreux ayant sollicit des soins dans le secteur
public est plus important que dans le secteur priv, savoir une mdiane de
42% (I: 31%-50%) contre 20% (I: 12%-28%).
Le pourcentage denfants fivreux nayant pas sollicit de soins est important
(mdiane de 36%, I: 26%-42%).
Diagnostic
Le pourcentage denfants fivreux ayant t soumis un test de diagnostic est
plus important dans le secteur public (mdiane de 51%, I: 35%-60%) que
dans le secteur priv formel (mdiane de 40%, I: 28%-57%) ou le secteur
priv informel (mdiane de 9%, I: 4%-12%). Le pourcentage denfants ayant
t soumis un test dans le secteur public est en augmentation, car il tait de
29% en 2010 (I: 19%-46%).
Les donnes rapportes par les PNLP indiquent que le pourcentage de cas
suspects de paludisme soumis un test parasitologique dans le secteur
public a augment de 40% dans la rgion Afrique de lOMS 76% en 2015.
Cette hausse est principalement due une plus grande utilisation des tests de
diagnostic rapide (TDR) qui reprsentent 74% des moyens de dpistage parmi
les cas suspects de paludisme en 2015.
La suppression de la HRP2, permettant aux parasites du paludisme dchapper
la dtection par les tests de diagnostic rapide habituels, a t rapporte dans
plus de 10 pays.
Traitement
Sur 11 enqutes nationales ralises auprs des mnages entre2013 et2015
en Afrique subsaharienne, le pourcentage mdian des enfants de moins de
5 ans prsentant, ou ayant rcemment prsent une infection Plasmodium
(P.) falciparum avec des antcdents de fivre et ayant reu un mdicament
antipaludique slve 30% (I: 20%-51%). Le pourcentage mdian ayant
reu une combinaison thrapeutique base dartmisinine (ACT) est de
14% (I: 5%-45%). Ces rsultats ne permettent nanmoins de tirer aucune
conclusion prcise; en effet, les plages associes aux valeurs mdianes sont
larges, indiquant des carts importants entre pays. Par ailleurs, ces enqutes
ralises auprs des mnages ne couvrent quun tiers de la population risque
en Afrique subsaharienne.

xxii WORLD MALARIA REPORT 2016


Points essentiels

Des financements plus importants sont ncessaires pour mieux suivre laccs
au traitement antipaludique au niveau des tablissements de soins (par le biais
des systmes de reporting de routine et des enqutes auprs des tablissements
de soins) et au niveau communautaire et ce, dans le but de mieux mesurer
lampleur des obstacles.
Le pourcentage dACT parmi les traitements antipaludiques administrs
aux enfants ayant eu de la fivre dans les 2 semaines prcdant lenqute
et eu un rsultat positif au TDR au moment de lenqute a augment dune
valeur mdiane de 29% en 2010-2012 (I: 17%-55%) 80% en 2013-2015 (I:
29%-95%).
Le traitement antipaludique tait plus susceptible dtre par ACT si les enfants
sollicitaient des soins dtablissements de soins publics ou dagents de sant
communautaires que sils sorientaient vers le secteur priv.
La rsistance du parasite Plasmodium falciparum lartmisinine a t dtecte
dans cinq pays de la sous-rgion du Grand Mkong. Au Cambodge, des taux
dchec au traitement ont t observs pour quatre types dACT.

5. Systmes de surveillance du paludisme


Le pourcentage de rapports reus au niveau national et provenant des
tablissements de soins a dpass 80% dans 40 des 47 pays ayant donn des
informations sur cet indicateur.
Cet indicateur na pas pu tre calcul pour 43 pays et ce, pour diffrentes
raisons: ou il ntait pas mentionn combien dtablissements de soins devaient
rapporter (le cas pour 2 pays), ou le nombre de rapports soumis ntait pas
indiqu (le cas pour 17 pays), ou les deux (24 pays).
Au total, 23 pays ont reu des rapports de la part des tablissements de soins
privs, mais ces rapports ne reprsentent quune minorit de tous les rapports
reus dans ces pays (valeur mdiane: 2,1%, I: 0,6%-13%).
En 2015, il est estim que les systmes de surveillance du paludisme ont dtect
19% des cas au niveau mondial (incertitude: 16%-21%).
Les obstacles au dpistage des cas ne sont pas les mmes dun pays et dune
rgion de lOMS lautre. Dans quatre dentre elles, une large proportion des
patients sollicitent un traitement dans le secteur priv, et ces cas ne sont pas
capturs par les systmes de surveillance existants. Dans trois rgions de lOMS,
une part relativement faible des patients se rendant dans des tablissements
de soins publics reoivent un test de diagnostic.
Le taux de dpistage des cas a augment depuis 2010 (10%), principalement
en raison de lintensification du diagnostic en Afrique subsaharienne.

6. Impact
Prvalence parasitaire
Le pourcentage dinfections palustres parmi la population risque en Afrique
subsaharienne est estime en baisse, passant de 17% en 2010 13% en 2015
(incertitude: 11%-15%).

WORLD MALARIA REPORT 2016 xxiii


En Afrique subsaharienne, le nombre de patients atteints dinfections palustres
aurait diminu de 131millions en 2010 (incertitude: 126-136 millions) 114millions
en 2015 (incertitude: 99-130 millions).
Le taux dinfection est plus lev chez les enfants de 2 10 ans; nanmoins la
plupart des infections (74%) concernent les tranches dge suprieures.
Incidence des cas
Au niveau mondial, le nombre de cas de paludisme est estim 212millions en
2015 (incertitude: 148-304millions).
En 2015, la plupart des cas (90%) ont t enregistrs dans la rgion Afrique de
lOMS, loin devant la rgion Asie du Sud-Est (7%) et la rgion Mditerrane
orientale (2%) de lOMS.
Les infections P. vivax sont estimes responsables denviron 4% des cas de
paludisme dans le monde mais, hors Afrique, cette proportion atteint 41%.
Au niveau mondial, lincidence du paludisme aurait diminu de 41% entre2000
et2015, et de 21% entre2010 et2015.
Entre2010 et2015, lincidence du paludisme aurait diminu dau moins 40%
dans 40 des 91 pays et territoires o la transmission du paludisme reste active
en 2015. On peut donc considrer que ces pays et territoires sont en bonne voie
pour atteindre une rduction de 40% dici 2020, qui est un objectif intermdiaire
du GTS.
Pour atteindre cet objectif dici 2020, la baisse doit sacclrer dans les pays o
lincidence du paludisme est la plus leve.
Mortalit
Au niveau mondial, le nombre de dcs dus au paludisme a t estim
429000 en 2015 (incertitude: 235000-639000).
En 2015, la plupart de ces dcs sont survenus dans la rgion Afrique (92%),
loin devant la rgion Asie du Sud-Est (6%) et la rgion Mditerrane orientale
(2%) de lOMS.
Limmense majorit (99%) des dcs sont dus au paludisme P. falciparum.
Les infections P. vivax seraient lorigine de 3100 dcs en 2015 (incertitude:
1 800-4 900), dont 86% hors Afrique.
En 2015, le nombre de dcs dus au paludisme chez les enfants de moins de 5
ans a t estim 303000 (incertitude: 165000-450000), soit 70% du total
mondial toutes tranches dge confondues. Ce nombre serait en baisse de 29%
depuis 2010; cependant, le paludisme reste lune des principales causes de
mortalit infantile, tuant un enfant toutes les deux minutes.
Au niveau mondial, la mortalit lie au paludisme aurait diminu de 62%
entre2000 et2015, et de 29% entre2010 et2015. Chez les enfants de moins de
5 ans, elle aurait chut de 69% entre2000 et2015, et de 35% entre2010 et2015.
Entre2010 et2015, la mortalit lie au paludisme aurait diminu dau moins
40% dans 39 des 91 pays et territoires o la transmission du paludisme reste
active en 2015. Dix autres pays ont rduit zro le nombre de dcs dus au
paludisme indigne en 2015.
Pour rduire la mortalit lie au paludisme dau moins 40% dici 2020 (objectif
intermdiaire du GTS), la baisse doit sacclrer dans les pays payant le plus
lourd tribut la maladie.

xxiv WORLD MALARIA REPORT 2016


Points essentiels

limination
Entre2000 et2015, 17 pays ont limin le paludisme (cest--dire rduit zro
le nombre de cas indignes pendant au moins trois ans) et 6 dentre eux ont
t certifis exempts de paludisme par lOMS.
Sur la voie de llimination du paludisme, ces 17 pays ont rapport une mdiane
de 184 cas indignes cinq ans avant davoir rduit le nombre de cas zro (I:
78-728) et une mdiane de 1748 cases dix ans auparavant (I: 423-5731).
En 2015, 10 pays et territoires ont rapport moins de 150 cas indignes, et 9 autres
pays en ont recens entre 150 et 1000. Il sagit l de rsultats encourageants
vers latteinte de lobjectif intermdiaire de 2020, savoir liminer le paludisme
dans au moins 10 pays.
La transmission du paludisme nest rapparue dans aucun des pays ayant
limin cette maladie entre2000 et2015.
Baisse de la mortalit lie au paludisme, augmentation de lesprance de vie et
valorisation conomique
Au total, 6,8millions de dcs dus au paludisme ont t vits au niveau mondial
entre2001 et2015, par rapport aux chiffres que nous aurions enregistrs si les
taux dincidence et de mortalit taient rests inchangs depuis 2000.
La plupart des dcs (94%) ont t vits dans la rgion Afrique de lOMS. Sur
les 6,8millions de dcs dus au paludisme vits entre2001 et2015, environ
6,6millions (97%) lont t parmi les enfants de moins de 5 ans.
Tous les dcs vits ne sont pas lis aux efforts de lutte contre le paludisme;
une partie dentre eux sexpliquent vraisemblablement par une urbanisation
accrue et la croissance conomique en gnral, lorigine de lamlioration
des conditions de logements et dune meilleure nutrition.
Consquence de la baisse de la mortalit due au paludisme, en particulier chez
les enfants de moins de 5 ans, lesprance de vie la naissance aurait augment
de 1,2 an dans la rgion Afrique de lOMS. Cette hausse reprsente 12% de
laugmentation de 9,4 ans de lesprance de vie en Afrique subsaharienne,
passe de 50,6 ans en 2000 60 ans en 2015.
Au niveau mondial, la baisse du risque de mortalit due au paludisme aurait
contribu une augmentation de lesprance de vie de 0,26 an dans les pays
endmiques, soit 5% des 5,1 ans gagns au total.
La baisse du risque de mortalit due au paludisme entre2000 et2015 et donc, les
gains en termes desprance de vie, peuvent tre valoriss US$ 1810milliards
dans la rgion Afrique de lOMS (incertitude: US$ 1330-2480milliards), soit
44% du produit intrieur brut (PIB) des pays affects en 2015.
Au niveau mondial, la baisse du risque de mortalit due au paludisme est
valorise US$ 2040milliards (incertitude: US$ 1 560-2 700 milliards), soit
3,6% du total du PIB des pays affects.
Ces valeurs de bien-tre conomique sont exprimes en termes de pourcentage
du PIB titre comparatif; elles ne sauraient laisser entendre que la valeur de
la longvit est une composante de la richesse nationale produite, ni que la
valeur de ces gains est directement intgre dans le revenu national. Cette
comparaison suggre seulement que la valeur conomique attache la baisse
de la mortalit due au paludisme est consquente.

WORLD MALARIA REPORT 2016 xxv


Prefacio

Dra. Margaret Chan,


Directora General
Organizacin Mundial de la Salud

El Informe Mundial sobre Paludismo, publicado anualmente por la Organizacin


Mundial de la Salud (OMS), ofrece un anlisis en profundidad del progreso y las
tendencias en la respuesta al paludismo (o malaria) a nivel mundial, regional y
nacional. Es el resultado de un continuo esfuerzo colaborativo entre los Ministerios
de Salud de los pases endmicos y numerosas organizaciones colaboradoras en
todo el mundo.
Nuestro informe 2016 destaca una serie de tendencias positivas, en particular, en
el frica subsahariana, la regin que padece la mayor carga de paludismo. Esto
demuestra que, en muchos pases, el acceso a las intervenciones preventivas se
est expandiendo a un ritmo acelerado entre las poblaciones ms necesitadas.
Los nios son especialmente vulnerables y representan ms de dos tercios de las
muertes por paludismo a nivel mundial. En 22 pases africanos, la proporcin de
nios con fiebre que recibieron una prueba de diagnstico de paludismo en un
centro de salud pblico se increment un 77% en los ltimos 5 aos. Esta prueba
ayuda a los proveedores de salud poder distinguir rpidamente entre paludismo
y fiebres no paldicas, permitiendo asistir con un tratamiento adecuado.
El paludismo durante el embarazo puede causar mortalidad materna, anemia y
recin nacidos con bajo peso al nacer, una de las principales causas de mortalidad
infantil. La OMS recomienda el tratamiento preventivo intermitente durante el
embarazo, conocido como el TPIe, para todas las mujeres embarazadas en el
frica subsahariana, que viven en zonas de transmisin moderada y alta. En los
ltimos 5 aos, la tasa de administracin de al menos tres dosis de TPIe se ha
incrementado por cinco en 20 pases africanos.
Los mosquiteros (o toldillos) con insecticidas de larga duracin siguen siendo uno
de los pilares de la prevencin del paludismo y la OMS recomienda su uso para
toda poblacin en riesgo de contraer la enfermedad. En el frica subsahariana, la
proporcin de personas que duermen bajo mosquiteros tratados con insecticida
se ha duplicado por poco en los ltimos 5 aos.
Hemos hecho grandes progresos, pero nuestro trabajo sigue incompleto. Slo
en el ltimo ao, el recuento mundial del paludismo alcanz los 212 millones de

xxvi WORLD MALARIA REPORT 2016


casos y 429 000 muertes. En frica, millones de personas siguen sin acceso a las
herramientas necesarias para prevenir y tratar la enfermedad.
En muchos pases, el progreso se ve amenazado por el rpido desarrollo y la
propagacin de la resistencia del mosquito a los insecticidas. La resistencia a los
medicamentos antipaldicos tambin podra poner en peligro los logros recientes.
En 2015, la Asamblea Mundial de la Salud adopt la Estrategia tcnica mundial
contra la malaria 2016-2030, un marco operacional para los prximos 15 aos
para todos los pases que trabajan en el control y la eliminacin del paludismo.
Esta estrategia establece unos objetivos ambiciosos pero alcanzables para el
2030, con objetivos a corto y medio plazo que permiten hacer un seguimiento
del progreso.
La estrategia insta a la eliminacin del paludismo en al menos 10 pases para el
ao 2020: un objetivo a nuestro alcance. Segn este informe, 10 pases y territorios
han registrado menos de 150 casos de paludismo autctonos. Otros nueve pases
informaron entre 150 y 1000 casos.
Pero el progreso hacia los otros objetivos mundiales debe ser acelerado. El
informe llega a la conclusin de que menos la mitad de los 91 pases afectados
por el paludismo estn en vas de alcanzar los objetivos a medio plazo de 2020,
es decir, una reduccin del 40% en el caso de incidencia y mortalidad.
Para acelerar los progresos hacia nuestras metas a nivel mundial en relacin con
el paludismo, la OMS hace un llamamiento para nuevas y mejores herramientas
para la lucha contra la enfermedad. Se necesitan mayores inversiones en el
desarrollo de nuevas intervenciones de control vectorial, mejores diagnsticos y
medicamentos ms eficaces.
La OMS anunci que la primera vacuna contra el paludismo ser pilotada en 3
pases del frica subsahariana. La vacuna, conocida como RTS,S ha demostrado
proporcionar una proteccin parcial contra el paludismo en los ms jvenes. Ser
evaluada como un posible complemento al paquete de medidas y herramientas
existentes recomendadas por la OMS en materia de prevencin, diagnstico y
tratamiento.
La necesidad de contar con ms fondos es una prioridad urgente. Se estima
que en 2015, la financiacin para la lucha contra el paludismo super los
US$2,9milmillones. Para lograr nuestras metas a nivel mundial, las contribuciones
de fuentes nacionales e internacionales deben aumentar de manera considerable
para poder alcanzar los US$ 6,4 mil millones anuales para el ao 2020.
Los retos a los que nos enfrentamos son considerables, pero no insuperables. La
experiencia reciente ha demostrado que con una slida financiacin, programas
eficaces y liderazgo de los pases, el progreso en la lucha contra el paludismo
puede ser sostenido y acelerado.
Las ganancias potenciales bien valen el esfuerzo. Todos unidos, podemos derrotar
al paludismo y mejorar la salud de millones de personas alrededor del mundo.

WORLD MALARIA REPORT 2016 xxvii


Puntos clave

1. Metas mundiales, hitos e indicadores


Las metas para el 2030 de la Estrategia tcnica mundial contra la malaria 2016-
2030 (en adelante referido como el GTS, por sus siglas en ingls de Global
Technical Strategy for Malaria 2016-2030) consisten en: reducir a nivel mundial
la incidencia de casos de paludismo (o malaria) y la mortalidad asociada en
al menos un 90% en comparacin con los datos de 2015; eliminar el paludismo
en al menos 35 pases en los que haba transmisin en el 2015 y prevenir el
restablecimiento del paludismo en todos los pases que la han eliminado.
Respecto al paludismo en los Objetivos de desarrollo sostenibles (ODS), la
Meta 3.3 es poner fin a las epidemias del SIDA, la tuberculosis, la malaria y las
enfermedades tropicales desatendidas para el 2030 y es interpretado por la
Organizacin mundial de la salud (OMS) como el logro de las metas del GTS.
Para el seguimiento del progreso del GTS y de la Accin e inversin para
vencer a la malaria 2016-2030 (AIM), la OMS y el programa Roll Back Malaria
han definido conjuntamente una lista de 41 indicadores para utilizar a nivel
mundial, nacional y subnacional. De entre ellos, 12 son considerados clave para
monitorizar el GTS y el plan AIM a nivel mundial. El Informe mundial sobre el
Paludismo tiene como objetivo informar acerca de los avances realizados cada
ao en estos 12 y una seleccin de otros indicadores.
El Programa Mundial sobre Paludismo de la OMS produce el Informe mundial
sobre Paludismo en colaboracin con los equipos de las oficinas regionales
y nacionales de la OMS, Ministerios de Salud de los pases endmicos y un
amplio nmero de organizaciones colaboradoras.
Las principales fuentes de informacin son los informes procedentes de 91 pases
endmicos, complementados con datos procedentes de encuestas nacionales
representativas y bases de datos mantenidas por otras organizaciones.

2. Inversin en programas del paludismo e investigacin


En 2015, la financiacin total para el control y eliminacin del paludismo era
aproximadamente de US$ 2,9 mil millones, US$ 60 millones ms que en 2010.
Esta cantidad no representa ms que el 46% de la meta fijada por el GTS en
US$ 6,4 mil millones para el 2020.
Los gobiernos de pases con paludismo endmico han contribuido con un 32%
del total de la financiacin en 2015, de los cuales US$ 612 millones han sido
costes directos de los programas nacionales de control de malaria (PNCM) y
US$ 332 millones han sido costes de tratamientos de pacientes con paludismo.

xxviii WORLD MALARIA REPORT 2016


Los Estados Unidos de Amrica son el principal inversor internacional de fondos
para las actividades destinadas al control del paludismo, con una contribucin
estimada del 35% de la financiacin mundial para la lucha contra el paludismo
en 2015, seguido por el Reino Unido de Gran Bretaa e Irlanda del Norte (16%),
Francia (3,2%), Alemania (2,4%), Japn (2,3%), Canad (1,7%), la fundacin Bill
& Melinda Gates (1,2%) y las instituciones de la Unin Europea (1,1%). Alrededor
de la mitad de las inversiones internacionales (45%) son canalizadas a travs
del Fondo Mundial de lucha contra el sida, la tuberculosis y la malaria (Fondo
Mundial).
El gasto en investigacin y desarrollo para la lucha contra el paludismo se ha
estimado en US$ 611 millones en 2014 (el ltimo ao con datos disponibles),
incrementando la cifra de US$ 607 millones en 2010, y representando ms del
90% de la meta de la inversin anual fijada por el GTS en US$ 673 millones.
Los pases con el mayor nmero de casos de paludismo, son aquellos que
estn ms alejados de la meta de gasto per cpita para el 2020 establecida
por el GTS.

3. Prevencin del paludismo


Control de vectores
En el frica subsahariana, el porcentaje de la poblacin en riesgo de paludismo
que duerme bajo un mosquitero tratado con insecticida (MTI) o protegido con
el rociado residual intradomiciliario (RRI) se estima que habra incrementado
de un 37% en 2010 (Intervalo de incertidumbre [II]:25%48%) al 57% en 2015 (II:
44%70%).
Para los pases en el frica subsahariana donde los MTI son el principal mtodo
de intervencin para el control vectorial, 53% de la poblacin en riesgo duerme
bajo un MTI en 2015 (Intervalo de confianza [IC] de 95%: 50%57%), contra el
30% en 2010 (IC de 95%: 28%32%).
El crecimiento en el acceso a los MTI en los hogares (60% en 2015, IC de 95%:
57%64%; 34% en 2010, IC de 95%: 32%35%) ha logrado un gran aumento de
la poblacin en riesgo de paludismo que duerme bajo un MTI.
El porcentaje de hogares con al menos un MTI ha aumentado, alcanzando el
79% en 2015 (IC de 95%: 76%83%); por lo tanto, una quinta parte de los hogares
donde los MTI son la principal herramienta para la lucha antivectorial no tienen
acceso a una red tratada.
El porcentaje de hogares con un nmero suficiente de MTI para todos los
miembros del hogar se ha elevado a un 42% (IC de 95%: 39%45%)
El RRI es generalmente usado por los PNMC en zonas especficas. A nivel global,
el porcentaje de la poblacin en riesgo protegida por el RRI ha decado de un
mximo del 5,7% alcanzado en 2010 a un 3,1% en 2015, y de un 10,5% a un 5,7%
en el frica Subsahariana.
La reduccin en la cobertura del RRI podra ser atribuida al cese del rociamiento
con piretroides, en particular en la zona regional de frica de la OMS.

WORLD MALARIA REPORT 2016 xxix


De los 73 pases endmicos que proporcionaron datos a partir del 2010 en
adelante; 60 reportaron una resistencia de al menos un insecticida y 50
reportaron resistencia a dos o ms clases de insecticida.
La resistencia a los piretroides (la nica clase de insecticida que se utiliza
actualmente en los MTI) es la que se registra con ms frecuencia. La ltima
evaluacin llevada a cabo en 5 pases y bajo la coordinacin de la OMS, lleg
a la conclusin de que los MTI seguan siendo efectivos, sin embargo se siguen
necesitando nuevas herramientas para el control vectorial.
Tratamiento preventivo intermitente durante el embarazo
En los 20 pases africanos con datos suficientes, 31% de las mujeres
embarazadas elegibles recibieron tres o ms dosis de tratamiento preventivo
intermitente durante el embarazo (TPIe) en 2015, contra el 6% en 2010.

4. Pruebas de diagnstico y tratamiento


Acceso al tratamiento
En las 23 encuestas representativas a nivel nacional y realizadas en el frica
subsahariana entre 2013 y 2015 (representando el 61% de la poblacin en
riesgo), una mediana de 54% de nios febriles por debajo de los 5 aos (Rango
intercuartil [RI]: 41%59%) fueron llevados a un proveedor de salud formado.
El porcentaje de nios febriles que solicit tratamiento en el sector pblico
(mediana: 42%, RI: 31%50%) fue ms alto que en el sector privado (mediana:
20%, RI: 12%28%).
El porcentaje de nios febriles que no solicitaron tratamiento es importante
(mediana: 36%, RI: 26%42%)
Pruebas de diagnstico
El porcentaje de nios febriles que tuvieron una prueba de diagnstico del
paludismo ha sido mayor si solicitaban tratamiento en el sector pblico
(mediana: 51%, RI: 35%60%) que si recurran a un tratamiento en el sector
privado formal (mediana: 40%, RI: 28%57%) o el sector privado informal
(mediana: 9%, RI: 4%12%). El porcentaje de nios que tuvieron la prueba de
diagnstico en el sector pblico ha aumentado del 29% en 2010 (RI: 19%46%).
Los datos comunicados por los PNCM indican que el porcentaje de casos
sospechosos de paludismo que tienen una prueba parasitolgica en el sector
pblico ha aumentado de un 40% de casos sospechosos en la regin de frica
de la OMS en 2010 a un 76% en 2015. Este incremento es principalmente debido
a una mayor utilizacin de los test de diagnstico rpido (RDT, por sus siglas
en ingls Rapid diagnostic tests), que contribuyeron al 74% de las pruebas de
diagnstico entre los casos sospechosos en 2015.
En ms de 10 pases se han reportado deleciones del gen HRP2, lo cual permite
a parsitos del paludismo evadir la deteccin por los test de diagnsticos ms
comunes.

xxx WORLD MALARIA REPORT 2016


Puntos clave

Tratamiento
Entre las 11 encuestas representativas a nivel nacional que fueron llevadas a
cabo entre 2013 y 2015 en el frica subsahariana, la proporcin mediana de
nios por debajo de los 5 aos con evidencia de una infeccin de P. falciparum
reciente o presente e historia de fiebre que recibieron algn medicamento
antipaldico se elev a 30% (RI: 20%51%). De mediana, el 14% (RI: 5%45%)
recibi una terapia combinada con artemisinina (TCA). Sin embargo, no pudo
extraerse ninguna conclusin clara de estos resultados puesto que los rangos
asociados a las medianas eran muy amplios, indicando una gran variedad
entre los pases, a lo que hay que aadir que las encuestas solo representaban
un tercio de la poblacin en riesgo en el frica subsahariana.
Son necesarias mayores inversiones para poder mejorar el seguimiento de
los tratamientos en los centros de salud (a travs de los sistemas rutinarios de
reporte y de las encuestas a los centros de salud) y a nivel comunitario, para
poder entender hasta qu punto existen barreras que impiden el acceso a un
tratamiento contra el paludismo.
El porcentaje de tratamientos antipaldicos con TCA proporcionados a nios
con fiebre en las ltimas dos semanas y con un RDT positivo en el momento
de la encuesta, aument de una mediana inicial de 29% entre 2010-2012 (RI:
17%55%) al 80% en 2013-2015 (RI: 29%95%).
Los tratamientos antipaldicos fueron ms probables de ser TCA si los nios
buscaban tratamiento en centros de salud pblica o a travs de trabajadores
de salud de las comunidades, que si se dirigan al sector privado.
Se ha detectado resistencia de P. falciparum a la artemisinina en cinco pases
de la subregin del Gran Mekong. En Camboya, altos ndices de fracaso
despus de las TCA han sido detectados en cuatro diferentes.

5. Sistemas de vigilancia del paludismo


El porcentaje de informes recibidos a nivel nacional y procedente de los centros
de salud super el 80% en 40 de los 47 pases que informaron sobre este
indicador.
Este indicador no pudo ser calculado en 43 pases, por distintas razones: si
bien porque no se especific el nmero de centros de salud que se esperaba
para poder informar (en 2 pases) o bien porque no se especific el nmero
de informes entregados (en 17 pases), o por ltimo, con ambas situaciones
(en 24 pases).
En total, 23 pases recibieron informes de centros de salud privados, pero stos
representan una minora de todos los informes recibidos (mediana: 2,1%, RI:
0,6%13%).
En 2015, se estima que los sistemas de vigilancia del paludismo detectan el 19%
de los casos que ocurren a nivel mundial (II: 16%21%).
Los obstculos que se hallan en la deteccin de casos varan segn el pas y la
regin de la OMS. En cuatro de las regiones de la OMS una gran proporcin
de pacientes solicitan tratamiento en el sector privado, y en sus casos no se

WORLD MALARIA REPORT 2016 xxxi


contabiliza en los sistemas de vigilancia existentes. En tres de las regiones de
la OMS una proporcin relativamente baja de los pacientes que asisten a los
centros de salud pblicos reciben una prueba de diagnstico.
La tasa de deteccin de casos ha mejorado y aumentado su cifra desde
2010 (10%), principalmente debido al incremento del uso de las pruebas de
diagnstico en el frica subsahariana.

6. Impacto
Prevalencia del parsito que provoca el paludismo
El porcentaje de las poblaciones en riesgo en el frica subsahariana con
infecciones por el parsito del paludismo ha descendido de un 17% calculado
en 2010 a un 13% en 2015 (II: 11%15%).
En el frica subsahariana, el nmero de personas infectadas por el parsito
del paludismo ha descendido de 131 millones en 2010 (II: 126 136 millones) a
114 millones en 2015 (II: 99 130 millones.
La tasa de infeccin es ms alta en nios entre 2 y 10 aos, aunque la mayor
parte de las personas afectadas se encuentran en rangos de edades superiores.
Casos de incidencia
A nivel mundial, se calcularon 212 millones de casos de paludismo en 2015 (II:
148 304 millones).
En 2015, la mayora de los casos fueron registrados en la regin de frica de
la OMS (90%), seguida de la regin de Asia sudoriental (7%) y la regin del
Mediterrneo oriental (2%).
Las infecciones por P. vivax son responsables de un 4% de los casos mundiales
de paludismo, sin embargo fuera del continente africano el porcentaje de
infecciones por P. vivax es de 41%.
A nivel mundial, la tasa de incidencia de casos del paludismo ha disminuido
un 41% entre 2000 y 2015, y un 21% entre 2010 y 2015.
De los 91 pases y territorios con transmisin de paludismo en 2015, se estima
que 40 han alcanzado una reduccin en las tasas de incidencia de 40% o ms
entre 2010 y 2015, y se puede considerar que estn en el camino de alcanzar
la meta del GTS de una reduccin adicional del 40% para el 2020.
Si se quiere alcanzar la meta del GTS en reducir de 40% la tasa de incidencia
de casos para el ao 2020, se debera acelerar la disminucin de la tasa de
incidencia de casos en pases con un alto nmero de casos reportados.
Mortalidad
En 2015, se estimaron 429 000 muertes por paludismo en todo el mundo (II:
235 000 639 000).
En 2015, se estim que la mayora de las muertes ocurrieron en la regin de
frica de la OMS (92%), seguida de la regin de Asia sudoriental de la OMS
(6%) y la regin del Mediterrneo oriental de la OMS (2%).

xxxii WORLD MALARIA REPORT 2016


Puntos clave

La inmensa mayora de las muertes (99%) por paludismo fueron debidas al


P. falciparum. Se estima que P. vivax pudo haber sido el responsable de 3100
muertes en 2015 (rango: 1800 4900), 86% de ellas fuera de frica.
En 2015, el nmero estimado de muertes causadas por paludismo en nios
menores de 5 aos fue de 303 000 (rango: 165 000 450 000), el equivalente
al 70% del total mundial. Se estima que el nmero de muertes ha disminuido
un 29% desde 2010, aunque sigue siendo una de las principales causas de
mortalidad infantil, acabando con la vida de un nio cada dos minutos.
A nivel mundial, la tasa de mortalidad por paludismo habra disminuido un
62% entre 2000 y 2015, y un 29% entre 2010 y 2015. En nios menores de 5 aos,
habra disminuido un 69% entre 2000 y 2015, y en un 35% entre 2010 y 2015.
Entre 2010 y 2015, la tasa de mortalidad por paludismo habra disminuido al
menos un 40% en 39 de los 91 pases y territorios con transmisin de paludismo
activa en 2015. Otros 10 pases no tuvieron muertes autctonas en 2015.
Si se quiere alcanzar la meta del GTS en reducir la tasa de la mortalidad en
ms de un 40% para el 2020, se debera acelerar la reduccin de la tasa de
mortalidad en pases con un alto nmero de muertes.
Eliminacin
Entre 2000 y 2015, 17 pases han eliminado el paludismo (es decir, que han
reducido a cero los casos autctonos en tres aos o ms) y entre los cuales, seis
pases han sido certificados por la OMS como libres de paludismo.
En el progreso hacia la eliminacin del paludismo, estos 17 pases han reportado
una media de 184 casos autctonos cinco aos antes de alcanzar los cero casos
(RI: 78 728) y una mediana de 1748 casos en diez aos antes de alcanzar los
cero casos (RI: 423 5731).
En 2015, 10 pases y territorios reportaron menos de 150 casos autctonos,
y otros 9 pases reportaron entre 150 y 1000 casos autctonos. Por tanto, en
perspectiva positiva, parecera que sera posible alcanzar la meta del GTS
para el 2020 y eliminar el paludismo en 10 pases.
El paludismo no ha sido reintroducida en ninguno de los pases que eliminaron
esta enfermedad entre 2000 y 2015.
Reduccin de la mortalidad por paludismo, el incremento de la esperanza de
vida y la evaluacin econmica
Entre 2001 y 2015, se estima que un total acumulado de 6,8 millones de muertes
por paludismo han sido evitadas a nivel mundial entre 2000 y 2015, en relacin
a la cifras que se hubiesen producido si la incidencia y las tasas de mortalidad
se hubiesen mantenido inalteradas desde 2000.
La mayora de las muertes (94%) fueron evitadas en la regin de frica de la
OMS. Del total estimado de 6,8 millones menos de muertes por paludismo
entre 2001 y 2015, alrededor de 6,6 millones (97%) fueron entre nios menores
de 5 aos.
No todas las muertes pueden ser atribuidas a los esfuerzos para controlar
el paludismo. Parte del progreso es probable que est relacionado con un

WORLD MALARIA REPORT 2016 xxxiii


incremento de la urbanizacin y de un desarrollo econmico generalizado, lo
que ha llevado a la mejora de la vivienda y la nutricin.
Como consecuencia de la reduccin de la tasa de mortalidad por paludismo, en
particular, entre los nios menores de 5 aos, se ha estimado que la esperanza
de vida al nacer habra incrementado en ms de 1,2 aos en la regin de
frica de la OMS. Este incremento representara el 12% del aumento total de
la esperanza de vida de 9,4 aos en el frica subsahariana, que ha pasado
de 50,6 aos en 2000 a 60 aos en 2015.
A nivel mundial, la reduccin de la tasa de mortalidad por paludismo ha
contribuido a un incremento en la esperanza de vida de 0,26 aos en los pases
endmicos, siendo el 5% de los 5,1 aos ganados en total.
Los mtodos de anlisis actuales sugieren que el incremento en la esperanza
de vida originados por la reduccin de la mortalidad por paludismo observada
entre los aos 2000 y 2015 se puede valorar en US$ 1810 mil millones dentro de
la regin de frica de la OMS (II: US$ 1330 2480 mil millones), lo que equivale
al 45% del Producto Interior Bruto (PIB) de los pases afectados en 2015.
A nivel mundial, la reduccin del riesgo de mortalidad debido al paludismo
se valoriza en US$ 2040 mil millones (II: US$ 1560 2700 mil millones), siendo
alrededor del 3,6% del PIB.
Estos valores de bienestar econmico se expresan en trminos porcentuales
del PIB a ttulo comparativo, porque no pueden representar una parte actual
de la riqueza producida ni dar a entender que pueden medir el mismo tipo de
riqueza. Esta comparacin sugiere nicamente que el valor econmico que
se atribuye a la disminucin de la mortalidad por paludismo es substancial.

xxxiv WORLD MALARIA REPORT 2016


WORLD MALARIA REPORT 2016 1
1. Global targets,
milestones and indicators

Since 2000, substantial progress has been made in fighting malaria. According
to the latest estimates, between 2000 and 2015, malaria case incidence was
reduced by 41% and malaria mortality rates by 62% (see Section 6 of this report).
At the beginning of 2016, malaria was considered to be endemic in 91 countries
and territories, down from 108 in 2000 (Figure 1.1). Much of the change can be
attributed to the wide-scale deployment of malaria control interventions(1).
Despite this remarkable progress, malaria continues to have a devastating impact
on peoples health and livelihoods. Updated estimates indicate that 212million
cases occurred globally in 2015, leading to 429000 deaths, most of which were
in children aged under 5 years in Africa.
Recognizing the need to hasten progress in reducing the burden of malaria, WHO
developed the Global Technical Strategy for Malaria 20162030 (GTS) (2), which
sets out a vision for accelerating progress towards malaria elimination. The WHO
strategy is complemented by the Roll Back Malaria advocacy plan, Action and
investment to defeat malaria 20162030 (AIM) (3). Together, these documents
emphasize the need for universal access to interventions for malaria prevention,
diagnosis and treatment; that all countries1 should accelerate efforts towards
malaria elimination; and that malaria surveillance should be a core intervention.
The GTS and AIM also recognize the importance of innovation and research and
a strong enabling environment, and share the same global targets for 2030 and
the same milestones for 2020 and 2025, as shown in Table 1.1. The time frame
of the GTS and AIM is aligned with that of the Sustainable Development Goals
(SDGs) (4). For malaria, Target 3.3 of the SDGs to end the epidemics of AIDS,
tuberculosis, malaria and neglected tropical diseases and combat hepatitis,
waterborne diseases, and other communicable diseases by 2030 is interpreted
as the attainment of the GTS and AIM targets. The indicator used to track progress
of Target 3.3 is malaria case incidence.
1. In order to facilitate reading throughout the report, countries is used as a generic term referring to
countries and areas or territories. The term area or territory is used only when mentioning one or more
areas/territories in lists of specific countries.

2 WORLD MALARIA REPORT 2016


Figure 1.1 Countries endemic for malaria in 2000 and 2016. Countries with 3 consecutive years of zero
indigenous cases are considered to have eliminated malaria. No country in the WHO European region reported indigenous
cases in 2015 but Tajikistan has not yet had 3 consecutive years of zero indigenous cases, its last case being reported in July
2014. Source: WHO database

Countries endemic for malaria, 2016 Countries endemic in 2000, no longer endemic in 2016
Countries not endemic for malaria, 2000 Not applicable

Table 1.1 Global targets for 2030 and milestones for 2020 and 2025. Source: (2)

Milestones Targets
Goals
2020 2025 2030

1. Reduce malaria mortality rates globally


40% 75% 90%
compared with 2015

2. Reduce malaria case incidence globally


>40% 75% 90%
compared with 2015

3. Eliminate malaria from countries in which At least At least At least


malaria was transmitted in 2015 10countries 20countries 35countries

4. Prevent re-establishment of malaria in all Re-establishment Re-establishment Re-establishment


countries that are malaria free prevented prevented prevented

WORLD MALARIA REPORT 2016 3


1 Global targets, milestones and indicators

The GTS highlights a minimal set of 14 outcome and impact indicators against
which progress in malaria control and elimination should be monitored, of which 12
are relevant at global level. The World Malaria Report 2016 aims to report on these
global indicators, and a selection of other indicators as shown in Table 1.2. It also
reports on the supply of key commodities to endemic countries (which influences
the progress of malaria control and elimination programmes) (Section 2.4); the
evolution of resistance to interventions by vectors and parasites (Sections 3.6 and
4.6, respectively). This year, the report also considers the gain in life expectancy
that the reductions in malaria mortality have brought about, and the economic
value society places on such changes (Section 6.7). The main text is followed by
methods, regional profiles, country trends in selected indicators and data tables.
Country profiles and methods are available online at http://www.who.int/malaria/
publications/world-malaria-report-2016/en/.
The World Malaria Report is produced by the WHO Global Malaria Programme,
with the help of WHO regional and country offices, ministries of health in endemic
countries, and a broad range of other partners. The primary sources of information
are reports from national malaria control programmes (NMCPs) in the 91 endemic
countries. This information is supplemented by data from nationally representative
household surveys (demographic and health surveys, malaria indicator surveys
and multiple indicator cluster surveys) and databases held by other organizations:
the Alliance for Malaria Prevention; the Global Fund to Fight AIDS, Tuberculosis
and Malaria (Global Fund), the Organisation for Economic Co-operation and
Development; Policy Cures; United Nations Childrens Fund (UNICEF); the
USPresidents Malaria Initiative; and WHO. Adescription of data sources and
methods is provided in Annex 1.

Table 1.2 Indicators reviewed in World Malaria Report 2016. Indicators among minimal set of 14 recommended
indicators in GTS are highlighted in light grey.

Applicability of indicator
by transmission setting
Indicator Elimination or
High Low prevention of
re-establishment

Inputs
1.1 Total malaria funding and expenditure per capita
Financing
for malaria control and elimination
1.2 Funding for malaria relevant research
Outcome
Vector control 2.1 Proportion of population at risk that slept under an
ITN the previous night
2.2 Proportion of population with access to an ITN
within their household
2.3 Proportion of households with at least one ITN for
every two people
2.4 Proportion of households with at least one ITN
2.5 Proportion of available ITNs used the previous night

4 WORLD MALARIA REPORT 2016


Applicability of indicator
by transmission setting
Indicator Elimination or
High Low prevention of
re-establishment
Vector control 2.6 Proportion of targeted risk group receiving ITNs
2.7 Proportion of population at risk protected by IRS in
the previous 12 months
2.8 Proportion of population at risk sleeping under an
ITN or living in house sprayed by IRS in the previous
12 months
Chemoprevention 3.1 Proportion of pregnant women who received
3doses of IPTp
3.2 Proportion of pregnant women who received
2doses of IPTp
3.3 Proportion of pregnant women who received 1 dose
of IPTp
3.4 Proportion of pregnant women who attended ANC
at least once
Case detection 4.1 Proportion of children under 5 with fever in the
previous 2 weeks for whom advice or treatment was
sought
Diagnostic 5.1 Proportion of patients with suspected malaria who
testing received a parasitological test
5.2 Proportion of children under 5 with fever in the
previous 2 weeks who had a finger or heel stick
Treatment 6.1 Proportion of patients with confirmed malaria who
received first-line antimalarial treatment according
to national policy
6.2 Proportion of treatments with ACTs (or other
appropriate treatment according to national policy)
among febrile children <5
Surveillance 7.1 Proportion of malaria cases detected by
surveillance systems
7.2 Proportion of expected health facility reports
received
Impact
8.1 Parasite prevalence: proportion of population with
Prevalence
evidence of infection with malaria parasites
9.1 Malaria case incidence: number and rate per
Incidence
1000persons per year
10.1 Malaria mortality: number and rate per
Mortality
100000persons per year
11.1 Number of areas/countries that have newly
Elimination
eliminated malaria since 2015
Prevention of 12.1 Number of areas/countries that were malaria free in
re-establishment 2015 in which malaria has been re-established
Indicator highly relevant to setting Indicator potentially relevant to setting
ACT, artemisinin-based combination therapy; ANC, antenatal care; GTS, Global Technical Strategy for Malaria 2016-2030;
IPTp, intermittent preventive treatment in pregrancy; IRS, indoor residual spraying; ITN, insecticide-treated mosquito net

WORLD MALARIA REPORT 2016 5


6 WORLD MALARIA REPORT 2016
2. Investments in malaria
programmes and research

Progress in reducing malaria incidence and mortality between 2000 and 2015
was made possible by large increases in the financing of malaria control and
elimination programmes. Further progress in reducing malaria depends on
increased investments in malaria programmes. The GTS estimated that annual
investments in malaria control and elimination need to increase to US$ 6.4 billion
per year by 2020 to meet the first milestone under that strategy of a 40% reduction
in malaria incidence and mortality rates.
The GTS also recognized that innovations in tools and approaches are needed
to achieve its targets, and estimated that an additional US$ 674 million (range:
US$ 530 million832 million) would be required annually for malaria research
and development.
This section of the report examines recent trends in the financing of malaria
programmes and of malaria research and development. It considers the indicators
listed in Box 2.1.
This section also considers the quantities of commodities delivered, because this
provides insight into malaria expenditures, and because the availability of supplies
is a key determinant of programme coverage.

Box 2.1 Indicators related to investments in malaria programmes


and research
>> Total expenditure for malaria control and elimination
>> Funding for malaria research and development
>> Expenditure per capita for malaria control and elimination

WORLD MALARIA REPORT 2016 7


2 Investments in malaria programmes and research

2.1 Total expenditure for malaria control and elimination


Total funding for malaria control and elimination in 2015 is estimated at
US$2.9billion, rising just US$ 0.06 billion since 2010 and representing only 46%
of the GTS 2020 milestone of US$ 6.4 billion (Figure 2.1). Funding for malaria
increased year on year between 2005 and 2010, but subsequently fluctuated, with
totals for 2014 and 2015 lower than 2013. Pledges at the Global Fund replenishment
conference for funding in 20172019 increased by 8% compared with 20142016.
However, total funding needs to increase by a substantially greater amount if the
2020 milestone is to be achieved.
Governments of endemic countries provided 32% of total funding in 2015, of which
US$ 612 million was direct expenditure through NMCPs and US$ 332 million was
expenditure on patient service delivery care (Figure 2.2). Domestic government
contributions are greatest in the WHO African Region (US$ 528 million), followed by
the WHO Region of the Americas (US$ 202 million) and the WHO South-East Asia
Region (US$ 92 million). Domestic governments accounted for the greatest share
of funding for malaria in the WHO European Region (99%) and the WHO Region
of the Americas (88%), but represented 50% or less in the other WHO regions. The
level of domestic government financing reflects the size of the malaria burden in
each region, and the willingness and ability of governments to tackle this burden.
International funding accounts for most (68%) of the funding for malaria control
and elimination programmes. Such funding may be provided direct to endemic
countries through bilateral aid or through intermediaries such as the Global Fund,
World Bank or other multilateral institutions (Figure 2.2). The United States of

Figure 2.1 Investments in malaria control activities by funding source, 20052015. Annual values have
been converted to constant 2015 US$ using the gross domestic product implicit price deflator from the USA in order to measure
funding trends in real terms. Sources: ForeignAssistance.gov, Global Fund to Fight AIDS, Tuberculosis and Malaria, national
malaria control programme reports, Organisation for Economic Cooperation and Development (OECD) creditor reporting
system, the World Bank Data Bank, WHO estimates of malaria cases and treatment seeking at public facilities, and WHO
CHOICE unit cost estimates of outpatient visit and inpatient admission
Governments of endemic countries Global Fund USA UK World Bank Others
4

3
US$ (billion)

0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; UK, United Kingdom of Great Britain and Northern Ireland;
USA, United States of America

8 WORLD MALARIA REPORT 2016


Figure 2.2 Annual flow of funding for malaria control and elimination, 20142015. Sources of funds are
listed on the left and destination WHO regions on the right. Intermediaries through which much donor funding is channelled
are shown in the middle. Sources: ForeignAssistance.gov, Global Fund to Fight AIDS, Tuberculosis and Malaria, national
malaria control programme reports, Organisation for Economic Cooperation and Development (OECD) creditor reporting
system, the World Bank Data Bank, WHO estimates of malaria cases and treatment seeking at public facilities, and WHO
CHOICE unit cost estimates of outpatient visit and inpatient admission

Government of
endemic countries
$944 m, 32%

Africa
$ 2083 m, 70%

USA $1048 m, 35%

Americas
$ 230 m, 8%
UK $465 m, 16% Global Fund $911 m
Eastern
Mediterranean
$122 m, 4%
Europe
$27 m, 1%
France $94 m, 3% South
Germany $72 m, 2% East Asia
$207 m, 7%
Japan $68 m, 2%
Canada $51 m, 2% Western Pacific
BMGF $36 m, 1% $102 m, 3%
EU institutions Unspecified
$33 m, 1% World Bank $74 m recipients
Others $154 m, 5% $186 m, 6%
EU institutions, WHO, UNICEF $13 m

BMGF, Bill & Melinda Gates Foundation; EU, European Union; Global Fund, Global Fund to Fight AIDS, Tuberculosis and
Malaria; UK, United Kingdom of Great Britain and Northern Ireland; UNICEF, United Nations Childrens Fund; USA, United States
of America

WORLD MALARIA REPORT 2016 9


2 Investments in malaria programmes and research

America is the largest single international funder of malaria control activities; it


accounted for an estimated 35% of total malaria funding in 2015 (including bilateral
aid and contributions to intermediaries), followed by the United Kingdom of Great
Britain and Northern Ireland (16%), France (3.2%), Germany (2.4%), Japan (2.3%),
Canada(1.7%), the Bill & Melinda Gates Foundation (1.2%) and European Union
institutions (1.1%). Contributions from other countries represented 5% of total funding.
Nearly half of all international funding (45%) is channelled through the Global Fund.
The Global Fund is responsible for a significant share of malaria funding in the
WHO Eastern Mediterranean Region (62%), the WHO South-East Asia Region
(45%) and the WHO Western Pacific Region (35%). In the WHO African Region,
25% of funding comes from domestic governments, 33% from the Global Fund
and 29% from bilateral support from the United States Agency for International
Development (USAID).
Almost 90% of domestic funding is accounted for by health system spending
(Figure 2.3). In contrast, more than half of the funding from the Global Fund and
USAID is devoted to the delivery of preventive interventions. Around a sixth of
Global Fund, and a third of USAID funding is spent on treatment. The progress of
prevention and treatment programmes is therefore highly sensitive to variations
in donor spending.

Figure 2.3 Malaria financing, 20132015, by type of expenditure. Health-system spending includes planning,
monitoring and evaluation, communications and advocacy, supply management, training and human resources (apart
from those used for the delivery of services). Prevention includes procurement and delivery of insecticide-treated mosquito
nets, support of indoor residual spraying and delivery of intermittent preventive therapy in pregnancy. Treatment includes
commodities and resources for service delivery such as human resources, infrastructure and equipment. Sources: Global
Fund Enhanced Financial Reporting (EFR), USAID PMI malaria operational plans for 2013-2015 available at https://www.
pmi.gov/resource-library/mops/fy-2016, national malaria control programme reports, WHO estimates of malaria cases and
treatment seeking at public facilities, and WHO CHOICE unit cost estimates of outpatient visit and inpatient admission
Health systems Prevention Treatment
6%
6%

17%
24%

15%

88% 32%

Governments of endemic countries 59%

Global Fund
53%

USAID PMI

Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; PMI, Presidents Malaria Initiative; USAID, United States
Agency for International Development

10 WORLD MALARIA REPORT 2016


2.2 Funding for malaria-related research
Spending on research and development for malaria rose from an estimated
US$607 million in 2010 to US$ 611 million in 2014 (the latest year for which data are
available). The 2014 total represents more than 90% of the GTS annual investment
target of US$674million (Figure 2.4). The largest research and development
spending category was antimalarial medicines (35%), followed by vaccines (28%)
and basic research (27%). Investments in diagnostics and vector-control tools were
each estimated to account for only 3% of the 2014 spending.
Public sector investors contributed to nearly half of total research and development
funding in 2014, with the US National Institutes for Health and the US Department
of Defence comprising 55% of this category (Figure 2.5). Philanthropic investment
sources (primarily the Bill & Melinda Gates Foundation and the United Kingdoms
Wellcome Trust) accounted for 28% of the total. Private sector funding sources,
namely pharmaceutical and biotechnology companies, accounted for 23% of total
spending in 2014.

Figure 2.4 Funding for malaria-related research Figure 2.5 Source of funding for malaria-
and development, 20102014. Source: Gfinder Public related research and development, 2014.
Search Tool. Policy Cures. https://gfinder.policycures.org/Public Source: Gfinder Public Search Tool. Policy Cures.
SearchTool/ https://gfinder.policycures.org/PublicSearchTool/

Basic research Vector control Drugs


Vaccines Diagnostics Unspecified
800

Unspecified
GTS annual target: US$ 674 million
0%

600 Private sector


Public sector
22%
50%
US$ (million)

400

200

0 Philanthropic
2010 2011 2012 2013 2014 28%

GTS, Global Technical Strategy for Malaria 20162030

WORLD MALARIA REPORT 2016 11


2 Investments in malaria programmes and research

2.3 Malaria expenditure per capita for malaria control and


elimination
An analysis of malaria spending in relation to population at risk can help in
assessing the adequacy of current funding levels. The composition and costs of
malaria control and elimination programmes vary by setting. Based on resource
need estimates from the GTS, countries with more than 1 million cases require a
higher per capita spending (US$ 3.40) than those with between 10000 and 1 million
cases (US$2.50). Countries with fewer than 10000 cases require the highest per
capita spending (US$ 3.75) owing to the added cost of case-based surveillance,
which becomes feasible with low case numbers. Countries with more than 1 million
cases are furthest from the per capita spending milestones for 2020 set in the GTS
(Figure 2.6). Countries with fewer than 10000 cases are able to meet a greater
proportion of funding requirements from domestic sources because of a lower
total financial requirement (related to the lower number of cases) and generally
higher gross national incomes.

Figure 2.6 Malaria financing per person at risk, 20132015, by estimated number of malaria cases,
2015. The solid bar shows the interquartile range among countries endemic for malaria in 2015, and the white line shows the
median. The 10th and 90th percentiles are shown as black cross-bars. Sources: ForeignAssistance.gov, Global Fund to Fight
AIDS, Tuberculosis and Malaria, national malaria control programme reports, Organisation for Economic Co-operation and
Development creditor (OECD) reporting system and the Data Bank of the World Bank
International Domestic Total 2020 global milestone
10

8
US$ per person at risk

0
> 1 000 000 cases (33 countries) 10 0001 000 000 cases (32 countries) <10 000 cases (26 countries)

12 WORLD MALARIA REPORT 2016


2.4 Commodity procurement trends
Insecticide-treated mosquito nets
Between 2013 and 2015, a total of 510 million insecticide-treated mosquito nets
(ITNs) were reported by manufacturers as having been delivered to countries in
sub-Saharan Africa, which exceeds the minimum amount required to achieve
universal access to an ITN in the household (491 million)1. More ITNs were delivered
in 2014 (189 million) and 2015 (178 million) than in any previous year (Figure 2.7).
Decreasing prices may have contributed to increased procurement, with the
average procurement price falling from US$ 6.27 to US$ 4.36 per net between 2010
and 2014 (2015 prices). Six countries accounted for more than 50% of deliveries in
sub-Saharan Africa (Nigeria, 93 million ITNs; Democratic Republic of the Congo,
61 million; Ethiopia, 45 million; Uganda, 28 million; Burkina Faso, 20 million and
Kenya, 18 million). Outside sub-Saharan Africa, 73 million ITNs were delivered by
manufacturers between 2013 and 2015, with more than half of those deliveries
accounted for by five countries (India, 13 million ITNs; Indonesia, 9.3 million;
Myanmar, 8.9 million; Cambodia, 4.3 million and Papua New Guinea, 4.1 million).
Manufacturer deliveries are a forward indicator of in-country distribution and
household coverage with ITNs. NMCP distributions to households lag the deliveries
of ITNs to countries by an average of 0.51.0 years, and ITN coverage indicators,
reviewed in Section 3 of this report, lag 3-year cumulative totals of manufacturer
deliveries by about 1 year. A total of 128 million ITNs are projected to be delivered
to countries in sub-Saharan Africa in 2016, based on shipments up to October 2016.
The 3-year cumulative totals of manufacturer deliveries suggest that although ITN
coverage will rise further in 2016 it may drop in 2017.

1. Based on the assumption that every household received the exact number of nets required for 100%
access within households and that nets are retained for at least 3 years. In practice, ITNs are lost or
replaced before 3 years, so the number of ITNs required to achieve universal access is greater.

Figure 2.7 Number of ITNs delivered by manufacturers and delivered by NMCPs 20092016. Data
from NMCPs for 2016 and 2017 not yet available. Sources: Milliner Global Associates and NMCP reports

Manufacturer Outside Africa NMCP Outside Africa


250 deliveries: Sub-Saharan Africa deliveries: Sub-Saharan Africa

200
Number of ITNs (million)

150

100

50

0
2009 2010 2010 2011 2011 2012 2012 2013 2013 2014 2014 2015 2015 2016 2016 2017
ITN, insecticide-treated mosquito net; NMCP, national malaria control programme

WORLD MALARIA REPORT 2016 13


2 Investments in malaria programmes and research

Rapid diagnostic tests


Sales of rapid diagnostic tests (RDTs) reported by manufacturers rose from
88million globally in 2010 to 320 million in 2013, but fell to 270 million in 2015
(Figure 2.8). The decrease in sales was most pronounced in Asia, with sales of
falciparum only tests falling from 22 million to less than 1 million between 2014
and 2015. In contrast, sales of falciparum only tests increased in Africa from
166million to 179 million, whereas combination tests decreased from 89 million to
61million between 2014 and 2015.
The number of RDTs distributed by NMCPs, while following a similar trend to
manufacturer sales before 2015, did not show the same dip in 2015. In sub-Saharan
Africa, the numbers distributed rose from 165 million in 2014 to 179million in 2015;
outside Africa, they rose from 25 million to 28 million. Some of the difference in
trends and levels may be due to incomplete reporting. The differences may also
be due to the fact that RDT sales reported by manufacturers include both public
and private health sectors, whereas RDTs distributed by NMCPs represent tests in
the public sector only. Because of inconsistencies in how data are reported, it is
not possible to establish how trends in each variable are linked over time. It is not
known to what extent the 2015 decline in reported manufacturer RDT deliveries
will affect the availability of diagnostic testing for patients with fever.

Figure 2.8 Number of RDTs sold by manufacturers and distributed by NMCPs, 20102015. Sources:
NMCP reports and data from manufacturers eligible for the WHO Foundation for Innovative New Diagnostics/US Centers for
Disease Control and Prevention Malaria Rapid Diagnostic Test Product Testing Program

350 Manufacturer deliveries


Sub-Saharan Africa:
P. falciparum only tests
300 Combination tests
Outside Africa:
P. falciparum only tests
Number of RDTs (million)

250
Combination tests

NMCP deliveries
200
Sub-Saharan Africa
Outside Africa

150

100

50

0
2010 2011 2012 2013 2014 2015

NMCP, national malaria control programme; RDT, rapid diagnostic test

14 WORLD MALARIA REPORT 2016


Artemisinin-based combination therapies
The number of courses of artemisinin-based combination therapy (ACT) procured
from manufacturers increased from 187 million in 2010 to a peak of 393 million in
2013, but subsequently fell to 311 million in 2015, of which 209 million were delivered
to the public sector (Figure 2.9). The number of ACT treatments distributed by
NMCPs to public sector health facilities also declined from 192 million in 2013
to 153 million in 2015. The discrepancy between manufacturer deliveries to the
public sector and the number of courses distributed through public facilities can
be accounted for, in part, by incomplete reporting by NMCPs. The WHO African
Region accounted for 98% of all manufacturer deliveries in 2015 (in cases where
the destination is known) and 97% of NMCP deliveries.
In the WHO African Region, the number of ACT treatments distributed by NMCPs in
the public sector (148million) is now fewer than the number of malaria diagnostic
tests provided (170 million) (Figure 2.10). The decreasing ratio of treatments to tests
in the public sector (87:100 in 2015) is a reflection that more patients are receiving a
diagnostic test before being treated. However, there is still scope for improvement
in the ratio of treatments to tests, because this ratio should approximate the
malaria test positivity rate of patients seeking treatment, which is generally 52%
(or 0.52) across all countries in sub-Saharan Africa.

Figure 2.9 Number of ACT treatment courses Figure 2.10 Ratio of ACT treatment courses
delivered by manufacturers and distributed by distributed to diagnostic tests performed
NMCPs, 20102015. AMFm/GF indicates AMFm operated (RDTs or microscopy), WHO African Region
from 2010 to 2013, and GF co-payment mechanism from 2014. 2010-2015. Source: National malaria control
Sources: Companies eligible for procurement by WHO/United programme reports, WHO African Region, 20102015
Nations Childrens Fund and NMCP reports

Public sector Public sector - AMFm/GF 3.00


Ratio of ACTs: tests undertaken and test positivity rate

Private sector - AMFm/GF Distributed by NMCPs


500 2.50
Ratio of ACTs: tests undertaken
ACT treatment courses (million)

400 2.00

300 1.50

200 1.00

Test positivity rate


100 0.50

0 0
2010 2011 2012 2013 2014 2015 2010 2011 2012 2013 2014 2015

ACT, artemisinin-based combination therapy; AMFm,Affordable ACT, artemisinin-based combination therapy; RDT,
Medicines Facilitymalaria; GF, Global Fund to Fight AIDS, rapid diagnostic test
Tuberculosis and Malaria; NMCP, national malaria control
programme

WORLD MALARIA REPORT 2016 15


16 WORLD MALARIA REPORT 2016
3. Preventing malaria

Cases of malaria can be prevented by vector control (stopping mosquitoes


from biting human beings), by chemoprevention (providing drugs that suppress
infections) or, potentially, by vaccination. These prevention strategies are discussed
below.
Vector control
The most commonly used methods to prevent mosquito bites are sleeping under
an ITN and spraying the inside walls of a house with an insecticide indoor
residual spraying (IRS). Use of ITNs has been shown to reduce malaria incidence
rates by 50% in a range of settings, and to reduce malaria mortality rates by
55% in children aged under 5 years in sub-Saharan Africa (5,6). Historical and
programme documentation suggest a similar impact for IRS, but randomized
trial data are limited (7). These two core vector-control interventions use of ITNs
and IRS are considered to have made a major contribution to the reduction in
malaria burden since 2000, with ITNs estimated to account for 50% of the decline
in parasite prevalence among children aged 210 years in sub-Saharan Africa
between 2001 and 2015 (1). In a few specific settings and circumstances, ITNs and
IRS can be supplemented by larval source management (8) or other environmental
modifications that reduce the suitability of environments as mosquito habitats or
that otherwise restrict biting of humans.

WORLD MALARIA REPORT 2016 17


3 Preventing malaria

Chemoprevention
In sub-Saharan Africa, intermittent preventive treatment of malaria in pregnancy
(IPTp) with sulfadoxine-pyrimethamine (SP) has been shown to reduce maternal
anaemia (7), low birth weight (1) and perinatal mortality (8). Intermittent preventive
treatment in infants (IPTi) with SP provides protection against clinical malaria and
anaemia (9); however, as of 2015, no countries have reported implementation of
an IPTi policy. Seasonal malaria chemoprevention (SMC) with amodiaquine (AQ)
plus SP (AQ+SP) for children aged 359 months reduces the incidence of clinical
attacks and severe malaria by about 80% (10,11) and could avert millions of cases
and thousands of deaths in children living in areas of highly seasonal malaria
transmission in the Sahel subregion (12). As of 2015, 10 countries had adopted the
policy (Burkina Faso, Chad, Gambia, Guinea, Guinea Bissau, Mali, Niger, Nigeria,
Senegal and Togo).
Vaccines
A number of malaria vaccine research projects are underway (13). The only
vaccine to have completed Phase 3 testing is RTS,S/AS01, which reduced clinical
incidence by 39% and severe malaria by 31.5% among children aged 517months
who completed four doses. Following the positive scientific opinion of the European
Medicines Authority under Article 58 (14), WHO recommended that RTS,S
be implemented on a pilot scale in parts of three to five sub-Saharan African
countries(15). The aim is to provide information on feasibility, safety and mortality
impact, to guide recommendations on the potential wider scale use of this vaccine
in 35 years time. The first phase of vaccination is expected to commence in 2018.
RTS,S is being considered as a complementary malaria control tool in Africa that
could potentially be added to, rather than replace, the core package of proven
malaria preventive, diagnostic and treatment interventions.
Indicators
Ensuring universal access of populations at risk to preventive interventions is
central to achieving the goals and milestones of the GTS. Accordingly, this section
reviews the indicators listed in Box 3.1 to assess the extent to which universal access
to interventions has been achieved. Use of ITNs is reported only for sub-Saharan
Africa, where malaria vectors are most amenable to control with this intervention.
Similarly, the analysis of IPTp is confined to sub-Saharan Africa, the region where
it is applicable. The coverage of IPTi, SMC and vaccines is not reported given their
current limited adoption.

18 WORLD MALARIA REPORT 2016


Box 3.1 Indicators related to preventing malaria
Insecticide-treated mosquito nets
>> Proportion of population at risk that slept under an ITN the previous night
>> Proportion of population with access to an ITN within their household
>> Proportion of households with at least one ITN for every two people
>> Proportion of households with at least one ITN
>> Proportion of existing ITNs used the previous night
>> Proportion of targeted risk group receiving ITNs (antenatal and immunization clinic
attenders)
Indoor residual spraying
>> Proportion of population at risk protected by IRS in the previous 12 months
Insecticide-treated mosquito nets and indoor residual spraying
>> Proportion of population at risk sleeping under an ITN or living in a house sprayed by
IRS in the previous 12 months
Intermittent preventive therapy in pregnancy
>> Proportion of pregnant women who received at least three doses of IPTp
>> Proportion of pregnant women who received 2 doses of IPTp
>> Proportion of pregnant women who received 1 dose of IPTp
>> Proportion of pregnant women who attended antenatal care at least once

WORLD MALARIA REPORT 2016 19


3 Preventing malaria

3.1 Population at risk sleeping under an insecticide-treated


mosquito net
For countries in sub-Saharan Africa, it is estimated that 53% of the population at risk
slept under an ITN in 2015 (95%confidence interval [CI]: 5057%), increasing from 5%
in 2005 and from 30% in 2010 (95%CI: 2832%) (Figure 3.1). The rise in the proportion
of the population sleeping under an ITN has been driven by increases in the proportion
of the population that have access to an ITN in their house (in 2015 the proportion was
60%, 95% CI: 5764%). The proportion sleeping under an ITN is generally close to the
proportion with access to an ITN. Thus, while it continues to be important to encourage
consistent ITN use among those who have access to a net, ensuring access to ITNs for
those who do not have them is central to increasing overall use.
The proportion of households with one or more ITNs increased to 79% in 2015
(95%CI:7683%). However, this means that a fifth of households do not have access to
any nets. Moreover, the proportion of households with sufficient ITNs for all household
members was just 42% (95% CI: 3945%), substantially short of universal access (100%)
to this preventive measure. This reiterates the need to ensure that all households
receive sufficient nets so there is at least one for every two persons.

3.2 Targeted risk group receiving ITNs


In addition to mass distribution campaigns, WHO recommends the continuous distribution
of ITNs to all pregnant women attending antenatal care (ANC) and all infants attending
child immunization clinics (17). Data reported by NMCPs indicate that, between 2013
and 2015, mass campaigns accounted for 86% of ITNs distributed in sub-Saharan Africa,
while antenatal clinics accounted for 10% and immunization clinics for 4% (Figure 3.2).
The number of ITNs distributed through antenatal and immunization clinics can be
compared to the number of pregnant women attending ANC and the number of
children receiving immunization, to determine the extent to which these channels are
used for ITN delivery (18). Data reported by NMCPs in 20132015 indicate that 39% of
pregnant women that attended ANC and 20% of children that attended immunization
clinics received an ITN. Hence, these continuous distribution channels for ITNs appear
to be underused. Some of the gap can be attributed to countries not yet adopting a
policy to distribute ITNs through these channels; four countries that did not distribute
ITNs through ANC clinics accounted for 10% of the 61% gap, and nine countries that did
not distribute ITNs through immunization clinics accounted for 22% of the 80% gap.

3.3 Population at risk protected by indoor residual spraying


NMCPs reported that 106 million people worldwide were protected by IRS in 2015; this
figure includes 49 million people in the WHO African Region and 44 million people in
the WHO South-East Asia Region (of whom >41 million are in India). The proportion of
the population at risk protected by IRS declined globally from a peak of 5.7% in 2010
to 3.1% in 2015, with decreases seen in all WHO regions (Figure 3.3). The proportions of
the population protected by IRS are low because IRS is generally used only in particular
areas. Declining IRS coverage may be attributed to a change from pyrethroids to
more expensive insecticide classes, although heavy reliance on pyrethroids continues
particularly outside of the WHO African Region (Figure 3.4). Concurrent, sequential or
mosaic use of insecticide classes with different modes of action is one component of a
comprehensive insecticide resistance management strategy.

20 WORLD MALARIA REPORT 2016


Figure 3.1 Proportion of population at risk with Figure 3.2 Proportion of ITNs distributed through
access to an ITN and sleeping under an ITN, different delivery channels in sub-Saha ran
and proportion of households with at least one Africa, 20132015. Source: National malaria control
ITN and enough ITNs for all occupants, sub- programme reports
Saharan Africa, 20052015. Source: Insecticide-
treated mosquito net coverage model from Malaria Atlas
Project (16)

100% Mass campaign,


Child immunization 86%
Household with at least 1 ITN
Proportion of population at risk or households

clinics, 4%
Population with access to an ITN in household
80% Antenatal care
Household with enough ITNs for all occupants
clinics, 10%
Population sleeping under an ITN
60%

40%

20%

0
2005 2010 2015

ITN, insecticide-treated mosquito net

Figure 3.3 Proportion of the population at risk Figure 3.4 Insecticide class used for indoor
protected by IRS by WHO region, 20102015. residual spraying 20102015. Source: National
Source: National malaria control programme reports malaria control programme reports

12% Pyrethroids only


Pyrethroids and other insecticides
AFR 50 Other insecticides only
AMR
10%
World 40
Number of countries

SEAR
Proportion of population at risk

EMR 30
8% WPR
20

6% 10
0
2010 2011 2012 2013 2014 2015
4% WHO African Region
50
2% 40
Number of countries

30
0
2010 2011 2012 2013 2014 2015 20

AFR, WHO African Region; AMR, WHO Region of the 10


Americas; EMR, WHO Eastern Mediterranean Region; 0
IRS, indoor residual spraying; SEAR, WHO South-East Asia 2010 2011 2012 2013 2014 2015
Region; WPR, WHO Western Pacific Region Other WHO regions

WORLD MALARIA REPORT 2016 21


3 Preventing malaria

3.4 Population at risk sleeping under an insecticide-treated


mosquito net or protected by indoor residual spraying
Combining data on the proportion of the population sleeping under an ITN with
information on the proportion protected by IRS and accounting for households
that may receive both interventions the proportion of the population in
sub-Saharan Africa protected by vector control was estimated at 57% in 2015
(uncertainty interval [UI], 4470%) compared with 37% in 2010 (UI, 2548%)
(Figure3.5). The proportion exceeded 80% in three countries in 2015: Cabo Verde,
Zambia and Zimbabwe.

Figure 3.5 Proportion of the population at risk protected by IRS or


sleeping under an ITN in sub-Saharan Africa, 20102015. Sources:
Insecticide-treated mosquito net coverage model from Malaria Atlas Project (16),
national malaria control programme reports and further analysis by WHO

ITN only ITN & IRS IRS only


100%

80%
Proportion of population at risk

60%

40%

20%

0
2010 2011 2012 2013 2014 2015

IRS, indoor residual spraying; ITN, insecticide-treated mosquito net

22 WORLD MALARIA REPORT 2016


WORLD MALARIA REPORT 2016 23
3 Preventing malaria

3.5 Vector insecticide resistance


Resistance of malaria vectors to the four insecticide classes currently used in ITNs
and IRS threatens malaria prevention efforts. Of the 73 malaria endemic countries
that provided monitoring data to WHO for 2010 onwards, 60 reported resistance
to at least one insecticide in one malaria vector from one collection site, and 50
reported resistance to two or more insecticide classes. Resistance to pyrethroids
the only class currently used in ITNs is the most commonly reported (Figure 3.6); in
2015, over three quarters of the countries monitoring this insecticide class reported
resistance. However, the impact of pyrethroid resistance on ITN effectiveness is
not yet well established. A WHO-coordinated five-country evaluation conducted
in areas with pyrethroid-resistant malaria vectors did not find an association
between malaria disease burden and levels of resistance, and showed that ITNs still
provided personal protection (19). Nevertheless, evidence of geographical spread
of resistance and intensification in some areas underscores the need to urgently
take action to manage resistance and to reduce reliance on pyrethroids.
Priority actions include establishing and applying national insecticide resistance
monitoring and management plans in line with the WHO Global plan for insecticide
resistance management in malaria vectors (GPIRM), released in 2012. New vector
monitoring and control tools and approaches are also urgently required. WHO
Test procedures for monitoring insecticide resistance in malaria vector mosquitoes
were updated in November 2016 to include bioassays for resistance intensity and
metabolic mechanisms. Information from national programmes and partners on
insecticide resistance in malaria vectors is collated by WHO in a global database.

Figure 3.6 Insecticide resistance and monitoring status for malaria endemic countries (2015), by
insecticide class and WHO region, 20102015. Source: National malaria control programme reports, African
Network for Vector Resistance, Malaria Atlas Project, Presidents Malaria Initiative (United States), scientific publications
Resistance reported Resistance not reported Not monitored
50

40
Number of countries

30

20

10

0
AFR AMR EMR EUR SEAR WPR AFR AMR EMR EUR SEAR WPR AFR AMR EMR EUR SEAR WPR AFR AMR EMR EUR SEAR WPR
Pyrethroids Organochlorine (DDT) Carbamates Organophosphates

AFR, WHO African Region; AMR, WHO Region of the Americas; DDT, dichloro-diphenyl-trichloroethane; EMR, WHO Eastern
Mediterranean Region; EUR, WHO European Region; SEAR, WHO South-East Asia Region; WPR, WHO Western Pacific Region

24 WORLD MALARIA REPORT 2016


3.6 Pregnant women receiving three or more doses of
intermittent preventive therapy
It is estimated that, in 2015, among 20 countries that reported, 31% of eligible
pregnant women (UI: 2932%) received three or more doses of IPTp in 36 African
countries that have adopted the policy a large increase from the 18% receiving
three or more doses in 2014 and 6% in 2010 (Figure3.7). The proportion still remains
below full coverage. Asignificant proportion of pregnant women do not attend
ANC (20% in 2015) and, of those who do, 30% do not receive a single dose of IPTp.
The proportion of women receiving IPTp varied across the continent, with
24countries reporting that more than 50% of pregnant women received one or
more doses, and 17 countries reporting more than 50% received two or more doses.
Only three countries reported that more than 50% of pregnant women received
three or more doses of IPTp.

Figure 3.7 Proportion of pregnant women receiving IPTp, by dose,


sub-Saharan Africa, 2010-2015. Source: National malaria control programme
reports and United Nations population estimates
95% uncertainty interval
100%

80%
Proportion of pregnant women

60%
Receiving at least
1 dose of IPTp
40%
Receiving at least
2 doses of IPTp
20% Receiving at least
3 doses of IPTp

0
2010 2011 2012 2013 2014 2015

IPTp, intermittent preventive treatment in pregnancy

WORLD MALARIA REPORT 2016 25


Box 4.1 Indicators related to diagnostic testing and treatment
Care seeking
>> Proportion of children under 5 with fever in the previous 2 weeks for whom advice or
treatment was sought
Diagnostic testing
>> Proportion of children under 5 with fever in the previous 2 weeks who had a finger or
heel stick
>> Proportion of patients with suspected malaria attending public health facilities who
received a parasitological test
Treatment
>> Proportion of patients with confirmed malaria who received first-line antimalarial
treatment according to national policy
>> Proportion of treatments with ACTs (or other appropriate treatment according to national
policy) among febrile children <5

26 WORLD MALARIA REPORT 2016


4. Diagnostic testing
and treatment

Prompt diagnosis and treatment of malaria can cure a patient, preventing the
development of severe malaria and subsequent death. It also reduces the length
of time that patients carry malaria parasites in their blood, which in turn reduces
the risk of onward transmission.
Diagnostic testing
WHO recommends that every suspected malaria case be confirmed by microscopy
or an RDT before treatment (20). Accurate diagnosis improves the management
of febrile illnesses and ensures that antimalarial medicines are only used when
necessary. Only in areas where parasite-based diagnostic testing is not possible
should malaria treatment be initiated solely on clinical suspicion.
Treatment
Prompt and appropriate treatment of uncomplicated malaria is critical in
preventing progression to severe disease and death. WHO recommends ACTs
for the treatment of uncomplicated Plasmodium falciparum malaria. ACTs have
been estimated to reduce malaria mortality in children aged 123 months by 99%
(range: 94100%), and in children aged 2459 months by 97% (range: 8699%) (21).
Indicators
The ability of health systems to diagnose and treat cases is influenced by the extent
to which patients with suspected malaria seek treatment, and by the proportion
of patients who receive a diagnostic test and appropriate treatment after seeking
health care. This section of the report discusses indicators covering care seeking,
diagnostic testing and treatment, as listed in Box 4.1. It also considers the parasites
evolutionary responses to interventions; namely, the potential for selection of
parasites that can evade diagnostic tests and the evolution of drug resistance.

WORLD MALARIA REPORT 2016 27


4 Diagnostic testing and treatment

4.1 Children aged under 5 years with fever for whom advice or
treatment was sought from a trained provider
Evidence on the extent to which patients with suspected malaria seek treatment
is derived mainly from household surveys that measure the proportion of children
with fever for whom advice or treatment is sought. A disadvantage of this indicator
is that it considers fever rather than confirmed malaria. Nonetheless, malaria
should be suspected in febrile children who live in malaria endemic areas, and
such children should be taken to a trained provider to obtain a diagnostic test and
treatment, if appropriate. Although the indicators measurement is largely confined
to sub-Saharan Africa and children aged under 5 years, sub-Saharan Africa
accounts for more than 90% of global malaria cases, with most cases occurring
in children aged under 5 years.
Among 23 nationally representative surveys completed in sub-Saharan Africa
between 2013 and 2015 (representing 61% of the population at risk), a higher
proportion of febrile children sought care in the public sector (median: 42%,
interquartile range [IQR]: 3150%) than in the private sector (median: 20%,
IQR:1228%), as shown in Figure 4.1. Most visits to the private sector were to the
informal sector (median: 11%, IQR: 721%), which comprises pharmacies, kiosks
and traditional healers, rather than to the formal private sector (median: 5%,
IQR:721%), which comprises private hospitals and clinics. Overall, a median of
54% (IQR: 4159%) of febrile children were taken to a trained provider (i.e. to public
sector health facilities, formal private sector facilities or community health workers).
A large proportion of febrile children are not brought for care (median: 36%,
IQR:2642%); possible reasons for this are poor access to health-care providers
or a lack of awareness among caregivers about necessary care for febrile children.

Figure 4.1 Proportion of febrile children seeking care, by health sector, sub-Saharan Africa,
20132015. Sources: Nationally representative household survey data from demographic and health surveys, and malaria
indicator surveys

100%

80%
Proportion of children <5 years
with fever in previous 2 weeks

60%

40%

20%

0
Public sector Formal Informal Community No treatment
private sector private sector health worker sought

28 WORLD MALARIA REPORT 2016


4.2 Suspected malaria cases receiving a parasitological test
Since 2010, WHO has recommended that all persons with suspected malaria
should undergo malaria diagnostic testing, by either microscopy or RDT. Household
surveys can provide information on diagnostic testing among febrile children aged
under 5 years across all sources of care. Among 22 nationally representative surveys
completed in sub-Saharan Africa between 2013 and 2015 that asked questions on
diagnostic testing, the proportion of febrile children who received a finger or a
heel stick, indicating that a malaria diagnostic test was performed, was greater
in the public sector (median: 51%, IQR: 3560%) than in both the formal private
sector (median: 40%, IQR: 2857%) and the informal private sector (median: 9%,
IQR: 412%), as shown in Figure 4.2. Although the proportion of children seeking
care from a community health worker was low, about a third received a diagnostic
test (median: 31%; IQR: 1146%). Combining the proportions of febrile children aged
under 5 years who sought care with the proportion who received a parasitological
test among those who sought care, a median of 31% of febrile children received
a parasitological test among the 22 nationally representative household surveys
analysed between 2013 and 2015 (IQR: 1637%).

Figure 4.2 Proportion of febrile children receiving a blood test, by health sector, sub-Saharan
Africa, 20132015. Proportions shown are among those that sought care. Sources: Nationally representative household
survey data from demographic and health surveys, and malaria indicator surveys

100%
that sought care at treatment outlet

80%
Proportion of febrile children

60%

40%

20%

0
Public sector Formal Informal Community
private sector private sector health worker

WORLD MALARIA REPORT 2016 29


4 Diagnostic testing and treatment

4.3 Suspected malaria cases attending public health facilities


and receiving a parasitological test
Data reported by NMCPs indicate that the proportion of suspected malaria cases
receiving a parasitological test among patients presenting for care in the public
sector has increased in most WHO regions since 2010 (Figure 4.3). The largest
increase has been in the WHO African Region, where diagnostic testing increased
from 40% of suspected malaria cases in 2010 to 76% in 2015, mainly owing to an
increase in the use of RDTs, which accounted for 74% of diagnostic testing among
suspected cases in 2015.
The reported testing rate may overestimate the true extent of diagnostic testing
in the public sector, because, among other factors, the rate relies on accurate
reporting of suspected malaria cases, and reporting completeness may be higher
in countries with stronger surveillance systems and higher testing rates. A trend
of increased testing in the public sector is also evident in the results of household
surveys, where the proportion of febrile children who received a malaria diagnostic
test in the public sector rose from a median of 29% in 2010 (IQR: 1946%) to a
median of 51% in 2015 (IQR: 3560%) (Figure 4.4). However, the two sources of
information are not directly comparable because the numbers reported by NMCPs
relate to all age groups, and because household surveys are undertaken in only
a limited number of countries each year.

Figure 4.3 Proportion of suspected malaria Figure 4.4 Proportion of febrile children
cases attending public health facilities who attending public sector health facilities who
receive a diagnostic test, by WHO region, 2010 receive a blood test, sub-Saharan Africa,
2015. Source: National malaria control programme reports 20102015. Sources: Nationally representative household
survey data from demographic and health surveys, and
100% malaria indicator surveys

100%
Proportion of suspected malaria cases

80%

80%
Proportion of children <5 years
with fever in previous 2 weeks

60%

60%
40%
AMR
SEAR 40%
20% WPR
EMR
AFR 20%
0
2010 2011 2012 2013 2014 2015
0
AFR, WHO African Region; AMR, WHO Region of the 20102012 20112013 20122014 20132015
Americas; EMR, WHO Eastern Mediterranean Region;
SEAR, WHO South-East Asia Region; WPR, WHO Western
Pacific Region

30 WORLD MALARIA REPORT 2016


4.4 Malaria cases receiving first-line antimalarial treatment
according to national policy
In recent years, more nationally representative household surveys have
administered an RDT to children included in the survey. Thus, it is now possible
to examine the treatment received by children with both a fever in the previous
2weeks and a positive RDT at the time of survey (Figure 4.5).
The median proportion of children aged under 5 years with evidence of recent
or current P. falciparum infection and a history of fever, and who received any
antimalarial drug was 30% among 11 household surveys conducted in sub-Saharan
Africa in 20132015 (IQR: 2051%). The median proportion receiving an ACT
was 14% (IQR: 545%). The low values can be attributed to two factors: many
febrile children are not taken for care to a qualified provider (Section 4.2) and, in
cases where children are taken for care, a significant proportion of antimalarial
treatments dispensed are not ACTs (Section 4.6). The apparent proportions and
trends indicated are uncertain because the interquartile ranges of the medians
are wide, indicating considerable variation among countries. Moreover, the
number of household surveys is comparatively small, covering an average of 37%
of the population at risk in sub-Saharan African in any one 3-year period. Further
investments are needed to better track malaria treatment at health facilities
(through routine reporting systems and surveys) and at community level, to gain
a greater understanding of the extent of barriers to accessing malaria treatment.

Figure 4.5 Proportion of febrile children with a positive RDT at


time of survey who received antimalarial medicines, sub-Saharan
Africa, 20102015. Sources: Nationally representative household survey data from
demographic and health surveys, and malaria indicator surveys

Any antimalarial ACT


100%
Proportion of children with fever in previous
2 weeks and positive RDT at time of survey

80%

60%

40%

20%

0
20102012 20112013 20122014 20132015

ACT, artemisinin-based combination therapy; RDT, rapid diagnostic test

WORLD MALARIA REPORT 2016 31


4 Diagnostic testing and treatment

4.5 ACT treatments among all malaria treatments


Based on nationally representative household surveys, the proportion of
antimalarial treatments that are ACTs (for children with both a fever in the previous
2 weeks and a positive RDT at the time of survey) increased from a median of
29% in 20102012 (IQR: 1755%) to 80% in 20132015 (IQR: 2995%) (Figure 4.6).
However, the ranges associated with the medians are wide, indicating large
variation between countries, and the number of household surveys covering any
one 3-year period is comparatively small. Antimalarial treatments are more likely
to be ACTs if children seek treatment at public health facilities or via community
health workers than if they seek treatment in the private sector (Figure 4.7).

4.6 Parasite resistance


As the coverage of malaria programmes increases, malaria parasites respond to
the selection pressure applied and parasite evolution can potentially compromise
the effectiveness of current tools to diagnose and treat malaria.
Diagnostic testing
Some malaria parasites lack the histidine rich protein 2 (HRP2) protein, the most
common target antigen used in RDTs for detection of P. falciparum. Hence, the
parasites can evade detection by rapid diagnostic tests and subsequent treatment
with an ACT. This not only prevents a patient from receiving appropriate treatment,
but also enables the parasite to survive, reproduce and increase in relative
frequency. Non-HRP2 expressing parasites were first reported in 2010 amongst
cases in Peru and subsequently in several other South American countries (Bolivia
[Plurinational State of], Brazil, Colombia and Suriname) between 20122013.

Figure 4.6 Proportion of antimalarial treatments Figure 4.7 Proportion of antimalarial treatments
that are ACTs received by febrile children that that are ACTs received by febrile children, by
are RDT positive at the time of survey, sub- health sector, sub-Saharan Africa, 20132015.
Saharan Africa, 20052015. Sources: Nationally Sources: Nationally representative household survey data
representative household survey data from demographic from demographic and health surveys, and malaria
and health surveys, and malaria indicator surveys indicator surveys

100% 100%
Proportion of antimalarial treatments
Proportion of antimalarial treatments

80% 80%

60% 60%

40% 40%

20% 20%

0
0 Public sector Formal Informal Community
20102012 20112013 20122014 20132015 private sector private sector health worker

ACT, artemisinin-based combination therapy; RDT, rapid ACT, artemisinin-based combination therapy
diagnostic test

32 WORLD MALARIA REPORT 2016


In 20152016, pfhrp2/3 gene deletions were reported in studies from the China
Myanmar border, Ghana, in the Democratic Republic of the Congo, Eritrea, India,
Uganda, and Rwanda. These reports confirm that populations of P. falciparum
lacking one or both of the pfhrp2/3 genes are now present outside South America
in both high and low transmission areas, and with varying prevalence across
narrow geographical ranges.
Only RDTs that specifically target non-HRP2 antigens including pan- or Pf-specific
lactate dehydrogenase or aldolase will detect P. falciparum with pfhrp2 gene
deletions. Currently, very few RDTs of this type meet WHO recommended
procurement criteria or are WHO prequalified and therefore, new and/or improved
RDTs that can detect these mutated parasites are needed.
Treatment
Plasmodium falciparum resistance to artemisinin has been detected in five
countries in the Greater Mekong subregion. Artemisinin resistance is defined as
delayed clearance of the parasites; it represents a partial resistance. Most patients
who have delayed parasite clearance after treatment with an ACT are still able
to clear their infections, except where the parasites are also resistant to the ACT
partner drug.
Resistance to ACT partner drugs can pose a challenge to the treatment of malaria
in some areas. In Cambodia, high failure rates after treatment with an ACT have
been detected for four different ACTs (Figure 4.8). Resistance to dihydroartemisinin-
piperaquine, first detected in Cambodia in 2008, has spread eastwards and was
detected in Viet Nam in 2015. Selection
of an appropriate antimalarial medicine
Figure 4.8 Distribution of malarial multidrug resistance, is based on the efficacy of the medicine
2016. Source: WHO database against the malaria parasite. Monitoring
the therapeutic efficacy of antimalarial
medicine is therefore a fundamental
component of treatment strategies.
Yunnan Province,
China WHO recommends that all malaria
endemic countries conduct therapeutic
efficacy studies at least every 2years
to inform national treatment policy
(22). Studies of molecular markers of
Myanmar
Lao Peoples Democratic Republic drug resistance can provide important
additional information for detecting and
tracking antimalarial drug resistance.
Thailand
WHO collects information on therapeutic
Viet Nam efficacy and molecular markers in a
Cambodia global database.

1 ACT
2 ACTs
4 ACTs

ACT, artemisinin-based combination therapy

WORLD MALARIA REPORT 2016 33


34 WORLD MALARIA REPORT 2016
5. Malaria surveillance systems

Effective surveillance of malaria cases and deaths is essential for identifying


which areas or population groups are most affected by malaria, and for targeting
resources to communities most in need. Such surveillance also alerts ministries of
health to epidemics, enabling control measures to be intensified when necessary.
The transformation of surveillance into a core intervention constitutes the third
pillar of the GTS, and recommendations for establishing effective surveillance
systems have been published by WHO (23,24).
Surveillance systems do not detect all malaria cases for several reasons. First,
not all malaria patients seek care or, if they do, they may not seek care at health
facilities that are covered by a countrys surveillance system (Section 5.1). Second,
not all patients seeking care receive a diagnostic test (Section 5.2). Finally,
recording and reporting within the surveillance system is not always complete.
This section of the report summarizes indicators covering surveillance of malaria
cases, listed in Box 5.1.

Box 5.1 Indicators related to malaria surveillance systems


>> Proportion of expected health facility reports received at the national level
>> Proportion of malaria cases detected by surveillance systems

WORLD MALARIA REPORT 2016 35


5 Malaria surveillance systems

5.1 Health facility reports received at national level


The completeness of health facility reporting is a good indicator of a surveillance
systems performance, because achieving a high reporting rate requires health
facilities to adhere to several processes. These processes include the enumeration
of a complete list of reporting units, compliance with reporting requirements and
monitoring of that compliance. A high reporting rate is also critical to the eventual
interpretation of indicators. Health facility reporting rates become less relevant
as countries progress towards elimination and begin to report individual cases.
Nonetheless, to ensure that coverage of surveillance systems is complete, the
number of health facilities testing for malaria should continue to be tracked.
In 2015, among the countries that could report on this indicator, most (40 of 47)
reported health facility reporting rates of over 80% (Figure 5.1). However, this
indicator could not be calculated for about half of the countries in which malaria
was endemic in 2015, either because the number of health facilities that were
expected to report was not specified (two countries) or because the number of
reports submitted was not stated (17 countries), or both (24 countries). A total of
23 countries received reports from private health facilities, but these comprised
a minority of all reports received in those countries (median: 2.1%, IQR: 0.613%).

Figure 5.1 Health facility reporting rates by WHO region, 2015. Source: National malaria control programme
reports

100% 8099% 6079% <60% Unable to calculate


100%

80%
Proportion of countries

60%

40%

20%

0
AFR AMR EMR SEAR WPR World

AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; SEAR, WHO South-
East Asia Region; WPR, WHO Western Pacific Region

36 WORLD MALARIA REPORT 2016


5.2 Malaria cases detected by surveillance systems
It is estimated that, in 2015, malaria surveillance systems detected 19% of cases that
occur globally (UI: 1621%) (Figure 5.2). The bottlenecks in case detection vary by
WHO region. In the WHO African Region, the WHO Eastern Mediterranean Region,
the WHO South-East Asia Region and the WHO Western Pacific Region, a large
proportion of patients seek treatment in the private sector, and these cases are
not captured by existing surveillance systems. Also, in the WHO African Region,
the WHO Eastern Mediterranean Region and the WHO Western Pacific Region, a
relatively low proportion of patients attending public health facilities also receive
a diagnostic test. The regional patterns are sometimes dominated by individual
countries with the highest number of cases; for instance, a large proportion of
patients in India seek treatment in the private sector. Case detection rates have
increased by 10% since 2010, with most of this improvement being due to increased
diagnostic testing in sub-Saharan Africa.

Figure 5.2 Bottlenecks in case detection 2015, by WHO region. Sources: Nationally representative household
survey data and national malaria control programme reports

Seeking treatment Seeking treatment at facility covered by surveillance system Receiving diagnostic test Case reported
100%

80%
Proportion of all malaria cases

60%

40%

20%

0
AFR AMR EMR SEAR WPR World

AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; SEAR, WHO South-
East Asia Region; WPR, WHO Western Pacific Region

WORLD MALARIA REPORT 2016 37


Box 6.1 Indicators related to impact
>> Parasite prevalence: proportion of population with evidence of infection with malaria
parasites
>> Malaria case incidence: number and rate per 1000 persons per year
>> Malaria mortality rate: number and rate per 100 000 persons per year
>> Number of countries that have newly eliminated malaria since 2015
>> Number of countries that were malaria free in 2015 in which malaria has been
re-established

38 WORLD MALARIA REPORT 2016


6. Impact

The GTS set ambitious yet achievable targets for 2030; namely, to reduce malaria
incidence and mortality rates globally by at least 90% by 2030, with a milestone
of at least a 40% reduction by 2020 (2). The GTS also set a target to eliminate
malaria from at least 35 countries by 2030 (with a milestone of elimination in at
least 10 countries by 2020), and simultaneously to prevent the re-establishment
of malaria in all countries that were malaria free in 2015.
To assess progress towards the targets and milestones of the GTS, this section of
the report reviews the total number of malaria cases and deaths estimated to
have occurred in 2015, and reviews progress according to the indicators listed in
Box6.1. It also considers the gains in life expectancy that have occurred owing
to a reduction in malaria mortality rates, and the economic value of such gains.
The prevalence of infections with malarial parasites in people of all ages, including
children, can provide information on the level of malaria transmission in a country.
Parasite prevalence is most relevant for sub-Saharan Africa, where it is measured
through nationally representative household surveys. Such surveys can be brought
together in a geospatial model to facilitate the mapping of parasite prevalence
and the analysis of trends over time (see Annex 1). This form of analysis is restricted
to sub-Saharan Africa.
Malaria case incidence and mortality rates are relevant in all settings. Surveillance
systems do not capture all malaria cases and deaths that occur; hence, it is
necessary to use estimates of the number of cases or deaths in a country to make
inferences about global trends in malaria case incidence and mortality rates (as
described in Annex 1). The methods for producing estimates either adjust the
number of reported cases to account for the estimated proportion of cases that are
not captured by a surveillance system, or model the relationship between parasite
prevalence and case incidence or mortality. The latter method is used for countries
in sub-Saharan Africa for which surveillance data are lacking. The estimates aim
to fill gaps in reported data; however, because they rely on relationships between
variables that are uncertain, and draw on data that may be imprecisely measured,
the estimates have a considerable degree of uncertainty.

WORLD MALARIA REPORT 2016 39


6 Impact

6.1 Estimated number of malaria cases by WHO region,


20002015
In 2015, an estimated 212 million cases of malaria occurred worldwide (UI:
148304million), a fall of 22% since 2000 and of 14% since 2010 (Table 6.1). Most
of the cases in 2015 were in the WHO African Region (90%), followed by the WHO
South-East Asia Region (7%) and the WHO Eastern Mediterranean Region (2%)
(Table 6.2, Figure 6.1). About 4% of estimated cases globally are caused by P.vivax,
but outside the African continent this proportion increases to 41% (Table 6.2). Most
cases of malaria caused by P. vivax occur in the WHO South-East Asia Region
(58%), followed by the WHO Eastern Mediterranean Region (16%) and the WHO
African Region (12%). About 76% of estimated malaria cases in 2015 occurred in just
13 countries (Figure 6.2). Four countries (Ethiopia, India, Indonesia and Pakistan)
accounted for 78% of P. vivax cases.

Table 6.1 Estimated malaria cases, 20002015. Estimated cases are shown with 95% upper and lower uncertainty
intervals. Source: WHO estimates
Number of cases (000s) % change
2000 2005 2010 2011 2012 2013 2014 2015 20102015
Lower 202 000 202 000 192 000 183 000 171 000 158 000 152 000 148 000
Estimated total 271 000 266 000 245 000 235 000 224 000 217 000 212 000 212 000 -14%
Upper 314 000 313 000 287 000 276 000 272 000 271 000 306 000 304 000
Lower 18 000 18 700 13 700 13 100 11 200 9 200 8 000 6 600
Estimated P. vivax 28 900 25 700 17 500 16 600 14 200 11 300 9 100 8 500 -51%
Upper 37 400 32 300 22 100 21 000 17 400 14 300 12 200 10 800
% cases P. vivax 8% 10% 7% 7% 6% 5% 4% 4%

Table 6.2. Estimated malaria cases by WHO region, 2015. Estimated cases are shown with 95% upper and
lower uncertainty intervals. Source: WHO estimates
Number of cases (000s)
Outside
AFR AMR EMR EUR SEAR WPR World
sub-Saharan Africa
Lower 131000 500 2400 0 13300 1000 148000 16300
Estimated total 191000 800 3800 0 14400 1200 212000 18100
Upper 258000 1200 7500 0 35200 2200 304000 40300
Lower 300 400 1100 0 3400 500 6600 5800
Estimated P. vivax 1000 500 1400 0 4900 700 8500 7400
Upper 2100 800 1700 0 6800 900 10800 9300
% cases P. vivax 1% 69% 35% 34% 58% 4% 41%
AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; SEAR, WHO South-
East Asia Region; WPR, WHO Western Pacific Region

40 WORLD MALARIA REPORT 2016


Figure 6.1 Estimated malaria cases (millions) by WHO region, 2015. The area of the circles is proportional
to the estimated number of cases in each region. Source: WHO estimates

P. falciparum P. vivax

AFR 191 SEAR 14 EMR 3.8 WPR 1.2 AMR 0.8

AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; SEAR, WHO South-
East Asia Region; WPR, WHO Western Pacific Region

Figure 6.2 Estimated country share of (a) total malaria cases and (b) P. vivax malaria cases, 2015.
Source: WHO estimates

Others, 24%
Nigeria, 29%

Niger, 2% (a)
United Republic of Tanzania, 2%
Cameroon, 3%
Kenya, 3% Democratic Republic of the Congo, 9%
Burkina Faso, 3%
Ghana, 3%
Mali, 4% India, 6%
Uganda, 4% India, 49%
Cte dIvoire, 4% Others, 22%
Mozambique, 4%

Indonesia, 7% (b)

Pakistan, 10%

Ethiopia, 12%

WORLD MALARIA REPORT 2016 41


6 Impact

6.2 Estimated number of malaria deaths by WHO region,


20002015
In 2015, it was estimated that 429 000 deaths from malaria occurred globally
(UI: 235 000639 000), a decrease of 50% since 2000 and of 22% since 2010
(Table6.3). Most deaths in 2015 were estimated to have occurred in the WHO
African Region (92%), followed by the WHO South-East Asia Region (6%) and the
WHO Eastern Mediterranean Region (2%) (Table 6.4, Figure 6.3). Almost all deaths
(99%) resulted from P. falciparum malaria. Plasmodium vivax is estimated to have
been responsible for 3100 deaths in 2015 (range: 18004900), with most (86%)
occurring outside Africa.
In 2015, 303 000 malaria deaths (range: 165 000450 000) were estimated to
have occurred in children aged under 5 years, equivalent to 70% of the global
total (Table 6.4). The number of malaria deaths in children aged under 5 years
is estimated to have decreased by 60% since 2000 and by 29% since 2010.
Nevertheless, malaria remains a major killer of children, and is estimated to take
the life of a child every 2 minutes.

Table 6.3 Estimated malaria deaths 20002015. Estimated deaths are shown with 95% upper and lower
uncertainty intervals. Source: WHO estimates
Number of deaths % change
2000 2005 2010 2011 2012 2013 2014 2015 20102015

Lower 655 000 525 000 370 000 334 000 303 000 287 000 248 000 235 000
Estimated deaths 864 000 741 000 554 000 511 000 474 000 452 000 435 000 429 000 -22%
Upper 1 087 000 955 000 740 000 687 000 635 000 610 000 656 000 639 000
Lower 4 600 4 600 3 300 3 300 2 800 2 400 2 200 1 800
Estimated P. vivax deaths 11 100 9 700 6 400 6 100 5 200 4 100 3 300 3 100 -52%
Upper 15 700 14 300 10 700 9 500 8 200 6 300 5 200 4 900
Lower 571 000 437 000 286 000 253 000 224 000 210 000 180 000 165 000
Estimated deaths <5 years 753 000 616 000 428 000 387 000 351 000 330 000 315 000 303 000 -29%
Upper 947 000 794 000 573 000 520 000 470 000 446 000 476 000 450 000
% deaths P. vivax 1.3% 1.3% 1.2% 1.2% 1.1% 0.9% 0.8% 0.7%
% deaths <5 years 87% 83% 77% 76% 74% 73% 73% 70%

42 WORLD MALARIA REPORT 2016


Table 6.4 Estimated malaria deaths by WHO region, 2015. Estimated deaths are shown with 95% upper and
lower uncertainty intervals. Source: WHO estimates
Number of deaths
Outside
AFR AMR EMR EUR SEAR WPR World sub-Saharan
Africa
Lower 230 000 90 900 0 4 100 300 235 000 6 000
Estimated total deaths 394 000 490 7 300 0 26 200 1 500 429 000 30 000
Upper 549 000 1 100 14 600 0 67 100 6 800 639 000 77 000
Lower 70 60 250 0 700 120 1 800 1 500
Estimated P. vivax deaths 380 110 510 0 1 800 260 3 100 2 700
Upper 1 000 190 830 0 3 400 420 4 900 4 300
Lower 171 000 20 300 0 1 100 100 165 000 2 000
Estimated deaths <5 years 292 000 130 2 400 0 7 100 500 303 000 8 000
Upper 408 000 280 4 700 0 18 300 2 300 450 000 21 000
% deaths P. vivax 0,1% 22% 7% 7% 17% 0,7% 9%
% deaths <5 years 74% 26% 32% 27% 34% 70% 27%
AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; EUR, WHOEuropean
Region; SEAR, WHO South-East Asia Region; WPR, WHO Western Pacific Region

Figure 6.3 Estimated malaria deaths (thousands) by WHO region, 2015. The area of the circles is
proportional to the estimated number of cases in each region. Source: WHO estimates
P. falciparum P. vivax

AFR 394 SEAR 26 EMR 7.3 WPR 1.5 AMR 0.5

AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; SEAR, WHO South-
East Asia Region; WPR, WHO Western Pacific Region

WORLD MALARIA REPORT 2016 43


6 Impact

In 2015, it is estimated that 13 countries accounted for 75% of malaria deaths


(Figure6.4). The global burden of mortality is dominated by countries in
sub-Saharan Africa, with Democratic Republic of the Congo and Nigeria together
accounting for more than 36% of the global total of estimated malaria deaths. Four
countries accounted for 81% of estimated deaths due to P. vivax malaria (Ethiopia,
India, Indonesia and Pakistan).

Figure 6.4 Estimated country share of (a) total malaria deaths and (b) P. vivax malaria deaths,
2015. Source: WHO estimates

Others, 25% Nigeria, 26%

(a)
Niger, 2%

Kenya, 3%
Democratic Republic of the Congo, 10%
Uganda, 3%
Ghana, 3%
Cte dIvoire, 3%
Angola, 3% India, 6%
Burkina Faso, 3%
Mali, 5%
Mozambique, 4%
United Republic of Tanzania, 4%

Others, 19%
India, 51%

Indonesia, 7%

(b)

Pakistan, 11%

Ethiopia*, 12%
* There were zero reported P. vivax malaria deaths in Ethiopia;
the proportion shown here refers to WHO estimates

44 WORLD MALARIA REPORT 2016


6.3 Parasite prevalence
The proportion of the population at risk in sub-Saharan Africa who are infected
with malaria parasites is estimated to have declined from 22% in 2005 (UI: 2023%)
to 17% in 2010 (UI: 1618%), and to 13% in 2015 (UI: 1115%) (Figure 6.5). The number
of people infected in sub-Saharan Africa is also estimated to have decreased, from
146million in 2005 (UI: 135156 million) to 131 million in 2010 (UI: 126136 million),
and to 114million in 2015 (UI: 99130 million). Infection rates are higher in children
aged 210, but the majority of infected people are in other age groups.
In 2015, it is estimated that 7 of the 43 countries in sub-Saharan Africa with malaria
transmission had more than 25% of their population infected with malaria parasites
(Burkina Faso, Cameroon, Equatorial Guinea, Guinea, Mali, Sierra Leone and
Togo); this number has decreased from 12 countries in 2010. Outside Africa, surveys
of parasite prevalence conducted in Papua New Guinea showed a fall in the
proportion of children infected, from 12.4% in 2009 to 1.8% in 2014 (25).

Figure 6.5 Estimated (a) parasite prevalence and (b) number of people
infected, sub-Saharan Africa, 20052015. Source: Malaria Atlas Project
(http://www.map.ox.ac.uk/) (1)
(a) 40% 95% confidence interval
Proportion of population infected

30% Aged 210 years

20%
All ages

10%

0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

(b) 160
Number of people infected (million)

120 Other ages

80

40

Aged 210 years


0
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

WORLD MALARIA REPORT 2016 45


6 Impact

6.4 Malaria case incidence rate


The incidence rate of malaria, which takes into account population growth, is
estimated to have decreased by 41% globally between 2000 and 2015, and by
21% between 2010 and 2015 (Figure 6.6). Reductions in incidence rates need to be
accelerated if the GTS milestone of a 40% reduction by 2020 is to be achieved(2).
Decreases in incidence rates are estimated to have been greatest in the WHO
European Region (100%) and the WHO South-East Asia Region (54%).
Of 91 countries and territories with malaria transmission in 2015, 40 are estimated
to have achieved a reduction in incidence rates of 40% or more between 2010
and 2015, and can be considered on track to achieve the GTS milestone of a
further reduction of 40% by 2020 (Figure 6.7). Another 20 countries achieved
reductions of 2040%. Most of the 40 countries with reductions of more than 40%
had fewer than 1 million cases in 2010; countries with more than 1 million cases had
smaller reductions. These data suggest that the GTS milestone of a 40% reduction
in case incidence by 2020 will be achieved only if reductions in case incidence are
accelerated in countries with high case numbers.
Incidence rates changed by less than or equal to 20% in 18 countries, and
increased by more than 20% in 13 countries between 2010 and 2015 (Figure
6.7). The proportion of countries with fewer than 10 000 cases that reported
increased incidence rates (21%) was higher than the proportion of countries with
10000 to 1 million cases (15%) and of countries with more than 1 million cases
(9%). These figures may be related to the greater variability in case incidence in
low-transmission settings. In addition, countries with fewer cases that previously
had high levels of malaria transmission may be more prone to resurgences if the
coverage of their malaria control programme is reduced.

Figure 6.6 Reduction in malaria case incidence Figure 6.7 Country-level changes in malaria
rate by WHO region, 20102015. No indigenous case incidence rate 20102015, by number of
cases were recorded in the WHO European Region in 2015. cases in 2010. Source: WHO estimates
Source: WHO estimates

Europe Estimated number of cases in 2010:


100%
> 1 000 000 10 000 to 1 000 000 < 10 000
50
South-East Asia 54%
40
Americas 31%
Number of countries

30
Western Pacific 30%

20
African 21%

10
Eastern Mediterranean 11%

0
World 21% Decrease >40% Decrease 2040% Change <20% Increase >20%
Change in malaria incidence 20102015

46 WORLD MALARIA REPORT 2016


6.5 Malaria mortality rate
Malaria mortality rates are estimated to have declined by 62% globally between
2000 and 2015, and by 29% between 2010 and 2015 (Figure 6.8). The rate of
decline between 2010 and 2015 has been fastest in the WHO Western Pacific
Region (58%) and the WHO South-East Asia Region (46%). In children aged under
5 years, malaria mortality rates are estimated to have fallen by 69% globally
between 2000 and 2015 and by 35% globally between 2010 and 2015. They fell by
38% in the WHO African Region between 2010 and 2015.
Of 91 countries and territories with malaria transmission in 2015, 39 are estimated
to have achieved a reduction of 40% or more in mortality rates between 2010
and 2015, 14 had reductions of 2040% and 8 experienced increases in mortality
rates of >20%. A further 10 countries reported no deaths in 2010 and in 2015 (the
remaining 20 countries experienced changes <20%). Reductions in mortality rates
were generally faster in countries with a smaller initial number of malaria deaths
(Figure 6.9). For the GTS milestone of a 40% reduction in mortality rates to be
achieved by 2020, rates of reduction will need to increase in those countries that
have higher numbers of deaths.

Figure 6.8 Reduction in malaria mortality Figure 6.9 Country-level changes in malaria
rate, by WHO region, 20102015. No deaths from mortality rate 20102015, by number of deaths
indigenous malaria were recorded in the WHO European in 2010. Source: WHO estimates
Region from 2010 to 2015. Source: WHO estimates

Western Pacific Estimated number of deaths in 2010:


58%
>500 50100 <50
50
South-East Asia 46%
40
Number of countries

Americas 37%
30

African 31% 20

Eastern Mediterranean 6% 10

0
World 29% Decrease >40% Decrease 2040% Change <20% Increase >20%
Change in malaria mortality rate 20102015

WORLD MALARIA REPORT 2016 47


6 Impact

6.6 Malaria elimination and prevention of re-establishment


A target of the GTS is, by 2030, to eliminate malaria from 35 countries in which
malaria was transmitted in 2015, and a milestone is to eliminate malaria in
at least 10countries by 2020 (2). A further target of the strategy is to prevent
re-establishment of malaria in all countries that are malaria free.
A country must report zero indigenous cases of malaria for 3 consecutive years
before it is considered to have eliminated the disease. Between 2000 and 2015,
17 countries attained zero indigenous cases for 3 years or more (Figure 6.10), and
10 of these countries attained zero indigenous cases for 3 years within the period
20112015. Malaria has not re-established in any of these countries.
Countries that have attained zero indigenous cases for 3 years or more, and
that have sufficiently robust surveillance systems in place to demonstrate this
achievement, are eligible to request WHO to initiate procedures for certification
that they are malaria free. The process of certification is optional. Between 2000
and 2015, six of the 17 countries that attained zero indigenous cases for 3 years or
more were certified as free of malaria by WHO (Figure 6.10).

Figure 6.10 Countries attaining zero indigenous malaria cases since 2000. Countries are shown by the
year that they attained 3 consecutive years of zero indigenous cases. Countries that have been certified as free of malaria are
shown in green, with the year of certification in brackets. Source: Country reports

2000 Egypt United Arab Emirates (2007)


2001
2002
2003
2004 Oman
2005
2006
2007 Morocco (2010) Syrian Arab Republic
2008 Armenia (2011)
2009 Turkmenistan (2010)
2010
2011 Iraq
2012 Georgia Turkey
2013 Argentina Kyrgyzstan (2016) Uzbekistan
2014 Paraguay
2015 Azerbaijan Costa Rica Sri Lanka (2016)

48 WORLD MALARIA REPORT 2016


In progressing to malaria elimination, the 17 countries reported a median of
184indigenous cases 5 years before attaining zero cases (IQR: 78728), and
a median of 1748 cases 10 years before attaining zero cases (IQR: 4235731)
(Figure6.11). However, three countries (Cabo Verde, El Salvador and Saudi Arabia)
did not reach zero cases by 2015, despite having fewer than 500 indigenous cases
in 20002005.
In 2015, 10 countries and territories reported fewer than 150 indigenous cases,1
and a further 9 countries reported between 150 and 1000 indigenous cases
(Figure6.12). Thus, there appears to be a good prospect of attaining the GTS
milestone of eliminating malaria from 10 countries by 2020. In April 2016,
WHO published an assessment of the likelihood of countries achieving malaria
elimination by 2020. The assessment was based not only on the number of cases
but also on the declared malaria objectives of affected countries and on the
informed opinions of WHO experts in the field (26).

1. Excludes Tajikistan, which reported zero indigenous cases in 2015 but has not yet attained 3years of
zero indigenous cases.

Figure 6.11 Indigenous malaria cases in the Figure 6.12 Number of indigenous malaria cases
years before attaining zero indigenous cases for countries endemic for malaria in 2015, by
for the 17 countries that eliminated malaria, WHO region. Source: WHO estimates
20002015. Median number of cases is shown as a blue
line. Interquartile range is shaded in light blue. Source: AFR AMR EMR SEAR WPR
Country reports
<150 10

100 000
1501000 9
Estimated cases in 2015

10 000
Number of malaria cases

100010 000 11

1000
10 000 29
1 000 000
100

>1 000 000 32


10
0 5 10 15 20 25 30 35
Number of countries

1 AFR, WHO African Region; AMR, WHO Region of the Americas;


15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 EMR, WHO Eastern Mediterranean Region; SEAR, WHO South-
Number of years before attaining zero cases East Asia Region; WPR, WHO Western Pacific Region

WORLD MALARIA REPORT 2016 49


6 Impact

6.7 Malaria cases and deaths averted since 2000 and change in
life expectancy
It is estimated that a cumulative 1.3 billion fewer malaria cases and 6.8 million
fewer malaria deaths occurred globally between 2001 and 2015 than would have
occurred had incidence and mortality rates remained unchanged since 2000. The
highest proportion of cases and deaths were averted in the WHO African Region
(94%). Of the estimated 6.8 million fewer malaria deaths between 2001 and 2015,
about 6.6 million (97%) were for children aged under 5 years.
Not all of the cases and deaths averted can be attributed to malaria control efforts.
Some progress is probably related to increased urbanization and overall economic
development, which has led to improved housing and nutrition. However, it has
previously been estimated that 70% of the cases averted between 2001 and 2015
were due to malaria interventions (1).
In the WHO African Region, reduced malaria mortality rates, particularly among
children aged under 5 years, have led to a rise in life expectancy at birth of
1.2years, accounting for 12% of the total increase in life expectancy of 9.4 years
from 50.6 years in 2000 to 60 years in 2015. Across all malaria endemic countries,
the contribution of malaria mortality reduction was 0.26 years or 5% of the total
increase in life expectancy between 2000 and 2015, from 66.4 years to 71.4 years
(Table 6.5, Figure 6.13).

6.8 Economic value of reduced malaria mortality risk, estimated


by full income approach
The full income approach attempts to assign a value to gains in life expectancy
by considering the importance that individuals and society place on reductions

Figure 6.13. Gains in life expectancy in malaria endemic countries, 20002015. Source: WHO estimates

Life expectancy at birth in 2000 Gain in life expectancy due to malaria mortality reduction
Gain in life expectancy due to reduction in deaths from other causes
80

70
Life expectancy (years)

60

50

40
AFR AMR EMR EUR SEAR WPR World

AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; EUR, WHO
European Region; SEAR, WHO South-East Asia Region; WPR, WHO Western Pacific Region

50 WORLD MALARIA REPORT 2016


in mortality (i.e. increased longevity). In monetary terms the method places a
value of US$ 1810 billion on the life-expectancy gains observed in sub-Saharan
Africa between 2000 and 2015, and US$ 2040 billion globally (Table 6.6). This is
equivalent to 44% of the gross domestic product (GDP) of the affected countries
in the WHO Africa Region in 2015, and 3.6% in affected countries globally. The
economic value of longer life is expressed here as a percentage of GDP in order
to provide a convenient and well-known comparison, but is not meant to suggest
that the value of longevity is itself a component of domestic output (i.e. GDP),
or that the value of these gains should enter directly into the national income
accounts (27). Nonetheless, the comparison suggests that the value of the gains
in life expectancy due to reduction in malaria mortality are substantial, and that
the total investments called for in the GTS in order to achieve the 2030 target of
a reduction in the malaria mortality rate of at least 90% would be repaid many
times over.

Table 6.5. Gains in life expectancy in malaria endemic countries, 20002015. Source: WHO estimates
Gain in life expectancy due to
Life expectancy at birth % gain due
reductions in mortality from
to malaria
2000 2015 Malaria Other causes
AFR 50.6 60.0 1.159 8.2 12.3%
AMR 73.7 76.9 0.003 3.2 0.1%
EMR 65.4 68.8 0.045 3.4 1.3%
EUR 72.3 76.8 0.000 4.5 0.0%
SEAR 63.5 69.0 0.034 5.4 0.6%
WPR 72.5 76.6 0.018 4.0 0.4%
World 66.4 71.4 0.255 4.8 5.0%
AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; EUR, WHO
European Region; SEAR, WHO South-East Asia Region; WPR, WHO Western Pacific Region

Table 6.6. Economic value of reduced malaria mortality risk, estimated by full income approach,
20002015. Source: WHO estimates
Value of malaria mortality risk reduction Value of malaria mortality risk reduction
20002015 (US$ 2015, PPP, billions) as % of GDP
Estimate Lower Upper Estimate Lower Upper
AFR 1 810 1 330 2 480 44.4% 32.6% 60.9%
AMR 8 7 9 0.1% 0.1% 0.1%
EMR 64 53 75 1.3% 1.1% 1.5%
EUR
SEAR 131 107 160 1.0% 0.8% 1.3%
WPR 28 24 33 0.1% 0.1% 0.1%
World 2 040 1 560 2 700 3.6% 2.8% 4.8%
AFR, WHO African Region; AMR, WHO Region of the Americas; EMR, WHO Eastern Mediterranean Region; EUR, WHO
European Region; GDP, gross domestic product; PPP, purchasing power parity; SEAR, WHO South-East Asia Region; WPR, WHO
Western Pacific Region

WORLD MALARIA REPORT 2016 51


Conclusions

The World Malaria Report 2016 is the first such report to be released during the era
of the GTS 20162030 (2). Because the latest data included in the report are mostly
from 2015, direct reporting on the progress of the GTS is not possible. However, the
World Malaria Report 2016 provides a baseline against which progress since 2015
can be assessed in the future. Also, by looking at trends in indicators since 2010,
the report can give an indication of where programmes are on track to meet the
GTS 2020 milestones and where progress needs to be accelerated.
Although malaria funding increased considerably between 2000 and 2010, it has
remained relatively stable since 2010. It totalled US$ 2.9 billion in 2015, representing
only 46% of the GTS funding milestone for 2020. Governments of malaria endemic
countries provided 32% of total funding in 2015, and the Global Fund accounted for
nearly half of international financing. Pledges to the Global Fund for financing for
20172019 have increased by 8% compared to 20142016 pledges. Total funding must
increase substantially if the GTS 2020 milestone of US$ 6.4 billion is to be achieved.
The coverage of malaria interventions rose between 2010 and 2015. More than half
of the population of sub-Saharan Africa (57%) now benefits from vector-control
interventions (IRS or ITNs), and an increased proportion of pregnant women receive
three doses of IPTp (31% in 2015). More than half of suspected malaria cases attending
public health facilities in the WHO African Region receive a diagnostic test, and the
proportion of malaria cases treated with effective antimalarial drugs is increasing.
Nevertheless, significant gaps in programme coverage remain. Access to vector
control has been greatly extended through mass-distribution campaigns; however,
increasing the coverage of chemoprevention, diagnostic testing and treatment
requires these interventions to be delivered through health systems that are frequently
under-resourced and poorly accessible to those most at risk of malaria. Moreover,
the potential for strengthening health systems in malaria endemic countries is often
constrained by low national incomes and per capita domestic spending on health
and malaria control. The limited ability to strengthen systems in order to deliver
interventions remains a significant challenge for ensuring universal access to malaria
prevention, diagnosis and treatment, as called for in Pillar 1 of the GTS (2).
Pillar 2 of the GTS calls for countries to accelerate efforts towards malaria
elimination and attainment of malaria free status (2). Ten countries eliminated

52 WORLD MALARIA REPORT 2016


malaria between 2010 and 2015, and malaria has not been re-established in
any malaria free country since 2000. In 2015, 10 countries had fewer than
150indigenous cases, and another nine had between 150 and 1000 cases. Thus,
there appear to be good prospects of attaining the GTS milestone of eliminating
malaria from at least 10 countries by 2020 and preventing re-establishment of
malaria in all countries that are malaria free.
Malaria surveillance systems detected a higher proportion of malaria cases
globally in 2015 (20% of cases) than in 2010 (10%). Most of this improvement
resulted from increased diagnostic testing in sub-Saharan Africa. However, a large
proportion of people with malaria either do not seek treatment or seek treatment
in the private sector, where they are less likely to receive a diagnostic test or to
be reported in a malaria surveillance system. Although patients may seek care
at public health facilities, diagnostic testing is not yet universal, nor is reporting
complete. Addressing the bottlenecks in case detection, diagnosis and reporting
is critical in order to transform malaria surveillance into a core intervention, as
envisaged in Pillar 3 of the GTS.
Malaria case incidence rates are estimated to have decreased by 21% globally
between 2010 and 2015, and malaria mortality rates by 29%. If the GTS milestone
of a 40% reduction in case incidence and mortality rates by 2020 is to be achieved
globally, reductions in case incidence and mortality rates must be accelerated in
countries with high numbers of cases and deaths. However, these countries are
currently furthest from the per capita spending milestone for 2020 in the GTS (2).
Target 3.3 of the SDGs End the epidemics of AIDS, TB, malaria and NTDs by
2030 is interpreted by WHO as the attainment of the GTS targets. The analysis
summarized above indicates that the world is not on track to meet Target 3.3.
for malaria. In addition to SDG Target 3.3, reaching the GTS targets will also
contribute to other health-related goals of SDG 3, which are to ensure healthy
lives and promote well-being for all at all ages. It will also contribute to other
SDGs, particularly Goal 1 (end poverty in all its forms everywhere), Goal 4
(ensure inclusive and equitable quality education and promote lifelong learning
opportunities for all), Goal 5 (achieve gender equality and empower all women
and girls), Goal 8 (promote sustained, inclusive and sustainable economic growth,
full and productive employment and decent work for all) and Goal 10 (reduce
inequality within and among countries).
Although it will be challenging to reach the 2020 milestones of the GTS, recent
experience in combatting malaria has shown that much progress is possible, and
that such progress can greatly improve the health and well-being of populations.
Reduced malaria mortality rates have led to an increase of 1.2 years in life
expectancy at birth in the WHO African Region. This increase represents 12% of
the total increase in life expectancy seen in sub-Saharan Africa, from 50.6 years
in 2000 to 60 years in 2015, a highly significant contribution. Although placing a
monetary value on malaria mortality reductions or increased life expectancy is
difficult, current methodologies suggest that the change observed can be valued
at US$ 1810 billion (UI: US$ 13302480 billion), which is equivalent to 44% of the
GDP of the affected countries in 2015. Thus, the benefits of pursuing the goals
and milestones of the GTS are considerable, and make it worth overcoming the
challenges presented.

WORLD MALARIA REPORT 2016 53


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al. Efficacy and safety of intermittent preventive treatment with sulfadoxine-
pyrimethamine for malaria in African infants: a pooled analysis of six randomised,
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12. Cairns M, Roca-Feltrer A, Garske T, Wilson AL, Diallo D, Milligan PJ et al. Estimating
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system efficiency and future needs for achieving international targets. Malar J.
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pdf?ua=1, accessed 15 November 2016).
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56 WORLD MALARIA REPORT 2016
Annexes
Annex 1 - Data sources and methods
Annex 2 - Regional profiles
>> A - West Africa
>> B - Central Africa
>> C - East and Southern Africa
>> D - Region of the Americas
>> E - Eastern Mediterranean Region
>> F - South-East Asia Region
>> G - Western Pacific Region

Annex 3 - Country trends in selected indicators


>> A - Funding per capita for malaria control and elimination (in US$)
>> B - Proportion of population at risk sleeping under an ITN
>> C - Estimated malaria case incidence rate (cases per 1000 population at risk)
>> D - Estimated malaria mortality rate (deaths per 100 000 population at risk)
>> E - Estimated change in malaria incidence and mortality rates, 20102015

Annex 4 - Data tables


>> A - Policy adoption, 2015
>> B - Antimalarial drug policy, 2015
>> C - Funding for malaria control, 20132015
>> D - Commodities distribution, 20132015
>> E - Household survey results, 20132015
>> F - Estimated malaria cases and deaths, 20002015
>> G - Population at risk and reported malaria cases by place of care, 2015
>> H - Reported malaria cases by method of confirmation, 20002015
>> I - Reported malaria cases by species, 20002015
>> J - Reported malaria deaths, 20002015

WORLD MALARIA REPORT 2016 57


Annex 1 Data sources and methods

Figure 1.1 Countries endemic for malaria in 2000 secondary or teaching hospitals. Costs of outpatient
and 2016 visits and inpatient bed-stays were estimated from the
Data on the number of indigenous cases (an indicator perspective of the public health-care provider, using
of whether countries are endemic for malaria) were WHO-CHOICE estimates.1 The estimates were updated
as reported to WHO by national malaria control for 20052015 by rerunning the regression model using
programmes (NMCPs). Countries with 3 consecutive the relevant gross domestic product (GDP) per capita
years of zero indigenous cases are considered to have in each year. When no GDP data were available for a
eliminated malaria. given year, outpatient department and inpatient unit
costs were imputed using the values from the most
Table 1.1 Global targets for 2030 and milestones recent year with available unit-cost data, and were
for 2020 and 2025 adjusted with the GDP deflator. When no unit-cost
Targets and milestones are as described in the Global data were available for the full period, a unit cost
Technical Strategy for Malaria 20162030 (GTS) (1) and was imputed from the median unit cost in that year in
Action and investment to defeat malaria 20162030 countries within the same World Bank income group.
(AIM) (2). Uncertainty around case and cost parameters was
estimated through probabilistic uncertainty analysis;
Table 1.2 Indicators reviewed in World Malaria
that is, by assigning a uniform distribution informed by
Report 2016 lower and upper estimates for each parameter. The
Indicators are as described in Monitoring and evaluation
figure shows the mean total costs of service delivery for
of the Global Technical Strategy for Malaria 20162030
patient care from 1000 estimations.
and Action and investment to defeat malaria 20162030
(3). International financing data were obtained from several
sources. The Global Fund to Fight AIDS, Tuberculosis and
Figure 2.1 Investments in malaria control activities Malaria (Global Fund) provided disbursed amounts by
by funding source, 20052015 year and country for 20052015. Data on funding from
Contributions from governments of endemic countries the government of the United States of America (USA)
are estimated as the sum of NMCP expenditures were sourced from the US Foreign Aid Dashboard, with
reported by NMCPs for the World Malaria Report of the technical assistance of the Kaiser Family Foundation.
the relevant year plus the estimated costs of delivery of Funding data were available for the US Agency for
patient-care services at government health facilities. If International Development (USAID), the US Centers
data on NMCP expenditures were missing for 2015, data for Disease Control (CDC) and the US Department of
from previous years were used after conversion to the Defense. Country-level data were available for USAID
equivalent 2015 US$ value. The number of malaria cases for 20062015. Financing data for other international
attending outpatient services at government facilities funders included annual disbursement flows for 2005
was derived from WHO estimates of malaria cases (see 2014, obtained from the Organisation for Economic
methods notes for Table 6.1) multiplied by the proportion Co-operation and Development (OECD) creditor
of estimated cases seeking care at government facilities. reporting system (CRS) database on aid activity. For
Between 1% and 3% of uncomplicated cases were each year and each funder, the country-level and
assumed to have moved to the severe stage of disease, regional-level project-type interventions and other
and 5080% of these severe cases were assumed to technical assistance were extracted. The 2014 value for
have been admitted to secondary or tertiary level international annual contributions was used as the 2015
hospitals. Outpatients were assumed to have been value, except for contributions from the United Kingdom
treated at health centres (with or without beds) or at of Great Britain and Northern Ireland; for this value, a
primary level hospitals (e.g. district hospitals). Inpatients linear increase was assumed based on trends from 2012
were assumed to have been admitted to primary,
1. http://www.who.int/choice/en/

58 WORLD MALARIA REPORT 2016


to 2014. To measure funding in real terms (i.e. correct for society strengthening, stigma-reduction efforts,
inflation), all values were converted to 2015 US$ values, and management and administration. For Figure
using the GDP implicit price deflators published by the 2.3, expenditures on health-system strengthening
World Bank. Estimates of total spent on malaria control and supportive environment were combined. For
and elimination exclude household spending on malaria expenditures of the US Presidents Malaria Initiative
prevention and treatment. (PMI), all operational plans that included planned
obligations for 20132015 were reviewed and
Figure 2.2 Annual flow of funding for malaria categorized as health-system strengthening, prevention
control and elimination, 20142015 or treatment. PMI health-system-strengthening
See methods notes for Figure 2.1 for sources of categories included communications, capacity-
information on funding from governments of malaria building, surveillance, M&E, and research and strategic
endemic countries and on international flows to endemic information. Prevention expenditures included those
countries. Contributions from individual countries to the for long-lasting insecticidal nets (LLINs), indoor
Global Fund are shown when their 2014 and 2015 annual residual spraying (IRS) and chemoprevention, which
average core contributions to the fund accounted for 3% encompass, for example, expenditures on commodities,
or more of the total amount of contributions received by human resources, distribution and transport. Treatment
the fund in 2014 and 2015. Contributions from funding expenditures included any resources used for malaria
sources to multilateral channels were estimated by case management. Costs for in-country mission staffing
calculating the proportion of the total contributions were excluded from the analysis (representing 12% of
received by a multilateral in 2014 (2014 and 2015 in total average spending). Government expenditures
the case of the Global Fund) that was contributed by included data reported by NMCPs for the relevant World
a funding source, then multiplying that figure by the Malaria Report, in similar categories to those used by
multilaterals estimated investment in malaria in 2015. the Global Fund. We included data from 36 countries
These data were sourced from the Global Fund and, that had data for the expenditure categories for at least
for other funders, from the OECD.Stat website2 using 2 years between 2013 and 2015.
the CRS and the Development Assistance Committee
(DAC) members total use of the multilateral system. Figure 2.4 Funding for malaria-related research
Contributions from non-DAC countries and other sources and development, 20102014
were not available and were therefore not included in Data on funding for malaria-related research and
this figure. All funding flows were converted to 2015 development for 20102014 were collected directly
equivalents in US$ (millions). from the G-Finder Public Search tool.3 All data were
converted to 2015 equivalents in US$.
Figure 2.3 Malaria financing, 20132015, by type
of expenditure Figure 2.5 Source of funding for malaria-related
The Global Fund provided expenditure data by research and development, 2014
category for 20132015. Expenditure categories were See methods notes for Figure 2.4.
health-system strengthening, supportive environment,
prevention and treatment. Expenditures related to Figure 2.6 Malaria financing per person at risk,
health-system strengthening included communication 20132015, by estimated number of malaria
and advocacy, human resources and technical cases, 2015
assistance, training, monitoring and evaluation (M&E), See methods notes for Figure 2.1 for sources of
procurement and supply management, and planning. information on malaria financing. The total population
Expenditures related to supportive environment of each country was taken from the 2015 revision of the
included spending on policy development, civil- World population prospects (4) and the proportion at

2. http://stats.oecd.org/ 3. https://gfinder.policycures.org/PublicSearchTool

WORLD MALARIA REPORT 2016 59


Annex 1 Data sources and methods

risk of malaria was derived from NMCP reports. Funding RDTs) divided by the total number of tests undertaken,
milestones for 2020 were derived from the costing of as reported by countries in the WHO African Region.
the GTS (1).
Figure 3.1 Proportion of population at risk with
Figure 2.7 Number of ITNs delivered by access to an ITN and sleeping under an ITN, and
manufacturers and distributed by NMCPs, proportion of households with at least one ITN
20092016 and enough ITNs for all occupants, sub-Saharan
Data on the number of insecticide-treated mosquito Africa, 20052015
nets (ITNs) delivered by manufacturers to countries were Estimates of ITN coverage were derived from a
provided to WHO by Milliner Global Associates. Data model developed by the Malaria Atlas Project,4 using
from NMCP reports were used for the number of ITNs a two-stage process. First, we defined a mechanism
distributed within countries. for estimating net crop (i.e. the total number of ITNs
in households in a country at a given point in time),
Figure 2.8 Number of RDTs sold by manufacturers taking into account inputs to the system (e.g. deliveries
and distributed by NMCPs, 20102015 of ITNs to a country) and outputs (e.g. loss of ITNs
The numbers of rapid diagnostic tests (RDTs) distributed from households). We then used empirical modelling
by WHO region are the annual totals reported as having to translate estimated net crops into resulting levels of
been distributed by NMCPs. Numbers of RDT sales were coverage (e.g.access within households, use in all ages
reported by 41 manufacturers that participated in RDT and use among children aged under 5 years).
product testing by WHO, the Foundation for Innovative The model incorporates data from three sources:
New Diagnostics, the CDC and the Special Programme
the number of ITNs delivered by manufacturers to
for Research and Training in Tropical Diseases. The
countries, as provided to WHO by Milliner Global
number of RDTs reported by manufacturers represents
Associates;
total sales to the public and private sectors worldwide.
the number of ITNs distributed within countries, as
Figure 2.9 Number of ACT treatment courses reported to WHO by NMCPs; and
delivered by manufacturers and distributed by data from nationally representative household
NMCPs, 20102015 surveys from 39 countries in sub-Saharan Africa,
Data on artemisinin-based combination therapy (ACT) from 2001 to 2015.
sales were provided by eight manufacturers eligible for
procurement by WHO or the United Nations Childrens Countries and populations at risk
Fund (UNICEF). ACT sales were categorized as being The main analysis covered 40 of the 47 malaria endemic
to either the public sector or the private sector. Data countries or areas of sub-Saharan Africa. The islands of
on ACTs distributed within countries through the public Mayotte (for which no ITN delivery or distribution data
sector were taken from NMCP reports to WHO. were available) and Cabo Verde (which does not distribute
ITNs) were excluded, as were the low-transmission
Figure 2.10 Ratio of ACT treatment courses countries of Namibia, Sao Tome and Principe, South
distributed to diagnostic tests performed (RDTs Africa and Swaziland, for which ITNs comprise a small
or microscopy), WHO African Region 20102015 proportion of vector control. Analyses were limited to
The ratio was calculated using the number of ACTs populations categorized by NMCPs as being at risk.
distributed, the number of microscopic examinations
of blood slides, and the number of RDTs performed Estimating national net crops through time
in the WHO African Region, as reported by NMCPs to As described by Flaxman et al. (5), national ITN systems
WHO. The test positivity rate was calculated as the were represented using a discrete-time stock-and-flow
total number of positive tests (i.e. slide examinations or
4. http://www.map.ox.ac.uk/

60 WORLD MALARIA REPORT 2016


model. Nets delivered to a country by manufacturers net ownership pattern (i.e. the proportion of households
were modelled as first entering a country stock with zero nets, one net, two nets and so on). In this way,
compartment (i.e. stored in-country but not yet the size of the net crop was linked to distribution patterns
distributed to households). Nets were then available among households while accounting for household size
from this stock for distribution to households by the in order to generate ownership distributions for each
NMCP or other distribution channels. To accommodate stratum of household size. The bivariate histogram
uncertainty in net distribution, the number of nets of net crop to distribution of nets among households
distributed in a given year was specified as a range, with by household size made it possible to calculate the
all available country stock (i.e. the maximum number of proportion of households with at least one ITN. Also,
nets that could be delivered) as the upper end of the because the number of both ITNs and people in each
range and the NMCP-reported value (i.e. the assumed household was available, it was possible to directly
minimum distribution) as the lower end. New nets calculate the two additional indicators: the proportion
reaching households joined older nets remaining from of households with at least one ITN for every two people,
earlier time steps to constitute the total household net and the proportion of the population with access to an
crop, with the duration of net retention by households ITN within their household. For the final ITN indicator
governed by a loss function. Rather than fitting the loss the proportion of the population who slept under
function to a small external dataset, as was done by an ITN the previous night the relationship between
Flaxman et al. (5), the loss function was fitted directly ITN use and access was defined using 62 surveys in
to the distribution and net crop data within the stock- which both these indicators were available (ITN useall
and-flow model itself. Loss functions were fitted on a ages
= 0.8133*ITN accessall ages + 0.0026, R = 0.773). This
country-by-country basis, were allowed to vary through relationship was applied to the Malaria Atlas Projects
time, and were defined separately for conventional countryyear estimates of household access in order to
ITNs (cITNs) and LLINs. The fitted loss functions were obtain ITN use among all ages. The same method was
compared to existing assumptions about rates of net used to obtain the countryyear estimates of ITN use
loss from households. The stock-and-flow model was in children aged under 5 years (ITN usechildren under five =
fitted using Bayesian inference and Markov chain Monte 0.9327x + 0.0282, R = 0.754).
Carlo methods, which provided time-series estimates of
national household net crop for cITNs and LLINs in each Figure 3.2 Proportion of ITNs distributed through
country, and an evaluation of underdistribution, all with different delivery channels in sub-Saharan
posterior credible intervals. Africa, 20132015
Data on the number of ITNs distributed within countries
Estimating indicators of national ITN access were as reported to WHO by 39 countries where ITNs
and use from the net crop are the primary method of vector control.
Rates of ITN access within households depend not
only on the total number of ITNs in a country (i.e. the Figure 3.3 Proportion of the population at risk
net crop), but also on how those nets are distributed protected by IRS by WHO region, 20102015
among households. One factor that is known to strongly The number of persons protected by IRS was reported
influence the relationship between net crop and net to WHO by NMCPs. The total population of each country
distribution patterns among households is the size of was taken from the 2015 revision of the World population
households, which varies among countries, particularly prospects (4) and the proportion at risk of malaria was
across sub-Saharan Africa. derived from NMCP reports.

Many recent national surveys report the number of Figure 3.4 Insecticide class used for indoor
ITNs observed in each household surveyed. Hence, it residual spraying, 20102015
is possible to not only estimate net crop, but also to Data on the type of insecticide used for IRS were
generate a histogram that summarizes the household reported to WHO by NMCPs. Insecticides were

WORLD MALARIA REPORT 2016 61


Annex 1 Data sources and methods

classified into pyrethroids or other classes (carbamates, Figure 3.7 Proportion of pregnant women
organochlorines or organophosphates). If data were not receiving IPTp, by dose, sub-Saharan Africa,
reported for a particular year, data from the most recent 20102015
year were used. For the period 20102015 this method The total number of pregnant women eligible for
of imputation was used for an average of 19 countries intermittent preventive treatment in pregnancy (IPTp)
each year. was calculated by adding total live births calculated
from the United Nations (UN) population data and
Figure 3.5 Proportion of the population at risk
spontaneous pregnancy loss (specifically, miscarriages
protected by IRS or sleeping under an ITN in and stillbirths) after the first trimester. Spontaneous
sub-Saharan Africa, 20102015 pregnancy loss has previously been calculated by
The proportion of the population at risk sleeping under Dellicour et al. (6). Country-specific estimates of IPTp
an ITN was derived as described for Figure 3.1, and coverage were calculated as the ratio of pregnant
the proportion benefiting from IRS was derived as women receiving IPTp at antenatal care (ANC) clinics
for Figure 3.4. In combining these proportions, the to the estimated number of IPTp-eligible pregnant
extent to which populations benefit from one or both women in a given year. ANC attendance rates were
of these interventions must be estimated. Analysis of derived in the same way, using the number of initial
household survey data indicates that about half of the ANC visits reported through routine information systems.
people in IRS-sprayed households are also protected Local linear interpolation was used to compute missing
by ITNs, but the extent of overlap between intervention values. Annual aggregate estimates exclude countries
coverage can vary from 0% to 100% (if the proportions for which a report or interpolation was not available
sum to <1). To reflect this uncertainty, we assumed the for the specific year. Among 34 countries with IPTp
combined coverage to have a rectangular distribution policy, IPTp1 dose coverage could be calculated for
with the range of maximum (0%, ITNcoverage + IRScoverage 34 countries, IPTp2 for 33 countries, and IPTp3 for 20
100%) to minimum (ITN coverage, IRScoverage). Palisades countries. Aggregate estimates of IPTp1 and IPTp2
@Risk software (version 6.0)5 was used to sample from coverage for 20 countries with IPTp3 estimates were
the distributions for each country, and a continental similar to estimates of IPT1 and IPTp2 coverage using
estimate of vector-control coverage was obtained by data from all countries.
summing the combined ITN and IRS coverage of all
countries. Figure 4.1 Proportion of febrile children seeking
care, by health sector, sub-Saharan Africa, 2013
Figure 3.6 Insecticide resistance and monitoring
2015
status for malaria endemic countries (2015), by Estimates were derived from 23 nationally representative
insecticide class and WHO region, 20102015 household surveys (demographic health surveys and
Insecticide resistance monitoring results were collected malaria indicator surveys) conducted between 2013 and
from NMCP reports to WHO, the African Network for 2015. The surveys asked caregivers whether their child
Vector Resistance, the Malaria Atlas Project, PMI and had had a fever in the 2 weeks preceding the survey,
the published literature. In these studies, confirmed whether care was sought for the fever and, if so, where
resistance was defined as mosquito mortality <90% in care was sought.
bioassay tests with standard insecticide doses. Where
multiple insecticide classes or types, mosquito species Figure 4.2 Proportion of febrile children receiving
or time points were tested, the highest resistance status a blood test, by health sector, sub-Saharan
was considered. Africa, 20132015
Estimates were derived from 22 nationally representative
household surveys (demographic health surveys and
malaria indicator surveys) conducted between 2013 and
5. https://www.palisade.com/risk/

62 WORLD MALARIA REPORT 2016


2015. The surveys asked caregivers whether their child had and interquartile ranges were calculated from available
had a fever in the 2 weeks preceding the survey; whether surveys in 3 year moving averages.
care was sought for the fever and, if so, where care was
sought; they also asked whether the child had received a Figure 4.5 Proportion of febrile children with
finger or heel stick as part of the care (indicating that a a positive RDT at time of survey who received
malaria diagnostic test was performed). antimalarial medicines, sub-Saharan Africa,
20102015
Figure 4.3 Proportion of suspected malaria cases Data from nationally representative household surveys
attending public health facilities who receive a were used to examine the treatment received by children
diagnostic test, by WHO region, 20102015 who had had both a fever in the previous 2 weeks and
The proportion of suspected malaria cases receiving a positive RDT at the time of survey. Estimates were
a malaria diagnostic test in public facilities was derived from 29 nationally representative household
calculated from NMCP reports to WHO. The number surveys (demographic health surveys and malaria
of malaria diagnostic tests performed comprised the indicator surveys). The surveys must have undertaken
number of RDTs and the number of microscopic slide diagnostic testing with a histidine rich protein 2 (HRP2)
examinations. Few countries reported the number of RDT at the time of the survey; also, they must have
suspected malaria cases as an independent value. For asked caregivers whether their child had had a fever
countries reporting the total number of malaria cases as in the 2 weeks preceding the survey, where care was
the sum of presumed malaria cases (i.e. cases classified sought, and what treatment was received for the fever,
as malaria without undergoing malaria parasitological particularly whether the child received an ACT or other
testing) and confirmed malaria cases, the number of antimalarial medicine.
suspected cases was calculated by adding the number
of negative diagnostic tests to the number of presumed Figure 4.6 Proportion of antimalarial treatments
and confirmed cases. Using this method, for countries that are ACTs received by febrile children that are
that reported only confirmed malaria cases as the total RDT positive at the time of survey, sub-Saharan
number of malaria cases, the number of suspected Africa, 20102015
cases is equal to the number of cases tested. This See methods notes for Figure 4.5.
value is not informative in determining the proportion
Figure 4.7 Proportion of antimalarial treatments
of suspected cases tested; therefore, countries were
excluded from the regional calculation for the years
that are ACTs received by febrile children, by
in which they reported only confirmed cases as total health sector, sub-Saharan Africa, 20132015
malaria cases. See methods notes for Figure 4.5.

Figure 4.4 Proportion of febrile children attending Figure 4.8 Distribution of multidrug resistance,
public health facilities who receive a blood test, 2016
sub-Saharan Africa, 20102015 Information was derived from WHOs database on
Estimates were derived from 41 nationally representative antimalarial treatment efficacy.6
household surveys (demographic health surveys and
Figure 5.1 Health facility reporting rates by WHO
malaria indicator surveys) conducted between 2010 and
region, 2015
2015. The surveys asked caregivers whether their child
Using data provided by NMCPs, reporting rates of
had had a fever in the 2 weeks preceding the survey;
health facilities were calculated as follows: (the number
whether care was sought for the fever and, if so, where
of health facility reports received in 2015) (number of
care was sought; and whether the child had received a
finger or heel stick as part of the care (indicating that a
malaria diagnostic test was performed). Median values 6. http://www.who.int/malaria/areas/drug_resistance/drug_effica-
cy_database/en/

WORLD MALARIA REPORT 2016 63


Annex 1 Data sources and methods

health facilities providing treatment for uncomplicated and 80%. Countries that were approaching elimination
malaria reporting frequency). were assigned a value of more than 80%.

Figure 5.2 Bottlenecks in case detection 2015, by Table 6.1 Estimated malaria cases, 20002015
WHO region The number of malaria cases was estimated by one of
The procedure for estimating the proportion of cases two methods. The first method was used for countries
detected by surveillance systems follows the method outside Africa and for low-transmission countries in
by which WHO estimates the number of malaria cases Africa. Estimates were made by adjusting the number
in a country using data reported by NMCPs(7,8). The of reported malaria cases for completeness of reporting,
procedure considers four proportions: the proportion the likelihood that cases were parasite positive, and
of cases that seek treatment, the proportion of cases the extent of health-service use. The procedure, which
that seek treatment in health facilities covered by a is described in the World Malaria Report 2008 (7,8),
countrys malaria surveillance system, the proportion combines data reported by NMCPs (reported cases,
of cases in these facilities that receive a diagnostic test reporting completeness and likelihood that cases are
and the proportion of cases in these facilities that are parasite positive) with data obtained from nationally
reported through the system. The proportion of malaria representative household surveys on health-service use.
cases seeking treatment was estimated using the latest The number of malaria cases caused by Plasmodium
nationally representative household survey for a country. vivax in each country was estimated by multiplying the
If no household survey was available, the proportion was countrys reported proportion of P. vivax cases by the
derived by sampling at random from results for other total number of estimated cases for the country. The
countries and areas in the region that had a household second method was used for high-transmission countries
survey: Bolivia (Plurinational State of), Botswana, in Africa in which the quality of surveillance data did not
Cabo Verde, French Guiana, Guatemala, South Sudan, permit a robust estimate from the number of reported
Suriname, Thailand and Venezuela (Bolivarian Republic cases. Estimates of the number of malaria cases were
of). For 13 countries approaching malaria elimination derived from information on parasite prevalence
(Algeria, Belize, Bhutan, China, Democratic Peoples obtained from household surveys. First, data on parasite
Republic of Korea, Ecuador, El Salvador, Iran [Islamic prevalence from 27 573 georeferenced population
Republic of], Malaysia, Mexico, Panama, Republic of clusters between 1995 and 2014 were assembled within
Korea and Saudi Arabia), it was assumed that 99% of a spatiotemporal Bayesian geostatistical model, along
cases sought treatment. The proportion of cases seeking with environmental and sociodemographic covariates,
treatment at a facility covered by a countrys surveillance and data on both the use of ITNs and access to ACTs.
system was derived in a similar way; the types of facility The geospatial model enabled predictions of P.
covered by a countrys surveillance system were provided falciparum prevalence in children aged 210 years, at
through NMCP reports. Reporting rates of health facilities a resolution of 5 5 km2, throughout all malaria endemic
were calculated according to the methods notes for African countries for each year from 2000 to 2015.
Figure 5.1. The reporting rates were assigned to three Second, an ensemble model was developed to predict
ranges (<50%, 5080% and >80%) to reflect uncertainty malaria incidence as a function of parasite prevalence.
about the number of cases represented in facility reports. The model was then applied to the estimated parasite
The rates were assigned a triangular distribution in the prevalence in order to obtain estimates of the malaria
outer ranges and a uniform distribution in mid-range, case incidence at 5 5 km2 resolution for each year from
with expected values in the low, mid and high ranges 2000 to 2015. Data for each 5 5 km2 area were then
of 33%, 65% and 87%, respectively. If the reporting aggregated within country and regional boundaries to
completeness was not available for 2015, the value from obtain both national and regional estimates of malaria
the most recent year reported was used. If this value was cases (9).
missing for all years, it was assumed to lie between 50%

64 WORLD MALARIA REPORT 2016


Table 6.2 Estimated malaria cases by WHO a verbal autopsy multicause model developed by the
region, 2015 Maternal and Child Health Epidemiology Estimation
See methods notes for Table 6.1. Group to estimate causes of death in children aged
159 months (15). Mortality estimates were derived
Figure 6.1 Estimated malaria cases (millions) by
for seven causes of post-neonatal death (pneumonia,
WHO region, 2015 diarrhoea, malaria, meningitis, injuries, pertussis and
See methods notes for Table 6.1.
other disorders), four causes arising in the neonatal
Figure 6.3 Estimated country share of (a) total period (prematurity, birth asphyxia and trauma, sepsis,
and other conditions of the neonate), and other causes
malaria cases and (b) P. vivax malaria cases,
(e.g. malnutrition). Deaths due to measles, unknown
2015
causes and HIV/AIDS were estimated separately. The
See methods notes for Table 6.1.
resulting cause-specific estimates were adjusted, country
Table 6.3 Estimated malaria deaths, 20002015 by country, to fit the estimated mortality envelope of 159
Numbers of malaria deaths were estimated by two main months (excluding HIV/AIDS and measles deaths) for
categories of method. corresponding years. Estimated prevalence of malaria
parasites (see methods notes for Table 6.1) was used as a
Category 1 methods covariate within the model. The malaria mortality rate in
Category 1 methods were used for countries outside children aged under 5 years that was estimated with this
Africa and for low-transmission countries in Africa. method was then used to infer malaria-specific mortality
Method 1(a). For countries in which vital registration is in those aged over 5 years, using the relationship
estimated to capture more than 50% of all deaths, and between levels of malaria mortality in a series of age
a high proportion of malaria cases are confirmed by groups and the intensity of malaria transmission (16).
parasite testing, reported malaria deaths are adjusted
for completeness of death reporting.
Table 6.4 Estimated malaria deaths by WHO
region, 2015
Method 1b. For countries considered in the elimination See methods notes for Table 6.3.
programme phase as described in the World Malaria
Report 2015 (10), reported malaria deaths are adjusted Figure 6.3 Estimated malaria deaths (thousands)
for completeness of case reporting. by WHO region, 2015
See methods notes for Table 6.3.
Method 1c. For other countries for which a Category 1
method was used, a case fatality rate of 0.256% was Figure 6.4 Estimated country share of (a) total
applied to the estimated number of P. falciparum malaria deaths and (b) P. vivax malaria deaths,
cases, which represents the average of case fatality 2015
rates reported in the literature (11-13) and rates from See methods notes for Table 6.3.
unpublished data from Indonesia, 20042009 (Dr Ric
Figure 6.5 Estimated (a) parasite prevalence
Price, Menzies School of Health Research, personal
communication). A case fatality rate of 0.0375% was
and (b) number of people infected, sub-Saharan
applied to the estimated number of P. vivax cases, Africa, 20052015
representing the midpoint of the range of case fatality See methods notes for Table 6.1.
rates reported in a study by Douglas et al. (14). Figure 6.6 Reduction in malaria case incidence
rate by WHO region, 20102015
Category 2 method
See the methods notes for Table 6.1 for the estimation of
A Category 2 method was used for countries in Africa
the number of malaria cases. Incidence rates were derived
with a high proportion of deaths due to malaria. In this
by dividing estimated malaria cases by the population at
method, child malaria deaths were estimated using

WORLD MALARIA REPORT 2016 65


Annex 1 Data sources and methods

risk of malaria within each country. The total population the peak number of cases were excluded. Thus, if
of each country was taken from the 2015 revision of the a country had experienced zero cases and malaria
World population prospects (4), and the proportion at risk returned, cases were only included from the year in
of malaria was derived from NMCP reports. which they peaked. This inclusion criterion generates a
slope that is steeper than if cases from all years were
Figure 6.7 Country-level changes in malaria case
included (because some increases are excluded). In
incidence rate, 20102015, by number of cases
some earlier years where data on indigenous case were
in 2010
not available, the total number of reported cases was
See methods notes for Figure 6.6 for estimates of case
used (i.e. for country years with larger numbers of cases,
incidence. See methods notes for Table 6.1 for estimates
in which the proportion of imported cases is expected
of number of cases.
to be low).
Figure 6.8 Reduction in malaria mortality rate by
Figure 6.12 Number of indigenous malaria cases
WHO region, 20102015
for countries endemic for malaria in 2015, by
See methods notes for Table 6.3 for estimation of number
WHO region
of deaths. Malaria death rates were derived by dividing
See methods notes for Table 6.1 for the estimation
annual malaria deaths by the midyear population at
of number of cases. For 18 countries (Algeria, Belize,
risk of malaria within each country. The total population
Bhutan, Cabo Verde, China, Democratic Peoples
of each country was taken from the 2015 revision of the
Republic of Korea, Dominican Republic, Ecuador, El
World population prospects (4), and the proportion at
Salvador, Iran [Islamic Republic of], Malaysia, Mexico,
risk of malaria was derived from NMCP reports. Where
Panama, Republic of Korea, Saudi Arabia, Suriname,
death rates were quoted for children aged under 5 years,
Swaziland and Tajikistan), estimates were based on
the number of deaths estimated in children aged under
indigenous cases only; these values were very close to
5 years was divided by the estimated number of children
the reported numbers of cases. For other countries in
aged under 5 years at risk of malaria.
which the numbers of locally transmitted and imported
Figure 6.9 Country-level changes in malaria cases were not individually available, estimates
mortality rate 20102015, by number of deaths included imported cases; however, imported cases
in 2010 were expected to comprise only a small proportion of
See methods notes for Figure 6.8 for estimates of the large total number of cases in these countries.
mortality rates. See methods notes for Table 6.3 for
Figure 6.13 and Table 6.5 Gains in life expectancy
estimates of number of deaths.
in malaria endemic countries, 20002015
Figure 6.10 Countries attaining zero indigenous The relative contribution of the decline in malaria
malaria cases since 2000 mortality risk to total life expectancy gain between
Countries are shown by the year in which they attained 2000 and 2015 was estimated using WHO annual
zero indigenous cases for 3 consecutive years, according life tables for 20002015 for countries with malaria
to reports submitted by NMCPs. transmission in 2000, and WHO estimates of malaria
age-specific death rates (17). A cause-decomposition
Figure 6.11 Indigenous malaria cases in the years of life expectancy gain approach was followed, with the
before attaining zero indigenous cases, for the analysis conducted at WHO regional level (18).
17 countries that eliminated malaria, 20002015
For the 17 countries that attained zero indigenous cases Table 6.6 Economic value of reduced malaria
for 3 consecutive years between 2000 and 2015, the mortality risk, estimated by full income approach,
number of NMCP-reported indigenous cases was 20002015
tabulated according to the number of years preceding Malaria mortality risk reductions between 2000 and
the attainment of zero cases. Data from years before 2015 were valued using a full income approach. The

66 WORLD MALARIA REPORT 2016


analysis, which covered 106 countries with malaria decreases, individuals require a smaller percentage
transmission in 2000, was conducted from the current of their income to accept an increase in mortality risk,
perspective by estimating how much individuals would because of competing basic needs in lower income
need to be compensated in 2015 to accept malaria populations, although this can vary across individual
mortality risks at their year 2000 levels. and community characteristics (21,22).

Changes in malaria mortality risk were valued as the Changes in malaria mortality risks were valued as the
payment that individuals would need to receive to sum of WTA of all individuals assumed to experience
accept an increase in mortality risk (19). This approach, these changes; 2015 life tables were used, and the
referred to as value of a statistical life (VSL), is a common calculations were as described in Jamison et al. (19).
method for valuing mortality risks in public policy studies VSL conversions used the OECD consumer price index
in high-income settings. It involves asking individuals data. 7 Calculations were conducted in 2015 US$, at
about their willingness to accept (WTA) compensation PPP with GDP data sourced from the World Bank. 8
for an increase in mortality risk, in stated-preference Probabilistic uncertainty analysis through 1000 Monte
surveys (20). These surveys have placed a value of Carlo simulations was used to determine the mean
US$380 (range: US$ 189569) on a 1 in 10 000 increase and 95% uncertainty range for the value of change
in mortality risk for a given year for individuals aged in mortality risk across malaria endemic countries in
50 years with an average life expectancy of 33 years, 20002015. The reference VSL was assigned a uniform
living in OECD countries that had an average GDP per distribution (range: US$ 189569), as were elasticity
capita of US$ 37 787 (in 2015 purchasing power parity values (range: 11.4).
[PPP] adjusted US$) (20,21). For this reference VSL to
be applied to other settings, it is necessary to take into
account differences in life expectancy and the GDP per
capita using the following formula:
ec50 GDPpc
VSL
c (
=VSLr
33 GDPr )
Where:

VSLc = VSL in country c;


ec50 = life expectancy at age 50 in country c;
33 = average remaining life expectancy, in years, at age
50 in OECD reference countries;
VSLr = VSL in OECD reference countries;
GDPc = 2015 GDP per capita in country c;
GDP r = average GDP per capita in group of OECD
reference countries, converted to 2015 equivalent; and
= income elasticity of the VSLc to changes in GDP.

The income elasticity that is, the responsiveness


of the VSL to a change in income was assumed to
range between 1 and 1.4 (20-22). An equal to 1
reflects situations where individuals require the same
proportional change in income as compensation for an
7. https://data.oecd.org/price/inflation-cpi.htm#indicator-chart
increase in mortality risk, irrespective of income level.
(accessed 1 November 2016)
An greater than 1 reflects situations where, as income 8. http://databank.worldbank.org/data/home.aspx (accessed 1 No-
vember 2016)

WORLD MALARIA REPORT 2016 67


Annex 1 Data sources and methods

References

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2030. Geneva: World Health Organization (WHO); Worldwide incidence of malaria in 2009: estimates,
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2. Roll Back Malaria Partnership. Action and investment 8. WHO. World Malaria Report. Geneva: World Health
to defeat malaria 20162030. For a Malaria free Organization; 2008 (http://www.who.int/malaria/
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to defeat malaria 20162030. Background
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publications/world-malaria-report-2015/report/
Committee Meeting, 1416 September 2016, Geneva,
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4. UN. Revision of world population prospects [website]. 12. Luxemburger C, Ricci F, Nosten F, Raimond D, Bathet
United Nations; 2015 (http://esa.un.org/unpd/wpp, S, White NJ. The epidemiology of severe malaria in
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Trop Med Hyg. 1997;91(3):256262.
5. Flaxman AD, Fullman N, Otten MW, Menon M,
Cibulskis RE, Ng M et al. Rapid scaling up of 13. Meek SR. Epidemiology of malaria in displaced
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for health: a systematic synthesis of supply,
14. Douglas NM, Pontororing GJ, Lampah DA, Yeo TW,
distribution, and household survey data. PLoS Med.
Kenangalem E, Poespoprodjo JR et al. Mortality
2010;7(8):e1000328.
attributable to Plasmodium vivax malaria: a
6. Dellicour S, Tatem AJ, Guerra CA, Snow RW, ter Kuile clinical audit from Papua, Indonesia. BMC Med.
FO. Quantifying the number of pregnancies at risk of 2014;12(1):217.
malaria in 2007: a demographic study. PLoS Med.
15. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE et
2010;7(1):e1000221.
al. Global, regional, and national causes of child

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mortality in 200013, with projections to inform
post-2015 priorities: an updated systematic analysis.
Lancet. 2015;385(9966):430440.

16. Ross A, Maire N, Molineaux L, Smith T. An


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integrated approach to cause-of-death analysis:
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expectancy. Demography Res. 2008;19:13231350.

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Berkley S, Binagwaho A et al. Global health 2035:
a world converging within a generation. Lancet.
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Cost Anal. 2011;2(1).

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impacts of air pollution: discussion of challenges and
proposed solutions. Washington, World Bank Group
2016.

WORLD MALARIA REPORT 2016 69


Annex 2 A. Regional profile: West Africa

A. Parasite prevalence, 2015


355 million
people at risk for
malaria in 2015
297 million
at high risk

Funding for
malaria increased
from
US$ 233 million
to
US$ 262 million >85

between 2010 0
Not applicable
and 2015

Estimated malaria
case incidence
decreased B. Share of estimated malaria cases, 2015
by 15%
between 2010 Others, 5%
and 2015 Togo, 2%

Benin, 3%
Guinea, 4%
Estimated malaria
Niger, 5%
mortality rate
reduced Bukina Faso, 6%
Nigeria, 55%
by 29%
between 2010 Ghana, 6%

and 2015
Mali, 7%

Zero countries
eliminated Cte dIvoire, 7%

malaria
since 2010

70 WORLD MALARIA REPORT 2016


C. Malaria funding by source, 20102015 D. Malaria funding per person at risk, average
20132015
Domestic* Global Fund World Bank Domestic* International
USAID UK Others
1000 Cabo Verde
Liberia
Gambia
800 Ghana
Benin
Senegal
Sierra Leone
US$ (million)

600
Mali
Guinea-Bissau
Nigeria
400 Burkina Faso
Guinea
Cte dIvoire
200 Togo
Niger
Mauritania
Algeria
0
2010 2011 2012 2013 2014 2015 0 4 8 12 16 20
Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; US$
UK, United Kingdom of Great Britain and Northern Ireland; USAID,
United States Agency for International Development * Includes NMCP spending and patient service delivery care costs;
* Includes NMCP spending and patient service delivery care costs; refer to Annex 1 for more information
refer to Annex 1 for more information

E. Proportion of population sleeping under an F. Change in reported malaria incidence and


ITN or protected with IRS, 2015 mortality rates, 20102015
Incidence Mortality
2020 milestone: -40%
ITN IRS
Cabo Verde Liberia*

Ghana Cte dIvoire*


Guinea-Bissau Benin*
Togo Guinea*
Cte dIvoire Ghana*
Sierra Leone Burkina Faso*
Benin Guinea-Bissau*
Senegal Senegal*
Gambia Niger*
Burkina Faso Sierra Leone*
Mali Togo*
Guinea Nigeria*
Liberia Gambia*
Nigeria Mauritania*
Niger Cabo Verde*
Mauritania Mali*
Algeria Algeria*
0% 20% 40% 60% 80% 100% -100% -50% 0% 50% 100%
f Reduction Increase p
IRS, indoor residual spraying; ITN, insecticide-treated mosquito net * Change in admission rate ()
Countries in bold reported <200 indigenous malaria cases

WORLD MALARIA REPORT 2016 71


Annex 2 B. Regional profile: Central Africa

A. Parasite
174 million prevalence, 2015
people at risk for
malaria in 2015
161 million
at high risk

Funding for
malaria increased
from
US$ 65 million
to
US$ 116 million
between 2010
and 2015
>85

Estimated malaria
0
Not applicable

case incidence
decreased B. Share of estimated malaria cases, 2015
by 33%
between 2010 Others, 4%
and 2015 Burundi, 4%

Central African Republic, 4%


Estimated malaria Chad, 6% Democratic
mortality rate Republic of the
Congo, 57%
reduced Angola, 9%
by 42%
between 2010
and 2015
Cameroon, 16%

Zero countries
eliminated
malaria
since 2010

72 WORLD MALARIA REPORT 2016


C. Malaria funding by source, 20102015 D. Malaria funding per person at risk, average
20132015
Domestic* Global Fund World Bank Domestic* International
USAID UK Others
Sao Tome
500 and Principe

Equatorial Guinea

400 Angola

Gabon

300 Democratic Republic


US$ (million)

of the Congo

Burundi
200
Central African
Republic

Chad
100
Cameroon

Congo
0
2010 2011 2012 2013 2014 2015 0 4 8 12 16 20
Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; US$
UK, United Kingdom of Great Britain and Northern Ireland; USAID,
United States Agency for International Development * Includes NMCP spending and patient service delivery care costs;
* Includes NMCP spending and patient service delivery care costs; refer to Annex 1 for more information
refer to Annex 1 for more information

E. Proportion of population sleeping under an F. Change in reported malaria incidence and


ITN or protected with IRS, 2015 mortality rates, 20102015
Incidence Mortality
2020 milestone: -40%
ITN IRS
Central African*
Sao Tome Republic*
and Principe*
Gabon*
Burundi

Burundi*
Chad
Democratic Republic*
Democratic Republic of the Congo*
of the Congo
Central African Chad*
Republic
Angola*
Cameroon

Cameroon*
Angola
Sao Tome*
Congo and Principe*

Congo*
Equatorial Guinea

Equatorial Guinea*
Gabon
0% 20% 40% 60% 80% 100% -100% -50% 0% 50% 100%
f Reduction Increase p
IRS, indoor residual spraying; ITN, insecticide-treated mosquito net * Change in admission rate ()
* Administrative ITN coverage

WORLD MALARIA REPORT 2016 73


Annex 2 C. Regional profile: East and Southern Africa

A. Parasite
319 million prevalence,
2015
people at risk for
malaria in 2015
232 million
at high risk

Funding
for malaria
decreased from
US$ 156 million
to
US$ 150 million
between 2010
and 2015
>85

Estimated malaria
0
Not applicable

case incidence
decreased B. Share of estimated malaria cases, 2015
by 22%
between 2010
Others, 7%
and 2015
Madagascar, 5% Uganda, 18%
Estimated malaria Ethiopia, 6%
mortality rate
reduced Zambia, 6%

by 22%
between 2010 Malawi, 7% Mozambique,
18%
and 2015
Rwanda, 8%

Zero countries
eliminated United Republic
of Tanzania, 11% Kenya, 14%
malaria
since 2010

74 WORLD MALARIA REPORT 2016


C. Malaria funding by source, 20102015 D. Malaria funding per person at risk, average
20132015
Domestic* Global Fund World Bank Domestic* International
USAID UK Others
1000 Swaziland
Zambia
Namibia
800 Rwanda
South Sudan
Malawi
Zimbabwe
US$ (million)

600
Mozambique
United Republic
of Tanzania
South Africa
400 Comoros
Uganda
Kenya
200 Eritrea
Madagascar
Botswana
Ethiopia
0
2010 2011 2012 2013 2014 2015 0 4 8 12 16 20
Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; US$
UK, United Kingdom of Great Britain and Northern Ireland; USAID,
United States Agency for International Development * Includes NMCP spending and patient service delivery care costs;
* Includes NMCP spending and patient service delivery care costs; refer to Annex 1 for more information
refer to Annex 1 for more information

E. Proportion of population sleeping under an F. Change in reported malaria incidence and


ITN or protected with IRS, 2015 mortality rates, 20102015
Incidence Mortality
2020 milestone: -40%
ITN IRS
South Sudan*
Swaziland*
Namibia*
Botswana*
Rwanda*
Zimbabwe
Kenya*
Madagascar
Madagascar*
Rwanda
Malawi*
Mozambique
United Republic of*
Uganda Tanzania (Mainland)*
Uganda*
Zambia
Zimbabwe*
Kenya
Mozambique*
Ethiopia
Swaziland*
South Sudan
Ethiopia*
Comoros
Eritrea*
Malawi
Zambia*
South Africa
Namibia* Botswana*
United Republic of United Republic of*
Tanzania (Zanzibar) Tanzania (Zanzibar)*
United Republic of South Africa*
Tanzania (Mainland) Comoros*
Eritrea
0% 20% 40% 60% 80% 100% -100% -50% 0% 50% 100%
f Reduction Increase p
IRS, indoor residual spraying; ITN, insecticide-treated mosquito net * Change in admission rate ()
* Administrative ITN coverage

WORLD MALARIA REPORT 2016 75


Annex 2 D. Regional profile: Region of the Americas

A. Confirmed
132 million malaria
people at risk for cases per
1000
malaria in 2015 population,
21 million 2015
at high risk

Funding for
malaria increased
from
US$ 170 million
to
Confirmed cases
per 1000 population

US$ 201 million Insufficient data

between 2010
0
00.1

and 2015 0.11.0


1.010
1050

Estimated malaria 50100

case incidence > 100

decreased
by 31% B. Share of estimated malaria cases, 2015
between 2010
and 2015 Guyana, 3% Others, 5%

Estimated malaria Haiti, 9%


mortality rate Venezuela
(Bolivarian
reduced Republic of),
by 37% Colombia, 10% 30%

between 2010
and 2015

Three countries Peru, 19%

achieved zero
indigenous cases
Brazil, 24%
for 3 years
since 2010

76 WORLD MALARIA REPORT 2016


C. Malaria funding by source, 20102015 D. Malaria funding per person at risk, average
20132015
Domestic* Global Fund World Bank Domestic* International
USAID UK Others
300 Panama
Suriname
Mexico
Peru
El Salvador
Colombia
200 Brazil
Guyana
US$ (million)

Nicaragua
Venezuela
(Bolivarian Republic of)
Belize
Dominican Republic
100 Bolivia
(Plurinational State of)
Honduras
Haiti
Guatemala
Ecuador
0 French Guiana
2010 2011 2012 2013 2014 2015 0 4 8 12 16 20
Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; US$
UK, United Kingdom of Great Britain and Northern Ireland; USAID,
United States Agency for International Development * Includes NMCP spending and patient service delivery care costs;
* Includes NMCP spending and patient service delivery care costs; refer to Annex 1 for more information
refer to Annex 1 for more information

E. Proportion of cases due to P.falciparum and F. Change in reported malaria incidence and
P.vivax, 20132015 mortality rates, 20102015
Incidence Mortality
2020 milestone: -40%
P. falciparum P. vivax Other
Nicaragua
Haiti Venezuela
Dominican Republic (Bolivarian Republic of)
Peru
Colombia
Panama
French Guiana
Guatemala
Guyana
Haiti
Suriname Bolivia
Ecuador (Plurinational State of)
Venezuela Guyana
(Bolivarian Republic of) Brazil
Honduras
Mexico
Peru
Colombia
Nicaragua
Ecuador
Brazil
Bolivia French Guiana
(Plurinational State of) Dominican Republic
Guatemala
Honduras
Panama
El Salvador
Belize
El Salvador Belize
Mexico Suriname

0% 20% 40% 60% 80% 100% -100% -50% 0% 50% 100%


f Reduction Increase p
Countries in bold reported <200 indigenous malaria cases

WORLD MALARIA REPORT 2016 77


Annex 2 E. Regional profile: Eastern Mediterranean Region

A. Confirmed malaria cases per 1000population/parasite


291 million prevalence (PP), 2015
people at risk for
malaria in 2015
111 million
at high risk

Funding Confirmed cases


for malaria per 1000 population

decreased from
Insufficient data
0

US$ 55 million 00.1

to 0.11.0

US$ 45 million
1.010
PP
1050 >85
between 2010 50100 0
and 2015 > 100 Not applicable

Estimated malaria
case incidence
decreased
by 11% B. Share of estimated malaria cases, 2015
between 2010
Yemen, 8%
and 2015

Estimated malaria
mortality rate Afghanistan, 11% Sudan, 36%

reduced
by 6%
between 2010
and 2015 Somalia, 18%

One country
achieved zero
indigenous cases
Pakistan, 27%
for 3 years
since 2010

78 WORLD MALARIA REPORT 2016


C. Malaria funding by source, 20102015 D. Malaria funding per person at risk, average
20132015
Domestic* Global Fund World Bank Domestic* International
USAID UK Others
200 Saudi Arabia

Iran
(Islamic Republic of)

150
Djibouti

Sudan
US$ (million)

100
Somalia

Afghanistan
50

Yemen

Pakistan
0
2010 2011 2012 2013 2014 2015 0 4 8 12 16 20
Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; US$
UK, United Kingdom of Great Britain and Northern Ireland; USAID,
United States Agency for International Development * Includes NMCP spending and patient service delivery care costs;
* Includes NMCP spending and patient service delivery care costs; refer to Annex 1 for more information
refer to Annex 1 for more information

E. Proportion of cases due to P.falciparum and F. Change in reported malaria incidence and
P.vivax, 20132015 mortality rates, 20102015
Incidence Mortality
2020 milestone: -40%
P. falciparum P. vivax Other

Djibouti
Saudi Arabia

Saudi Arabia
Djibouti

Afghanistan
Yemen

Somalia
Somalia

Pakistan
Sudan

Sudan
Pakistan

Iran Yemen
(Islamic Republic of)
Iran
Afghanistan (Islamic Republic of)

0% 20% 40% 60% 80% 100% -100% -50% 0% 50% 100%


f Reduction Increase p
Countries in bold reported <200 indigenous malaria cases

WORLD MALARIA REPORT 2016 79


Annex 2 F. Regional profile: South-East Asia Region

A. Confirmed malaria cases per 1000population, 2015


1.4 billion
people at risk for
malaria in 2015
237 million Confirmed cases

at high risk per 1000 population


Insufficient data
0
00.1
Funding 0.11.0

for malaria 1.010

decreased from 1050

US$ 170 million


50100
> 100
to Not applicable

US$ 92 million
between 2010
and 2015

Estimated malaria
case incidence
decreased
by 54% B. Share of estimated malaria cases, 2015
between 2010
and 2015 Myanmar, 2% Others, 0%

Indonesia, 9%
Estimated malaria
mortality rate
reduced
India, 89%
by 46%
between 2010
and 2015

One country
achieved zero
indigenous cases
for 3 years
since 2010

80 WORLD MALARIA REPORT 2016


C. Malaria funding by source, 20102015 D. Malaria funding per person at risk, average
20132015
Domestic* Global Fund World Bank Domestic* International
USAID UK Others
350 Timor-Leste

Bhutan
300

Myanmar
250
Bangladesh
200
US$ (million)

Thailand

150 Democratic Peoples


Republic of Korea

100 Indonesia

50 Nepal

India
0
2010 2011 2012 2013 2014 2015 0 4 8 12 16 20
Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; US$
UK, United Kingdom of Great Britain and Northern Ireland; USAID,
United States Agency for International Development * Includes NMCP spending and patient service delivery care costs;
* Includes NMCP spending and patient service delivery care costs; refer to Annex 1 for more information
refer to Annex 1 for more information

E. Proportion of cases due to P.falciparum and F. Change in reported malaria incidence and
P.vivax, 20132015 mortality rates, 20102015
Incidence Mortality
2020 milestone: -40%
P. falciparum P. vivax Other
India
Bangladesh
Democratic Peoples
Myanmar Republic of Korea

Indonesia
India

Myanmar
Timor-Leste

Indonesia Nepal

Thailand Thailand

Bhutan Bangladesh

Nepal Bhutan

Democratic Peoples
Republic of Korea Timor-Leste

0% 20% 40% 60% 80% 100% -100% -50% 0% 50% 100%


f Reduction Increase p
Countries in bold reported <200 indigenous malaria cases

WORLD MALARIA REPORT 2016 81


Annex 2 G. Regional profile: Western Pacific Region

A. Confirmed malaria cases per 1000population, 2015


740 million
people at risk for Confirmed cases

malaria in 2015 per 1000 population


Insufficient data
32 million 0

at high risk 00.1


0.11.0
1.010

Funding for
1050
50100
malaria increased > 100

from Not applicable

US$ 29 million
to
US$ 50 million
between 2010
and 2015

Estimated malaria
case incidence
decreased B. Share of estimated malaria cases, 2015
by 30%
between 2010 Solomon Islands, 3% Others, 3%
and 2015
Lao Peoples Democratic
Republic, 7%
Estimated malaria
mortality rate Cambodia, 10%
reduced
by 58%
between 2010
and 2015
Papua
New Guinea, 77%
Zero countries
eliminated
malaria
since 2010

82 WORLD MALARIA REPORT 2016


C. Malaria funding by source, 20102015 D. Malaria funding per person at risk, average
20132015
Domestic* Global Fund World Bank Domestic* International
USAID UK Others
200 Malaysia

Vanuatu

Solomon Islands
150
Papua New Guinea

Cambodia
US$ (million)

100
Lao Peoples
Democratic Republic

Philippines

50 Viet Nam

Republic of Korea

China
0
2010 2011 2012 2013 2014 2015 0 4 8 12 16 20
Global Fund, Global Fund to Fight AIDS, Tuberculosis and Malaria; US$
UK, United Kingdom of Great Britain and Northern Ireland; USAID,
United States Agency for International Development * Includes NMCP spending and patient service delivery care costs;
* Includes NMCP spending and patient service delivery care costs; refer to Annex 1 for more information
refer to Annex 1 for more information

E. Proportion of cases due to P.falciparum and F. Change in reported malaria incidence and
P.vivax, 20132015 mortality rates, 20102015
Incidence Mortality
2020 milestone: -40%
P. falciparum P. vivax Other
Lao Peoples
Democratic Republic
Philippines
Cambodia
Papua New Guinea
Solomon Islands
Cambodia

Viet Nam Viet Nam

Solomon Islands Republic of Korea

Lao Peoples
Democratic Republic Malaysia

China Philippines

Vanuatu
Papua New Guinea*

Malaysia
Vanuatu
Republic of Korea
China
0% 20% 40% 60% 80% 100% -100% -50% 0% 50% 100%
f Reduction Increase p
* Change in admission rate ()
Countries in bold reported <200 indigenous malaria cases

WORLD MALARIA REPORT 2016 83


Annex 3 A. Funding per capita for malaria control and elimination
(in US$)

Algeria Angola Benin Botswana Burkina Faso Burundi


>20

15

10

Cabo Verde Cameroon Central African Republic Chad Comoros Congo


>20

15

10

Democratic Republic
Cte dIvoire of the Congo Equatorial Guinea Eritrea Ethiopia Gabon
>20

15

10

Gambia Ghana Guinea Guinea-Bissau Kenya Liberia


>20

15

10

Madagascar Malawi Mali Mauritania Mayotte Mozambique


>20

15

10

Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal


>20

15

10

Sierra Leone South Africa South Sudan Swaziland Togo Uganda


>20

15

10

United Republic
of Tanzania Zambia Zimbabwe
>20

15
Domestic
10 Total
African Region
5

0
2005 2010 2015 2005 2010 2015 2005 2010 2015

84 WORLD MALARIA REPORT 2016


Bolivia
Belize (Plurinational State of) Brazil Colombia Dominican Republic Ecuador
>20

15

10

El Salvador French Guiana Guatemala Guyana Haiti Honduras


>20

15

10

Venezuela
Mexico Nicaragua Panama Peru Suriname (Bolivarian Republic of)
>20

15

10

Iran
Afghanistan Djibouti (Islamic Republic of) Pakistan Saudi Arabia Somalia
>20

15

10

Democratic Peoples
Sudan Yemen Tajikistan Bangladesh Bhutan Republic of Korea
>20

15

10

India Indonesia Myanmar Nepal Thailand Timor-Leste


>20

15

10

Lao Peoples
Cambodia China Democratic Republic Malaysia Papua New Guinea Philippines
>20

15

10

Republic of Korea Solomon Islands Vanuatu Viet Nam


Domestic
>20
Total
15 Region of the Americas
10 Eastern Mediterranean Region
European Region
5
South-East Asia Region
0 Western Pacific Region
2005 2010 2015 2005 2010 2015 2005 2010 2015 2005 2010 2015

WORLD MALARIA REPORT 2016 85


86 WORLD MALARIA REPORT 2016
Annex 3 B. Proportion of population at risk sleeping under an ITN

Angola Benin Burkina Faso Burundi Cameroon Central African Republic


100%

75%

50%

25%

Democratic Republic
Chad Comoros Congo Cte dIvoire of the Congo Equatorial Guinea
100%

75%

50%

25%

Eritrea Ethiopia Gabon Gambia Ghana Guinea


100%

75%

50%

25%

Guinea-Bissau Kenya Liberia Madagascar Malawi Mali


100%

75%

50%

25%

Mauritania Mozambique Niger Nigeria Rwanda Senegal


100%

75%

50%

25%

United Republic
Sierra Leone South Sudan Togo Uganda of Tanzania Zambia
100%

75%

50%

25%

0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015

Zimbabwe
100%

75%

50%

25%
Modelled data
0 95% confidence interval
2000 2005 2010 2015
African Region

No model estimates are available for Algeria, Botswana, Cabo Verde, Mayotte, Namibia,
SaoTome and Principe, South Africa and Swaziland, because ITNs are not the primary method
ofvector control in these countries

WORLD MALARIA REPORT 2016 87


Annex 3 C. Estimated malaria case incidence rate
(cases per 1000 population at risk)

Algeria Angola Benin Botswana Burkina Faso Burundi


>750

500

250

<1

Cabo Verde Cameroon Central African Republic Chad Comoros Congo


>750

500

250

<1

Democratic Republic
Cte dIvoire of the Congo Equatorial Guinea Eritrea Ethiopia Gabon
>750

500

250

<1

Gambia Ghana Guinea Guinea-Bissau Kenya Liberia


>750

500

250

<1

Madagascar Malawi Mali Mauritania Mayotte Mozambique


>750

500

250

<1

Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal


>750

500

250

<1

Sierra Leone South Africa South Sudan Swaziland Togo Uganda


>750

500

250

<1

United Republic
of Tanzania Zambia Zimbabwe
>750

500
Point estimate
250
95% confidence interval
African Region
<1
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015

88 WORLD MALARIA REPORT 2016


Bolivia
Belize (Plurinational State of) Brazil Colombia Dominican Republic Ecuador
>500

250

<1

El Salvador French Guiana Guatemala Guyana Haiti Honduras


>500

250

<1

Venezuela
Mexico Nicaragua Panama Peru Suriname (Bolivarian Republic of)
>500

250

<1

Iran
Afghanistan Djibouti (Islamic Republic of) Pakistan Saudi Arabia Somalia
>500

250

<1

Democratic Peoples
Sudan Yemen Tajikistan Bangladesh Bhutan Republic of Korea
>500

250

<1

India Indonesia Myanmar Nepal Thailand Timor-Leste


>500

250

<1

Lao Peoples
Cambodia China Democratic Republic Malaysia Papua New Guinea Philippines
>500

250

<1

Republic of Korea Solomon Islands Vanuatu Viet Nam


>500
Point estimate
95% confidence interval
Region of the Americas
250
Eastern Mediterranean Region
European Region
<1 South-East Asia Region
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 Western Pacific Region

WORLD MALARIA REPORT 2016 89


Annex 3 D. Estimated malaria mortality rate
(deaths per 100 000 population at risk)

Algeria Angola Benin Botswana Burkina Faso Burundi


400

300

200

100

Cabo Verde Cameroon Centra African Republic Chad Comoros Congo


400

300

200

100

Democratic Republic
Cte dIvoire of the Congo Equatorial Guinea Eritrea Ethiopia Gabon
400

300

200

100

Gambia Ghana Guinea Guinea-Bissau Kenya Liberia


400

300

200

100

Madagascar Malawi Mali Mauritania Mayotte Mozambique


400

300

200

100

Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal


400

300

200

100

Sierra Leone South Africa South Sudan Swaziland Togo Uganda


400

300

200

100

United Republic
of Tanzania Zambia Zimbabwe
400

300

200 Point estimate


100 95% confidence interval
African Region
0
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015

90 WORLD MALARIA REPORT 2016


Bolivia
Belize (Plurinational State of) Brazil Colombia Dominican Republic Ecuador
>100

75

50

25

El Salvador French Guiana Guatemala Guyana Haiti Honduras


>100

75

50

25

Venezuela
Mexico Nicaragua Panama Peru Suriname (Bolivarian Republic of)
>100

75

50

25

Iran
Afghanistan Djibouti (Islamic Republic of) Pakistan Saudi Arabia Somalia
>100

75

50

25

Democratic Peoples
Sudan Yemen Tajikistan Bangladesh Bhutan Republic of Korea
>100

75

50

25

India Indonesia Myanmar Nepal Thailand Timor-Leste


>100

75

50

25

Lao Peoples
Cambodia China Democratic Republic Malaysia Papua New Guinea Philippines
>100

75

50

25

Republic of Korea Solomon Islands Vanuatu Viet Nam


>100
Point estimate
75 95% confidence interval
Region of the Americas
50
Eastern Mediterranean Region
25 European Region
0 South-East Asia Region
2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 2000 2005 2010 2015 Western Pacific Region

WORLD MALARIA REPORT 2016 91


Annex 3 E. Estimated change in malaria incidence and mortality rates,
20102015

Decrease Zero
Change Increase indigenous
WHO region Country/area <20% >20% deaths
>40% 2040%
& subregion in 2015
African, West Algeria
African, Central Angola
African, West Benin
African, South-East Botswana
African, West Burkina Faso
African, Central Burundi
African, Central Cameroon
African, West Cabo Verde
African, Central Central African Republic
African, Central Chad
African, South-East Comoros
African, Central Congo
African, West Cte d'Ivoire
African, Central Democratic Republic of the Congo
African, Central Equatorial Guinea
African, South-East Eritrea
African, South-East Ethiopia
African, Central Gabon
African, West Gambia
African, West Ghana
African, West Guinea
African, West Guinea-Bissau
African, South-East Kenya
African, West Liberia
African, South-East Madagascar
African, South-East Malawi
African, West Mali
African, West Mauritania
African Mayotte
African, South-East Mozambique
African, South-East Namibia
African, West Niger
African, West Nigeria
African, South-East Rwanda
African, Central Sao Tome and Principe
African, West Senegal
African, West Sierra Leone
African, South-East South Africa
African, South-East South Sudan
African, South-East Swaziland
African, West Togo
African, South-East Uganda
African, South-East United Republic of Tanzania
African, South-East Zambia
African, South-East Zimbabwe
Change in estimated incidence rate Change in estimated mortality rate

92 WORLD MALARIA REPORT 2016


Decrease Zero
Change Increase indigenous
WHO region Country/area <20% >20% deaths
>40% 2040%
& subregion in 2015
Americas Belize
Bolivia (Plurinational State of)
Brazil
Colombia
Dominican Republic
Ecuador
El Salvador
French Guiana
Guatemala
Guyana
Haiti
Honduras
Mexico
Nicaragua
Panama
Peru
Suriname
Venezuela (Bolivarian Republic of)
Eastern Mediterranean Afghanistan
Djibouti
Iran (Islamic Republic of)
Pakistan
Saudi Arabia
Somalia
Sudan
Yemen
European Tajikistan
South-East Asia Bangladesh
Bhutan
Democratic People's Republic of Korea
India
Indonesia
Myanmar
Nepal
Thailand
Timor-Leste
Western Pacific Cambodia
China
Lao People's Democratic Republic
Malaysia
Papua New Guinea
Philippines
Republic of Korea
Solomon Islands
Vanuatu
Viet Nam

WORLD MALARIA REPORT 2016 93


Annex 4 A. Policy adoption, 2015

WHO region Insecticide-treated mosquito nets Indoor residual spraying Chemoprevention


Country/area
ITNs/LLINs ITNs/LLINs ITNs/LLINs IRS is DDT is used IPTp used Seasonal
are are distributed recommended for IRS to prevent malaria
distributed distributed through mass by malaria malaria chemo
free of charge to all age campaigns control during prevention
groups to all age programme pregnancy (SMC or IPTc)
groups is used

AFRICAN
Algeria - -
Angola
Benin
Botswana -
Burkina Faso
Burundi
Cabo Verde -
Cameroon
Central African Republic
Chad
Comoros
Congo
Cte d'Ivoire
Democratic Republic of the Congo
Equatorial Guinea -
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Liberia
Madagascar
Malawi
Mali
Mauritania -
Mayotte - - - -
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Sierra Leone
South Africa
South Sudan2
Swaziland -
Togo
Uganda
United Republic of Tanzania -
Mainland
Zanzibar
Zambia
Zimbabwe
AMERICAS
Belize NA NA
Bolivia (Plurinational State of) NA NA
Brazil NA NA
Colombia NA NA
Costa Rica NA NA
Dominican Republic NA NA

94 WORLD MALARIA REPORT 2016


Testing Treatment

Patients of all Malaria RDTs used at G6PD test is ACT for Pre-referral Single dose of Primaquine Directly
ages should diagnosis is community recommended treatment of treatment with primaquine is used for observed
get diagnostic free of charge level before P. f. quinine or is used as radical treatment
test in the public treatment with artemether IM gametocidal treatment of with
sector primaquine or artesunate medicine for P.vivax cases primaquine is
suppositories P.falciparum1 undertaken

- - NA -

-


-












- -









- - - -

-
-








- -

- - - -



NA



NA -
NA

WORLD MALARIA REPORT 2016 95


Annex 4 A. Policy adoption, 2015

WHO region Insecticide-treated mosquito nets Indoor residual spraying Chemoprevention


Country/area
ITNs/LLINs ITNs/LLINs ITNs/LLINs IRS is DDT is used IPTp used Seasonal
are are distributed recommended for IRS to prevent malaria
distributed distributed through mass by malaria malaria chemo
free of charge to all age campaigns control during prevention
groups to all age programme pregnancy (SMC or IPTc)
groups is used

AMERICAS
Ecuador NA NA
El Salvador NA NA
French Guiana NA NA
Guatemala NA NA
Guyana NA NA
Haiti NA NA
Honduras NA NA
Mexico NA NA
Nicaragua NA NA
Panama NA NA
Peru NA NA
Suriname NA NA
Venezuela (Bolivarian Republic of) NA NA
EASTERN MEDITERRANEAN
Afghanistan NA NA
Djibouti
Iran (Islamic Republic of) NA NA
Pakistan NA NA
Saudi Arabia - NA NA
Somalia
Sudan
Yemen NA NA
EUROPEAN
Tajikistan - NA NA
SOUTH-EAST ASIA
Bangladesh NA NA
Bhutan NA NA
Democratic People's Republic of
NA NA
Korea
India NA NA
Indonesia NA NA
Myanmar NA NA
Nepal NA NA
Thailand NA NA
Timor-Leste NA NA
WESTERN PACIFIC
Cambodia NA NA
China NA NA
Lao People's Democratic Republic NA NA
Malaysia - NA NA
Papua New Guinea NA NA
Philippines NA NA
Republic of Korea - - NA NA
Solomon Islands NA NA
Vanuatu NA NA
Viet Nam NA NA
ACT, artemisinin-based combination therapy; DDT, dichloro-diphenyl-trichloroethane; G6PD, glucose-6-phosphate dehydrogenase; IM, intramuscular; IPTc, intermittent
preventive treatment in children; IPTp, intermittent preventive treatment in pregnancy; IRS, indoor residual spraying; ITN, insecticide-treated mosquito net; LLIN, long-lasting
insecticidal net; KA, not applicable; NMCP, national malaria control programme; RDT, rapid diagnostic test; SMC, seasonal malaria chemoprevention

96 WORLD MALARIA REPORT 2016


Testing Treatment

Patients of all Malaria RDTs used at G6PD test is ACT for Pre-referral Single dose of Primaquine Directly
ages should diagnosis is community recommended treatment of treatment with primaquine is used for observed
get diagnostic free of charge level before P. f. quinine or is used as radical treatment
test in the public treatment with artemether IM gametocidal treatment of with
sector primaquine or artesunate medicine for P.vivax cases primaquine is
suppositories P.falciparum1 undertaken


NA
NA
NA

NA
NA
NA
NA
NA


-

- -

- -


- -



- NA -



-




- -


- NA -



= Actually implemented.
= Not implemented.
(-) = Question not answered or not applicable.
1 Single dose of primaquine (0.75mg base/kg) for countries in the WHO Region of the Americas
2 In May 2013 South Sudan was reassigned to the WHO African Region (WHA resolution 66.21, http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R21-en.pdf)

WORLD MALARIA REPORT 2016 97


Annex 4 B. Antimalarial drug policy, 2015

WHO region P. falciparum P. vivax


Country/area
Uncomplicated Uncomplicated Prevention during
Severe Treatment
unconfirmed confirmed pregnancy

AFRICAN
Algeria - - - - CQ
Angola AL AL AS; QN - -
Benin AL AL AS; QN - -
Botswana AL AL QN - -
Burkina Faso AL; AS+AQ AL; AS+AQ AS; QN SP(IPT) -
Burundi AS+AQ AS+AQ AS; QN - -
Cabo Verde AL AL QN - -
Cameroon AS+AQ AS+AQ AS, AM;QN - -
Central African Republic AL AL AS, AM; QN SP(IPT) -
Chad AL; AS+AQ AL; AS+AQ AS,QN SP(IPT) -
Comoros AL AL QN SP(IPT) -
Congo AS+AQ AS+AQ QN SP(IPT) -
Cte d'Ivoire AS+AQ AS+AQ QN SP(IPT) -
Democratic Republic of the Congo AS+AQ AS+AQ AS, QN - -
Equatorial Guinea AS+AQ AS+AQ AS - -
Eritrea AS+AQ AS+AQ QN - AS+AQ+PQ
Ethiopia AL AL AS; AM; QN - CQ
Gabon AS+AQ AS+AQ AS; AM; QN - -
Gambia AL AL QN SP(IPT) -
Ghana AS+AQ AL; AS+AQ AS; AM; QN SP(IPT) -
Guinea AS+AQ AS+AQ AS SP(IPT) -
Guinea-Bissau AL AL AS;QN - -
Kenya AL AL AS; AM; QN - -
Liberia AS+AQ AS+AQ AS; AM; QN - -
Madagascar AS+AQ AS+AQ QN SP(IPT) -
Malawi AL AL AS; QN SP(IPT) -
Mali AS+AQ AL; AS+AQ QN SP(IPT) -
Mauritania AS+AQ AL; AS+AQ QN - -
QN; AS; QN+AS;
Mayotte - AL - CQ+PQ
AS+D; QN+D
Mozambique AL AL AS, QN - -
Namibia AL AL QN - AL
Niger AL AL AS; QN SP(IPT) -
Nigeria AL; AS+AQ AL; AS+AQ AS; AM; QN SP(IPT) -
Rwanda AL AL AS; QN - -
Sao Tome and Principe AS+AQ AS+AQ QN - -
Senegal AL; AS+AQ; DHA-PPQ AL; AS+AQ; DHA-PPQ AS; QN SP(IPT) -
Sierra Leone AS+AQ AL; AS+AQ AS; AM; QN SP(IPT) -
South Africa - AL; QN+CL; QN+D QN - AL+PQ; CQ+PQ
South Sudan1 AS+AQ AS+AQ AM; AS; QN - AS+AQ+PQ
Swaziland - AL AS - -
Togo AL; AS+AQ AL; AS+AQ AS; AM; QN SP(IPT) -
Uganda AL AL AS, QN - -
United Republic of Tanzania AL; AS+AQ AL; AS+AQ AS, AM; QN - -
Mainland AL AL AS, AM; QN SP(IPT) -
Zanzibar AS+AQ AS+AQ AS; QN SP(IPT) -
Zambia AL AL AS; AM; QN - -
Zimbabwe AL AL QN - -
AMERICAS
Argentina - AL+PQ - - CQ+PQ
Belize - CQ+PQ(1d) AL; QN - CQ+PQ(14d)
Bolivia (Plurinational State of) - AL+PQ - - CQ+PQ(7d)
AL+PQ(1d); AM+CL; AS+CL;
Brazil - - CQ+PQ(7d)
AS+MQ+PQ(1d) QN+CL
Colombia - AL AS+AL - CQ+PQ(14d)
CQ+PQ(7d);
Costa Rica - CQ+PQ(1d) QN -
CQ+PQ(14d)

98 WORLD MALARIA REPORT 2016


WHO region P. falciparum P. vivax
Country/area
Uncomplicated Uncomplicated Prevention during
Severe Treatment
unconfirmed confirmed pregnancy

AMERICAS
Dominican Republic - CQ+PQ(1d) QN+CL - CQ+PQ(14d)
Ecuador - AL+PQ QN - CQ (3d)+PQ(7d)
El Salvador - CQ+PQ(1d) QN - CQ+PQ(14d)
French Guiana - AL AS; AL - CQ+PQ
Guatemala - - QN - CQ+PQ(14d)
Guyana - AL+PQ(1d) AM - CQ+PQ(14d)
Haiti - CQ+PQ(1d) QN - CQ+PQ(14d)
Honduras - CQ+PQ(1d) QN - CQ+PQ(14d)
Mexico - CQ+PQ AL - CQ+PQ
Nicaragua - CQ+PQ(1d) QN - CQ+PQ(7d)
CQ+PQ(7d);
Panama - AL+PQ(1d) QN -
CQ+PQ(14d)
Paraguay - AL+PQ AS - CQ+PQ
Peru - AS+MQ AS+MQ - CQ+PQ
Suriname - AL+PQ(1d) AS - CQ+PQ(14d)
Venezuela (Bolivarian Republic of) - AS+MQ+PQ AM; QN - CQ+PQ(14d)
EASTERN MEDITERRANEAN
Afghanistan CQ AS+SP+PQ AS; AM; QN - CQ+PQ(8w)
Djibouti AL AL+PQ QN - CQ+PQ (14d)
Iran (Islamic Republic of) - AS+SP; AS+SP+PQ AS; QN - CQ+PQ(14d & 8w)
Pakistan CQ AS+SP+PQ AS; QN - CQ+PQ (14d & 8w)
Saudi Arabia - AS+SP+PQ AS; AM; QN - CQ+PQ(14d)
Somalia AL AL+PQ AS; AM; QN SP(IPT) AL+PQ(14d)
Sudan AS+SP; AL AS+SP; AL QN; AM - AL+PQ(14d)
Yemen AS+SP AS+SP QN; AM - CQ+PQ(14d)
SOUTH-EAST ASIA
Bangladesh - AL AS+AL; QN - CQ+PQ(14d)
Bhutan - AL AM; QN - CQ+PQ(14d)
Democratic People's Republic of
- - - - CQ+PQ(14d)
Korea
India CQ AS+SP+PQ AM; AS; QN - CQ+PQ(14d)
Indonesia - DHA-PP+PQ AM; AS; QN - DHA-PP+PQ(14d)
AL; AM; AS+MQ;
Myanmar - AM; AS; QN - CQ+PQ(14d)
DHA-PPQ; PQ
Nepal CQ AL+PQ AS; QN - CQ+PQ(14d)
Sri Lanka - AL+PQ QN - CQ+PQ(14d)
Thailand - DHA-PPQ QN+D - CQ+PQ(14d)
Timor-Leste - AL AM; AS; QN - CQ+PQ(14d)
WESTERN PACIFIC
AS+MQ; DHA-
Cambodia - AM; AS; QN - DHA-PPQ
PPQ+PQ
ART+NQ; ART-PPQ;
China - AM; AS; PYR - CQ+PQ(8d)
AS+AQ; DHA-PPQ
Lao People's Democratic Republic - AL AS+AL - CQ+PQ(14d)
Malaysia - AS+MQ AS+D; QN - CQ+PQ(14d)
Papua New Guinea - AL AM; AS - AL+PQ
Philippines AL AL+PQ QN+T; QN+D; QN+CL SP(IPT) CQ+PQ(14d)
Republic of Korea CQ - - - CQ+PQ(14d)
Solomon Islands AL AL AL; AS - AL+PQ(14d)
Vanuatu - AL AS CQ(weekly) AL+PQ(14d)
Viet Nam DHA-PPQ DHA-PPQ AS; QN - CQ+PQ(14d)

AL=Artemether-lumefantrine AS=Artesunate D=Doxycycline PG=Proguanil QN=Quinine


AM=Artemether AT= Atovaquone DHA=Dihydroartemisinin PPQ=Piperaquine SP=Sulphadoxine-pyrimethamine
AQ=Amodiaquine CL=Clindamycline MQ=Mefloquine PQ=Primaquine T=Tetracycline
ART=Artemisinin CQ=Chloroquine NQ=Naphroquine PYR=Pyronaridine

1 In May 2013, South Sudan was reassigned to the WHO African Region (WHA resolution 66.21, http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R21-en.pdf)
WORLD MALARIA REPORT 2016 99
Annex 4 C. Funding for malaria control, 20132015

WHO region Year Contributions reported by donors


Country/area
Global Fund PMI/USAID The World Bank UK4

AFRICAN
2013 0 0 0 0
Algeria 2014 0 0 0 0
2015 0 0 0 0
2013 25654554 29044735 0 0
Angola 2014 -249457 29034800 0 0
2015 1319877 28000000 0 0
2013 28126482 16942762 0 0
Benin 2014 13120913 16519800 510289 0
2015 2663084 16500000 510901 0
2013 0 0 0 0
Botswana 2014 0 0 0 0
2015 1651425 0 0 0
2013 9563499 9584925 4360225 308128
Burkina Faso 2014 5970765 9511400 1922457 300665
2015 26642827 12000000 1924764 390300
2013 23148751 9389585 0 0
Burundi 2014 4779972 9511400 702875 0
2015 3431421 12000000 703719 0
2013 908176 0 0 0
Cabo Verde 2014 0 0 0 0
2015 507453 0 0 0
2013 11067992 0 0 0
Cameroon 2014 8623656 0 0 0
2015 44506703 0 0 0
2013 12489645 0 0 0
Central African Republic 2014 1994303 0 0 0
2015 2652313 0 0 0
2013 35277508 0 0 0
Chad 2014 12603052 0 0 0
2015 3685635 0 0 0
2013 3602626 0 0 0
Comoros 2014 1108648 0 0 0
2015 74394 0 0 0
2013 748670 0 0 0
Congo 2014 0 0 0 0
2015 -274505 0 0 0
2013 46135572 0 0 0
Cte d'Ivoire 2014 27529564 0 0 0
2015 15049821 0 0 0
2013 59219677 42597521 11516688 15009416
Democratic Republic of the Congo 2014 78210843 50060000 -34980 18098629
2015 126400000 50000000 -35022 23494261
2013 0 0 0 0
Equatorial Guinea 2014 -138287 0 0 0
2015 -136534 0 0 0
2013 14711707 0 0 0
Eritrea 2014 6805860 0 0 0
2015 7287106 0 0 0
2013 115100000 44534650 0 0
Ethiopia 2014 9902341 45054000 0 0
2015 36385300 44000000 0 0
2013 -120 0 0 0
Gabon 2014 -155013 0 0 0
2015 -297542 0 0 0

100 WORLD MALARIA REPORT 2016


Contributions reported by countries

Government Global Fund The World Bank PMI/USAID Other WHO UNICEF Other
(NMCP) bilaterals contributions6

0 5
- - - - - - 0
1705134 0 - - - 12000 - 0
1335355 - - - - - - -
64047348 5
19286339 - 27200000 - - 3555239 -
27851717 5378690 - 27000000 - - - -
47356258 5
2675645 - 28000000 - - - -
980000 - - - - - - -
1082000 40580540 - - - - - -
- - - - - - - -
1947775 0 0 0 0 - 0 0
2142552 0 0 0 0 - 0 0
1605618 280899 0 0 0 - 0 0
58920267 40645351 0 8552723 0 37800 521760 942955
3126963 2433376 697173 8571017 70804 19048 136540 379610
576253 42735771 284328 8579441 9454 11800 305704 2533200
1134923 19481377 - 9260000 2602730 65000 453631 1277376
2001113 6027330 - 9229345 0 79050 475936 1324385
464515 4523416 - 9500000 - 32595 47445292 -
397920 555169 - - - 130448 - -
253251 64285 - - - 19638 - -
1520070 5
325273 - - - 19142 - -
5246883 5
15293706 - - 5415537 904218 118341 5415537
43709021 5
147856497 - 1123490 - 460000 14718 669000
12122087 5
54918697 - - - 221000 - -
160000 5342710 0 0 - - 2000000 -
530000 5
2852385 - - - 20500 5596000 -
530000 5
- - - - 100000 - -
7493400 5
- - - - - - -
9122400 5
30125205 - - 239735 54574 2667358 673440
1184508 6141762 - - - 20000 216491 -
137147 499000 0 0 0 40000 5576 0
94797 1074877 0 0 0 104000 51630 58500
114685 224643 0 0 0 30000 6221 0
1651000 0 0 0 0 45000 10000 0
1675000 - - - - 45000 - 3827
446000 0 0 0 0 68000 18000 0
54723090 74853096 13119140 9839355 244000 36338 24975817 244000
53942249 33611939 - 9839355 - 6245966 29250235 -
913958253 14414815784 0 0 0 0 15070138 22954890
7812690 86281277 2952042 37001000 0 0 1790452 35020370
8104841 102540781 0 34000000 24838023 2100000 7196262 0
7014345 107594221 0 34000000 23018218 2933630 808130 0
2582747 5
0 - - - - - 4490030
- - - - - - - -
- - - - - - - -
- 15871769 - - - - - -
0 4906745 0 0 - 58832 0 0
0 6216618 0 0 0 46081 0 0
19705028 85723876 - 29370000 - 111677 - 15000000
- 93201479 - - - - - -
- 18448416 - 3800000 - - - 13114670
226596 0 0 0 0 11276 0 -
123200 0 0 0 0 34855 0 -
27677576 5
0 0 0 0 47147 0 272289

WORLD MALARIA REPORT 2016 101


Annex 4 C. Funding for malaria control, 20132015

WHO region Year Contributions reported by donors


Country/area
Global Fund PMI/USAID The World Bank UK4

AFRICAN
2013 9450471 0 0 3259541
Gambia 2014 4139913 0 0 3571824
2015 3570386 0 0 4636670
2013 68982118 29043718 1950363 159531
Ghana 2014 14858744 28033600 -193385 13571490
2015 48569128 28000000 -193617 17617474
2013 4683637 12586255 0 0
Guinea 2014 9155326 12515000 0 0
2015 11116893 12500000 0 0
2013 7447874 0 0 0
Guinea-Bissau 2014 2343620 0 0 0
2015 2442286 0 0 0
2013 33890896 34852054 0 24424951
Kenya 2014 49600626 35042000 0 10299449
2015 4178019 35000000 0 13369959
2013 5985313 12585238 0 0
Liberia 2014 10417780 12014400 0 0
2015 7326968 12000000 0 0
2013 23041363 26478852 0 0
Madagascar 2014 499916 26031200 0 0
2015 23405037 26000000 0 0
2013 9242261 24493905 0 0
Malawi 2014 7137815 22026400 0 0
2015 29090137 22000000 0 0
2013 14086732 25442122 0 0
Mali 2014 10815983 25030000 0 265099
2015 7156264 25000000 0 344131
2013 0 0 0 289208
Mauritania 2014 0 0 0 194250
2015 -186844 0 0 252160
2013 0 0 0 0
Mayotte 2014 0 0 0 0
2015 0 0 0 0
2013 12846315 29528000 2081542 8459472
Mozambique 2014 34683850 29034800 1051656 0
2015 18387135 29000000 1052918 0
2013 3671321 0 0 0
Namibia 2014 557477 0 0 0
2015 -428418 0 0 0
2013 9467744 0 0 0
Niger 2014 24038455 0 0 0
2015 7579029 0 0 0
2013 46154643 74546933 28656321 33723741
Nigeria 2014 145100000 75090000 60004274 25486088
2015 83002031 75000000 60076279 33084096
2013 23279708 18316252 0 0
Rwanda 2014 15445694 17521000 0 0
2015 10893839 18000000 0 0
2013 3763889 0 9689 0
Sao Tome and Principe 2014 3310033 0 0 156962
2015 1088458 0 0 203756
2013 3725853 24543758 0 0
Senegal 2014 21700475 24028800 0 107327
2015 15858305 24000000 0 139323

102 WORLD MALARIA REPORT 2016


Contributions reported by countries

Government Global Fund The World Bank PMI/USAID Other WHO UNICEF Other
(NMCP) bilaterals contributions6

726578 4919685 0 0 0 16000 26229 100000


799091 5934320 - - - 132833 150000 120814
793818 2887213 0 0 0 - 3062 2406568
8736726 67804357 0 27000000 38817 47050 0 -
8855177 64952156 - 4730000 825000 32514 7519 6429
9832327 39759327 0 28000000 520000 60000 0 0
3015335 - - 10000000 - - - -
956833 15603972 - 12052476 - 105114 36639 16581
48178445 28859411 - 12500000 3979774 21886 10419 -
0 701363 0 0 - 73734 218811 -
100000 5
2952761 0 0 0 16869 7231 0
- - - - - - - -
1372093 29089771 1127907 32400000 23457627 - 0 23457627
1178804 48916476 - 32400000 25635413 832402 - -
1520205 64945727 - 32400000 - 604058 100000 -
284306 5
14026642 0 12000000 - 44890 340647 -
11341797 10399555 0 12000000 0 - 0 0
- - - - - - - -
15286 29994536 0 27000000 369500 299000 737588 0
23658 2524013 600000 25920000 0 3369341 254170 0
25400 23199442 0 26000000 213615 298946 70000 56422
- 880267 - 23000000 - 150000 - -
- 8023075 - 19118000 - 150000 - -
4266640 5
22777197 - 12234171 - - - 1082008
1871915 18180392 0 25500000 0 92000 3092000 0
1756941 26392018 0 25500000 - 95000 1437552 -
5670552 21201959 0 25500000 - 120000 574693 5326854
1130593 - - - - 11767 42583 -
2328000 - - - - 46000 42000 -
173720 - - - - 67000 67000 -
- - - - - - - -
- - - - - - - -
- - - - - - - -
65800000 2497243 11000000 29000000 - 100000 2668555 -
4186129 37646902 3500000 29023096 - - 268993 -
5146910 4357070 0 29000000 0 200000 1688356 139501
14811934 882630 0 - 0 100000 - 0
2996923 2910095 0 0 0 100000 0 0
4051428 2796269 - - - 100000 - 136929
2668014 19000000 0 0 - 27000 4000000 -
2859000 2494013 0 0 0 70248 1249000 44000
8999547 9324003 0 72000 0 86567 18500 0
5541401 100362906 7040569 60462012 36736654 934980 3000000 -
- 137920815 52220588 73771000 20157565 861615 1000000 -
- 126250194 - 75000000 12322449 964784 - 4809717
- - - - - - - -
0 0 0 0 0 0 0 0
531541 10893838 - 18000000 - - - -
10724 1002778 0 0 1050830 32512 0 2000
11084 1715622 0 0 1020102 125209 0 1600
47033 1668679 0 0 1000000 60006 1293 1600
13986 4675836 - 24500000 - 12490 200000 -
24800 15023299 - 25302960 - 12491 9780 -
2069404 2427578 1000000 23666000 - - - 25705

WORLD MALARIA REPORT 2016 103


Annex 4 C. Funding for malaria control, 20132015

WHO region Year Contributions reported by donors


Country/area
Global Fund PMI/USAID The World Bank UK4

AFRICAN
2013 6322646 0 0 6665038
Sierra Leone 2014 13804625 0 1818657 1749926
2015 6177403 0 1820839 2271620
2013 0 0 0 0
South Africa 2014 0 0 0 89809
2015 0 0 0 116584
2013 8868037 7067878 0 9789412
South Sudan7 2014 14270616 6007200 0 11110486
2015 28351902 6000000 0 14422786
2013 1359333 0 0 0
Swaziland 2014 1656196 0 0 0
2015 -9242 0 0 0
2013 20867709 0 0 0
Togo 2014 7422179 0 0 0
2015 574092 0 0 0
2013 19851005 34369807 0 744053
Uganda 2014 14240284 34040800 0 23540773
2015 19156953 34000000 0 30558836
2013 53130202 46857374 0 8038848
United Republic of Tanzania8 2014 28978524 46055200 0 11797783
2015 56565404 46000000 0 15314982
2013 48951490 0 0 0
Mainland 2014 28978524 0 0 0
2015 56656620 0 0 0
2013 4178713 0 0 0
Zanzibar 2014 0 0 0 0
2015 -91216 0 0 0
2013 29845578 24446087 5025296 21025870
Zambia 2014 0 24028800 -79393 9560356
2015 9533481 24000000 -79489 12410525
2013 10159204 15296609 0 0
Zimbabwe 2014 10708651 15018000 0 0
2015 24281811 15000000 0 0
AMERICAS
2013 0 0 0 0
Belize 2014 0 0 0 0
2015 0 0 0 0
2013 2149471 0 0 0
Bolivia (Plurinational State of) 2014 1319756 0 0 0
2015 1164955 0 0 0
2013 -232760 0 0 0
Brazil 2014 0 0 0 0
2015 0 0 0 0
2013 6855077 0 0 0
Colombia 2014 2897670 0 0 0
2015 -572451 0 0 0
2013 1169538 0 0 0
Dominican Republic 2014 515308 0 0 0
2015 -23672 0 0 0
2013 1129922 0 0 0
Ecuador 2014 1003447 0 0 0
2015 0 0 0 0

104 WORLD MALARIA REPORT 2016


Contributions reported by countries

Government Global Fund The World Bank PMI/USAID Other WHO UNICEF Other
(NMCP) bilaterals contributions6

26898 13216219 1952807 - - 64000 7874921 112855


3074 13525631 0 0 6156320 50000 17912 2200067
190741 5353621 0 0 0 101207 100847 -
13511860 - - - 152277 - - -
17096911 - - - 68180 - - -
0 0 0 0 41140 40000 0 0
0 5
46437577 - 6900000 0 2934000 1000000 4108159
- - - - - - - -
- - - - - - - -
556245 1715525 0 0 132445 20250 0 0
678718 1203444 - - - 0 - 0
11847354 1714840 - - - - - -
- - - - - - - -
5139088 4897544 17304 0 0 1779 222460 0
- - - - - - - -
- 20146401 - 33781000 - - - -
8035963 5
24195015 3418520 33000000 39623353 - 1359595 4896045
8035963 5
74643525 0 33000000 32222500 - 5676820 4899062
952652 142485233 0 40602700 0 850 41153 2528703
6429082 147632422 0 1975000 50000 850 0 0
30523723 28982597 0 1060714 77966100 0 0 480412
937500 140356602 0 37117700 0 500 0 2487550
6022000 145506422 0 450000 0 500 0 0
30523723 28982597 0 1060714 77966100 0 0 480412
15152 2128631 0 3485000 - 350 41153 41153
407082 2126000 0 1525000 50000 350 0 -
- - - - - - - -
185325 19361732 0 24000000 3500000 204466 27318 0
15462950 24362218 - 24000000 - - 20000 6000000
22640090 10614665 - 24000000 - 170500 1006000 6500000
706200 7460006 - 13000000 - 90060 - -
520000 7626664 - 12000000 - - 42500 -
780000 33425777 - 12000000 - 39649 - -

261500 0 0 14223 0 0 0 -
270000 10121 0 6761 0 0 0 -
297500 189879 0 12747 0 0 0 0
787966 365193 0 0 0 0 0 0
718391 1631520 0 0 0 0 0 0
531609 1170000 0 0 0 38991 0 0
73291509 5
0 0 18700 0 0 0 0
72248286 5
0 0 47495 0 0 0 0
60803769 5
0 0 129288 0 0 0 0
23100498 4832745 0 142406 0 0 0 0
11493708 3257687 0 96194 0 0 0 0
13059553 0 0 73391 0 0 0 0
1966812 1158508 0 0 0 21930 0 23382
1883503 852947 0 0 0 0 0 106598
2663837 72511 0 0 0 0 0 213094
1852740 735047 0 19719 0 0 0 -
- 983835 0 98057 0 - 0 -
2444718 0 0 - 0 141000 0 -

WORLD MALARIA REPORT 2016 105


Annex 4 C. Funding for malaria control, 20132015

WHO region Year Contributions reported by donors


Country/area
Global Fund PMI/USAID The World Bank UK4

AMERICAS
2013 0 0 0 0
El Salvador 2014 0 0 0 0
2015 0 0 0 0
2013 0 0 0 0
French Guiana 2014 0 0 0 0
2015 0 0 0 0
2013 -2125749 0 0 0
Guatemala 2014 4393686 0 0 0
2015 4781163 0 0 0
2013 385865 0 0 0
Guyana 2014 0 0 0 0
2015 54389 0 0 0
2013 3970561 0 0 0
Haiti 2014 4537198 0 0 0
2015 4518050 0 0 0
2013 971241 0 0 0
Honduras 2014 968554 0 0 0
2015 3305959 0 0 0
2013 0 0 0 0
Mexico 2014 0 0 0 0
2015 0 0 0 0
2013 2473993 0 0 0
Nicaragua 2014 1011306 0 0 0
2015 555717 0 0 0
2013 0 0 0 0
Panama 2014 0 0 0 0
2015 0 0 0 0
2013 0 0 0 0
Peru 2014 0 0 0 0
2015 0 0 0 0
2013 559024 0 0 0
Suriname 2014 158942 0 0 0
2015 1274513 0 0 0
2013 0 0 0 0
Venezuela (Bolivarian Republic of) 2014 0 0 0 0
2015 0 0 0 0
EASTERN MEDITERRANEAN
2013 17932702 0 3233062 0
Afghanistan 2014 8413448 0 -978746 0
2015 8284767 0 -979921 0
2013 0 0 53289 0
Djibouti 2014 0 0 169381 0
2015 -283944 0 169584 0
2013 3235422 0 0 0
Iran (Islamic Republic of) 2014 2668430 0 0 0
2015 2480335 0 0 0
2013 5951734 0 0 0
Pakistan 2014 9014340 0 0 0
2015 8491910 0 0 0
2013 0 0 0 0
Saudi Arabia 2014 0 0 0 0
2015 0 0 0 0

106 WORLD MALARIA REPORT 2016


Contributions reported by countries

Government Global Fund The World Bank PMI/USAID Other WHO UNICEF Other
(NMCP) bilaterals contributions6

2854844 0 0 0 0 56948 0 0
0 0 0 0 0 54340 0 0
0 0 0 13376 0 11563 0 0
- 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0
- - - - - - - -
1385919 3498024 0 105373 0 0 0 0
542663 3278171 0 92461 0 0 0 0
2610850 8232108 0 56824 0 0 0 0
883314 809474 0 297569 0 71370 0 0
800439 451597 0 115708 0 140486 0 0
1023795 337939 0 288169 0 47500 0 0
2433241 1248119 0 - 0 169000 0 820000
- 1161379 0 102864 0 24413 0 -
- 1415674 - 62156 470000 - - 250064
971742 1106404 0 99330 6000 0 0 0
543312 792634 0 113187 0 0 0 6046
- - 0 118071 - 18457 0 -
25256768 0 0 0 0 0 0 0
23827054 0 0 0 0 0 0 0
46662926 0 0 0 0 0 0 0
1907755 2075252 0 37630 0 4814 0 0
2174840 1214811 0 51323 0 21868 0 0
2479318 1013568 0 59175 - 28098 - -
7220410 0 0 32136 0 0 0 0
7469311 5
100000 0 77562 0 0 0 0
7964427 10000 0 49079 0 11000 0 -
429285 5
0 0 56703 0 0 0 0
- 0 0 91037 0 0 0 0
- 0 0 98598 0 - 0 0
152805 550000 0 157887 400000 100000 0 400000
1650498 479600 0 30198 400541 77264 0 0
1049230 975757 0 47762 400541 41437 0 0
800000 5
0 0 0 - - - -
1000000 5
0 0 0 - - - -
19600139 0 0 0 - - - -

- 16651753 - - - 109068 - -
- 9083870 - - - 113341 - -
- 4571460 - - - 89167 - -
- - - - - 121616 200563 9200
- - - - - - - -
- - - - - - - -
5000000 0 - - - 60500 - -
6300000 2979260 - - - 34000 - -
2500000 2418943 - - - 5000 - -
- 8057177 - - - - - -
- 10718906 - - - 154000 - -
- 5910215 - - - 89000 - -
29440000 - - - - - - -
30000000 0 - - - 0 - 0
30000000 0 0 0 0 0 0 0

WORLD MALARIA REPORT 2016 107


Annex 4 C. Funding for malaria control, 20132015

WHO region Year Contributions reported by donors


Country/area
Global Fund PMI/USAID The World Bank UK4

EASTERN MEDITERRANEAN
2013 2306067 0 0 0
Somalia 2014 9683991 0 0 0
2015 10029201 0 0 0
2013 36300938 0 0 0
Sudan 2014 16072617 0 0 0
2015 45537876 0 0 0
2013 6077055 0 0 0
Yemen 2014 2019956 0 0 0
2015 1766950 0 0 0
EUROPEAN
2013 1330867 0 0 0
Tajikistan 2014 1033516 0 0 0
2015 310931 0 0 0
SOUTH-EAST ASIA
2013 16690261 0 0 0
Bangladesh 2014 4400680 0 0 0
2015 6752177 0 0 0
2013 412322 0 0 0
Bhutan 2014 240177 0 0 0
2015 564401 0 0 0
2013 2753419 0 0 0
Democratic People's Republic of Korea 2014 6712651 0 0 0
2015 3430639 0 0 0
2013 7298886 0 5510326 0
India 2014 4487320 0 336371 0
2015 32762209 0 336774 0
2013 31585463 0 0 325066
Indonesia 2014 11501914 0 0 309236
2015 12520343 0 0 401426
2013 15294281 6680248 0 12333480
Myanmar 2014 30390265 8009600 0 7795850
2015 26232472 9000000 0 10119978
2013 5007753 0 0 0
Nepal 2014 1815285 0 0 0
2015 1718309 0 0 0
2013 11522593 0 0 0
Thailand 2014 20562762 0 0 0
2015 7192438 0 0 0
2013 2649725 0 0 0
Timor-Leste 2014 1529674 0 0 0
2015 2515337 0 0 0
WESTERN PACIFIC
2013 12322502 4066548 0 0
Cambodia 2014 24223323 4505400 0 0
2015 8913449 4500000 0 0
2013 1888802 0 0 0
China 2014 -1740333 0 0 0
2015 -7270 0 0 0
2013 3312655 0 712658 0
Lao People's Democratic Republic 2014 4209255 0 637564 0
2015 5919559 0 638329 0

108 WORLD MALARIA REPORT 2016


Contributions reported by countries

Government Global Fund The World Bank PMI/USAID Other WHO UNICEF Other
(NMCP) bilaterals contributions6

64515 15062018 0 0 - 138400 - -


67740 9604810 0 0 0 85000 0 0
79488 7365620 0 0 0 121800 - 0
26724830 34938594 - - - 475893 140000 -
27316109 35883294 - - - 446160 - -
21536529 16251350 0 0 0 471552 0 0
2293553 5
6256730 - - - 200000 - 1986444
8480 2110776 - - 258495 465713 - 1674350
0 14326025 - - - 390259 - -

633740 1714393 - - - 35000 - -


773000 1057879 - - - 75000 - 0
- - - - - - - -

4134615 8033087 - - - 399189 - -


5586290 8912484 - - - - - -
935897 9507849 0 0 0 65000 0 0
- - - - - - - -
180328 390420 - - - 10000 - 166639
179104 487909 0 0 0 5552 0 0
1895000 2706329 0 0 0 25000 0 0
1957000 1571206 0 0 0 98000 0 0
2042000 6817631 0 0 0 30200 0 -
51336600 4811540 4299233 - - - - -
43802468 16129032 0 - - - - -
48419018 5244575 0 0 0 - 0 -
15288402 5
34580791 0 0 0 400000 3525000 0
16108194 5
15913410 0 0 0 277282 3490400 0
10940000 5
10966688 0 0 0 277282 1691397 0
1028807 14863117 - 5400000 - 142500 1000000 -
- 42620577 - 6565881 451400 25000 - 5561917
5272824 5
31629898 0 6500000 2800000 25000 0 0
1910485 3110685 - - - 46500 - -
- - - - - 46500 - -
2315400 5
5199862 - - - 45000 - -
5893255 9937671 - 278311 - 139166 - 70833
7546409 20175612 0 345667 0 0 0 0
7934078 13830845 0 685341 0 0 0 0
2981432 4372545 - - - 65012 - 120000
- 3482955 - - - - - -
791375 2610355 0 0 0 27280 0 0

3484029 13240888 0 3996624 0 431792 0 -


714343 2917174 0 4500000 0 334029 0 -
692698 4042964 0 4500000 0 406393 0 -
16812725 0 0 0 0 0 0 0
20843118 0 - - - 0 - 0
17620404 - - - - - - -
1122915 4038937 0 120132 0 20000 0 0
247375 2475938 0 0 0 113000 0 43620
211874 6458501 0 216986 600000 198357 0 0

WORLD MALARIA REPORT 2016 109


Annex 4 C. Funding for malaria control, 20132015

WHO region Year Contributions reported by donors


Country/area
Global Fund PMI/USAID The World Bank UK4

WESTERN PACIFIC
2013 0 0 0 376047
Malaysia 2014 0 0 0 5208116
2015 0 0 0 6760779
2013 23369832 0 0 0
Papua New Guinea 2014 10983626 0 0 122670
2015 7733450 0 0 159240
2013 4890556 0 0 0
Philippines 2014 6940774 0 0 0
2015 4271374 0 0 0
2013 0 0 0 0
Republic of Korea 2014 0 0 0 0
2015 0 0 0 0
2013 0 0 0 0
Solomon Islands 2014 0 0 0 0
2015 682023 0 0 0
2013 2961459 0 0 0
Vanuatu 2014 1487520 0 0 0
2015 763342 0 0 0
2013 4323107 0 0 0
Viet Nam 2014 13050120 0 0 0
2015 7904820 0 0 0

NMCP, National Malaria Control Programme; PMI, United States Presidents Malaria Initiative; UK, Funding from the United Kingdom of Great Britain and Northern Ireland
government; UNICEF, United Nations Childrens Fund; USAID, United States Agency for International Development
1 Source: The Global Fund
2 Source: www.foreignassistance.gov
3 Source: OECD Database
4 Source: OECD Database
5 Budget not expenditure
6 Other contributions as reported by countries: NGOs, foundations, etc.
7 South Sudan became an independent State on 9 July 2011 and a Member State of WHO on 27 September 2011. South Sudan and Sudan have distinct epidemiological profiles
comprising high-transmission and low-transmission areas, respectively. For this reason data up to June 2011 from the high-transmission areas of Sudan (10 southern states
which correspond to contemporary South Sudan) and low-transmission areas (15 northern states which correspond to contemporary Sudan) are reported separately.
8 Where national totals for the United Republic of Tanzania are unavailable, refer to the sum of Mainland and Zanzibar.
* Negative disbursements reflect recovery of funds on behalf of the financing organization.
- refers to data not available.

110 WORLD MALARIA REPORT 2016


Contributions reported by countries

Government Global Fund The World Bank PMI/USAID Other WHO UNICEF Other
(NMCP) bilaterals contributions6

39845997 - - - - 0 - 0
57535038 0 - - - 0 - 0
64881663 - - - - - - -
388000 25311547 0 0 - - 0 -
377000 695052 0 0 0 0 0 0
1637421 11000000 - - - - - -
5235686 8612874 0 0 0 315326 0 22220
5861758 7395343 0 0 0 0 0 0
6165334 6087433 0 0 0 0 0 0
519102 0 - - - 0 - 0
556200 0 - - - 0 - 0
538495 0 0 0 0 0 0 0
270180 1305840 0 0 1987523 852472 0 674896
260505 1362022 0 0 1820735 654985 0 0
281324 2232220 0 0 1017390 464914 0 0
812377 5
1162890 0 0 1692091 287615 0 0
812377 5
1310500 0 0 1064592 287615 0 0
166359 687267 0 0 424136 175894 0 0
4523810 5254143 0 0 0 410000 0 0
2666667 15263816 0 0 0 640700 0 0
2666666 5528000 0 0 0 560000 0 200000

WORLD MALARIA REPORT 2016 111


Annex 4 D. Commodities distribution, 20132015

WHO region Year No. of ITN + LLIN No. of people No. of RDTs First-line treatment ACT treatment
Country/area sold or delivered protected by IRS distributed courses delivered courses delivered
(including ACT)

AFRICAN
2013 0 17407 - 603 0
Algeria 2014 0 - - 266 92
2015 - - 0 747 -
2013 1182519 419353 900000 2814900 2814900
Angola 2014 2978937 58370 - - -
2015 2138331 - 2500000 3185160 3185160
2013 584285 694729 - - -
Benin 2014 6203924 789883 1332948 1101154 1101154
2015 - 802597 1486667 1177261 1177261
2013 0 176887 1600 3953 3953
Botswana 2014 - 205831 - - -
2015 50000 143268 1135 1386 1386
2013 9959820 0 5728612 5797938 5797938
Burkina Faso 2014 239559 0 6224055 7494498 7494498
2015 481107 0 8290188 7824634 7824634
2013 731981 0 2857991 3836437 3836437
Burundi 2014 5752583 0 3089202 4772805 4263178
2015 726767 - 5075437 4798379 4798376
2013 0 298475 - 4824 3144
Cabo Verde 2014 0 25780 - 46 41
2015 0 308586 - 26 26
2013 - 0 920382 1048811 497022
Cameroon 2014 - 0 - 1270172 1270172
2015 2751112 - 1573992 826434 826434
2013 150000 0 25000 420000 420000
Central African Republic 2014 555334 - 303582 522270 522270
2015 1170566 - 759245 1043674 1043674
2013 230043 - 994779 814449 814449
Chad 2014 6321676 - 1144686 1038000 1038000
2015 1218640 - 1057033 1326091 1326091
2013 377252 31150 23565 60868 60868
Comoros 2014 13576 22475 5375 4750 4750
2015 16969 20275 14813 577 550
2013 14005 0 39375 0 0
Congo 2014 180595 0 19746 0 0
2015 447 - 0 1304959 1304959
2013 1821267 - 3891695 2358567 2358567
Cte d'Ivoire 2014 12627282 - - - -
2015 3663080 - 5600100 3296991 3296991
2013 7947747 185252 9746694 14941450 7112841
Democratic Republic
2014 13918109 194566 13962862 19008927 19008927
of the Congo
2015 15419488 77643 13574891 9871484 9871484
2013 8397 129000 17630 40911 40911
Equatorial Guinea 2014 10010 165944 9801 14577 -
2015 - - - - -
2013 86597 275857 393780 182911 182911
Eritrea 2014 0 320881 54516 216195 216195
2015 2054194 328915 645 255602 255602
2013 11709780 23150388 18300000 12800000 9164641
Ethiopia 2014 13388552 16709249 7416167 7321471 5321471
2015 17233074 - 13148960 7036620 6049320
2013 21666 0 - - -
Gabon 2014 10000 - - 984423 984423
2015 10730 - - - -
2013 138149 800290 907880 468767 468767
Gambia 2014 1046510 350442 603900 319182 319182
2015 93375 438234 875850 351677 351677
2013 1926300 2936037 3840000 8330784 8330784
Ghana 2014 5190887 2154924 9309200 14267045 14267045
2015 9085339 1325507 4000000 2715640 4007385
2013 5268245 - 2436825 370771 1402400
Guinea 2014 73145 - 2870250 1312802 644829
2015 741450 - 2412597 1645493 -

112 WORLD MALARIA REPORT 2016


WHO region Year No. of ITN + LLIN No. of people No. of RDTs First-line treatment ACT treatment
Country/area sold or delivered protected by IRS distributed courses delivered courses delivered
(including ACT)

AFRICAN
2013 116268 - - - -
Guinea-Bissau 2014 1109568 - 917200 171540 171540
2015 - - - - -
2013 1641982 0 5000000 8300000 7000000
Kenya 2014 5450064 0 5500000 10839611 10614717
2015 11637493 0 4319000 11052564 10321221
2013 95775 - 610225 1332055 443900
Liberia 2014 236996 0 58248 100535 96787
2015 - 0 - - -
2013 6458693 1579521 1640095 2172536 2172536
Madagascar 2014 105442 1307384 2839325 1648093 1648093
2015 11249042 1327326 4962600 2040289 2040289
2013 636318 - - 7601460 7601460
Malawi 2014 1423507 - 8197250 8735160 8735160
2015 1100000 - 8462325 6240060 6240060
2013 636465 826386 4101525 3080130 3080130
Mali 2014 3790403 836568 2563993 2211118 2211118
2015 6080030 494163 4381050 3761319 3761319
2013 105000 - 225680 56015 56015
Mauritania 2014 178922 - 269941 176192 176192
2015 240000 - 360000 - 109000
2013 39400 381 - - -
Mayotte 2014 5252 450 - - -
2015 - - - - -
2013 3315727 9647202 10547052 13477650 13477650
Mozambique 2014 6112245 5597770 17374342 15976059 15976059
2015 5126340 3659845 17219225 13653685 13653685
2013 104249 598901 185025 90377 87520
Namibia 2014 163526 467930 - - -
2015 - 386759 30120 79215 -
2013 409400 0 2561900 6556070 6556070
Niger 2014 2048430 0 4197381 5731036 5731036
2015 6253448 0 3039594 3698674 3698674
2013 8559372 132211 13200766 32568349 32568349
Nigeria 2014 23328225 316255 10679235 22145889 22145889
2015 27628073 - - - -
2013 5249761 1562411 604565 1204913 1204913
Rwanda 2014 1373582 1243704 444729 1917021 1917021
2015 2066915 - 2015100 4392006 4392006
2013 14596 153514 30909 8752 8752
Sao Tome and Principe 2014 11385 124692 58005 1456 1456
2015 113221 143571 72407 1704 1704
2013 3902145 690090 1453000 976840 976840
Senegal 2014 3785595 708999 1193075 703712 703712
2015 556135 514833 2570500 958492 958492
2013 441859 0 2522058 2201370 2201370
Sierra Leone 2014 3846204 0 2057306 1391273 1391273
2015 395061 - 2494935 1687031 1687031
2013 0 2318129 242123 8272 5444
South Africa 2014 0 5650177 499086 14036 14036
2015 0 1178719 16007 0 0
2013 3144818 332968 764670 3125448 3125448
South Sudan1 2014 - - - - -
2015 - - - - -
2013 0 0 21575 356 307
Swaziland 2014 5399 3971 - 588 558
2015 3808 - 58700 491 396
2013 468575 0 989436 964927 802904
Togo 2014 4042425 0 1633891 1134604 1208529
2015 8600 - 1633891 1508016 1208529
2013 13219306 2581839 19048750 24375450 24375450
Uganda 2014 10615631 3219122 17157725 21698700 21698700
2015 1442500 3895232 27110800 30166620 30166620

WORLD MALARIA REPORT 2016 113


Annex 4 D. Commodities distribution, 20132015

WHO region Year No. of ITN + LLIN No. of people No. of RDTs First-line treatment ACT treatment
Country/area sold or delivered protected by IRS distributed courses delivered courses delivered
(including ACT)

AFRICAN
2013 2547391 3793027 21785950 20382485 20382485
United Republic of Tanzania 2014 619189 2224900 24126300 19937820 19937820
2015 21141998 14684925 17031950 10164660 10164660
2013 2489536 3537097 21491950 20377410 20377410
Mainland 2014 510000 2000000 24126300 19937820 19937820
2015 20794000 14386280 16416675 10160910 10160910
2013 57855 255930 294000 5075 5075
Zanzibar 2014 109189 224900 - - -
2015 347998 298645 615275 3750 3750
2013 3362588 1063460 9221210 15926301 15926301
Zambia 2014 6368026 5538574 7500000 13000845 13000845
2015 - 5930141 11310350 14365969 14365969
2013 2010000 3106659 1671832 815260 815260
Zimbabwe 2014 1743542 3460871 2446996 960455 960455
2015 84087 3548246 1981613 847333 847333
AMERICAS
2013 2324 21413 0 26 0
Belize 2014 2452 21413 0 19 0
2015 4152 36796 0 13 0
2013 20965 30280 15000 7342 959
Bolivia
2014 23580 16573 - 7401 325
(Plurinational State of)
2015 17514 11138 - 6907 6907
2013 147736 324477 100050 452990 122290
Brazil 2014 229947 287150 46950 334740 59690
2015 - 276278 101700 290580 94380
2013 146196 154000 43600 68879 48285
Colombia 2014 169500 519333 2960 86228 32489
2015 25100 252500 0 108469 55469
2013 54139 49510 71000 579 4
Dominican Republic 2014 6733 6066 54425 496 7
2015 105906 100090 50220 661 3
2013 20337 94321 - 378 161
Ecuador 2014 - - - - -
2015 120532 - - 686 227
2013 10000 15076 0 10865 0
El Salvador 2014 0 6424 0 8 0
2015 0 37500 0 9 0
2013 2920 16932 - - -
French Guiana 2014 2990 - - - -
2015 - - - - -
2013 282788 37450 139525 - -
Guatemala 2014 49905 1700 50459 - -
2015 600049 - 108900 0 0
2013 27921 41000 0 31479 13655
Guyana 2014 152996 25592 0 12354 12354
2015 24201 146 0 9984 3219
2013 0 0 0 109625 0
Haiti 2014 0 0 - 2030300 -
2015 - - - - -
2013 66920 121121 8000 37248 2
Honduras 2014 25118 116490 4275 54466 8
2015 36149 125975 9750 - 8
2013 4500 49401 - 2974 4
Mexico 2014 7500 47775 - 4592 6
2015 15000 214032 0 3133 6
2013 17100 127601 19029 1162 0
Nicaragua 2014 83279 56675 15620 1142 0
2015 0 59282 12527 2307 -
2013 0 17055 0 705 0
Panama 2014 0 11422 0 874 0
2015 0 11581 0 562 0
2013 4600 43617 - 42670 6504
Peru 2014 45000 69155 - 65252 10416
2015 64687 142253 - 66609 13618

114 WORLD MALARIA REPORT 2016


WHO region Year No. of ITN + LLIN No. of people No. of RDTs First-line treatment ACT treatment
Country/area sold or delivered protected by IRS distributed courses delivered courses delivered
(including ACT)

AMERICAS
2013 4892 0 - 800 300
Suriname 2014 3000 0 24425 401 144
2015 0 - 17625 - -
2013 467 4369755 - - 27659
Venezuela (Bolivarian
2014 2666 4189850 0 120979 32005
Republic of)
2015 1041 2739290 - 136389 35509
EASTERN MEDITERRANEAN
2013 359622 0 188370 11135 11135
Afghanistan 2014 4325552 0 355160 21625 21625
2015 58830 - 98065 - 200
2013 25700 0 20800 8920 8920
Djibouti 2014 25000 36630 - - -
2015 0 - 40761 - -
2013 169084 281203 - 6230 3400
Iran (Islamic Republic of) 2014 70360 289249 - 8830 8830
2015 91845 217773 114450 37971 2042
2013 2238300 1161825 1170000 2150000 590840
Pakistan 2014 1519947 1103480 857690 907200 162880
2015 1822015 1685264 770074 890500 80000
2013 750000 1736400 - 974 974
Saudi Arabia 2014 1450000 752851 - 1155 1155
2015 125000 131661 - 1444 1444
2013 525000 90060 809520 292000 292000
Somalia 2014 413000 61362 617640 155450 155450
2015 291085 15645 424140 386200 386200
2013 5803319 3902712 1800000 2630400 2077204
Sudan 2014 4432714 3942110 2200000 3823175 3823175
2015 2729334 2460816 4344150 2551310 2551310
2013 1405837 2204429 233311 303847 303847
Yemen 2014 375899 2188436 412350 215486 215486
2015 847946 798707 334525 153682 153682
EUROPEAN
2013 100000 437436 - 1 1
Tajikistan 2014 50000 387010 - 0 0
2015 - - - - -
SOUTH-EAST ASIA
2013 612000 0 186700 42390 42390
Bangladesh 2014 728773 0 - 75479 58770
2015 2380759 - 259171 40742 35708
2013 93726 32824 - 518 518
Bhutan 2014 10609 144669 - 118 118
2015 26000 70926 16875 416 416
2013 0 2651612 0 15673 0
Democratic People's
2014 0 2617120 0 11212 0
Republic of Korea
2015 864750 1146750 253320 29272 0
2013 0 45854424 16200000 147000 147000
India 2014 0 45150612 15562000 211500 211500
2015 7241418 41849017 21182000 2123760 2123760
2013 913135 253815 1047504 300008 300008
Indonesia 2014 6416947 103285 879650 212346 212165
2015 56337 53497 300000 406614 406614
2013 1508557 - 1497545 371663 371663
Myanmar 2014 904613 48626 3048440 281103 281103
2015 3398941 129545 1309300 243515 243515
2013 1395865 345000 65500 38113 325
Nepal 2014 1064518 372000 60000 24500 195
2015 304437 235000 56000 3350 300
2013 670000 106374 160000 15069 15069
Thailand 2014 528850 362469 258823 19314 19314
2015 251500 348713 15400 8125 8125
2013 253037 51627 121991 1042 513
Timor-Leste 2014 99572 110707 86592 347 105
2015 24607 93019 90818 80 56

WORLD MALARIA REPORT 2016 115


Annex 4 D. Commodities distribution, 20132015

WHO region Year No. of ITN + LLIN No. of people No. of RDTs First-line treatment ACT treatment
Country/area sold or delivered protected by IRS distributed courses delivered courses delivered
(including ACT)

WESTERN PACIFIC
2013 5418 0 1085325 117547 117547
Cambodia 2014 70411 0 538500 118483 114159
2015 1517074 - 483600 128004 122013
2013 0 447639 821000 4127 3919
China 2014 19899 504936 - 43150 9350
2015 29611 1697188 - 67555 20710
2013 439677 13113 160000 58470 58470
Lao People's Democratic
2014 276655 4691 312075 50092 50092
Republic
2015 152791 - 324225 86456 86456
2013 317943 682288 - 3850 2873
Malaysia 2014 622673 615384 - 3923 3182
2015 285946 489030 - 2311 1616
2013 1625831 0 1032600 915330 915330
Papua New Guinea 2014 1613140 - 963900 802080 802080
2015 991440 - 1000000 728310 728310
2013 715125 1108220 70550 24771 24771
Philippines 2014 996180 1175136 201775 30095 30095
2015 932736 847845 79300 16989 16989
2013 0 - - 443 -
Republic of Korea 2014 5250 - - 638 -
2015 5250 - 4900 699 -
2013 371124 98971 1677 146439 146439
Solomon Islands 2014 47258 128673 47450 147430 147430
2015 10721 175683 107425 242456 242456
2013 94232 3033 35000 24000 24000
Vanuatu 2014 42916 0 50000 24000 24000
2015 38211 - 53400 20256 20256
2013 0 1310820 412530 218389 141570
Viet Nam 2014 526366 616670 434160 194397 106100
2015 658450 620093 459332 97570 45000

ACT, artemisinin-based combination therapy; IRS, indoor residual spraying; ITN, insecticide-treated mosquito net; LLIN, long-lasting insecticidal net; RDT, rapid diagnostic test
1 In May 2013, South Sudan was reassigned to the WHO African Region (WHA resolution 66.21, http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R21-en.pdf)

116 WORLD MALARIA REPORT 2016


WHO region Source % of HH % of HH % of % of % of the % of % of % of HH % of HH % of % of children aged % children <5 years with
Country/area that with popula- existing popula- children pre- sprayed with = 1 women 6-59months with fever in last 2 weeks
have enough tion with ITNs tion who <5years gnant by IRS ITN for who
at least ITNs for access in HH slept who women within 2pers. received a a for who who
one ITN indivi- to an ITN used the under slept who last 12 and/or at least hemo- positive whom received had a
duals in their previous an ITN under slept months sprayed 3doses globin micros- advice an ACT finger
who household night the an ITN under by IRS of IPT mea- copy or among or heel
slept previous the an ITN within during sure- blood treat- those stick
in the night previous the last 12 ANC ment smear ment who
house night previous months visits <8g/dL was received
the night during sought any
previous their last antima-
night pre- larial
gnancy

AFRICAN
Burkina Faso MIS 2014 - 47 71 85 66 - 76 1 47 - - 46 64 28 31
Burundi DHS 2013 - 23 46 83 47 - 55 6 - - - - - 69 48
Chad DHS 2015 - 27 40 47 21 - 22 1 41 8 - - 43 10 13
Democratic Republic DHS 2013 - 24 47 85 49 - 59 - - - 8 - - 19 19
of the Congo DHS 2014 - 24 47 85 49 - 59 - - 6 8 23 59 18 19
Gambia DHS 2013 - 19 45 77 36 46 46 32 43 6 12 1 66 31 37
Ghana DHS 2014 - 45 59 49 36 47 43 10 50 39 8 27 77 78 34
DHS 2014 - 32 48 79 41 - 50 2 34 10 - - 73 85 35
Kenya
DHS 2015 - 39 53 78 47 57 58 - - 23 - 8 73 92 39
Liberia DHS 2013 - 20 37 71 31 - 36 13 30 18 - - 80 43 42
Madagascar DHS 2013 - 28 48 85 54 - 61 30 - - 4 - - 41 13
Malawi MIS 2014 - 30 52 86 52 67 61 9 37 - 7 33 67 93 49
DHS 2013 - 38 65 90 58 68 73 6 42 13 21 53 49 17 12
Mali
DHS 2015 - 37 70 91 63 71 78 5 40 - - 36 58 29 14
Namibia DHS 2013 - 12 18 23 4 - 4 17 26 3 3 - 66 46 22
DHS 2013 - 22 36 35 13 - 16 2 23 7 - - 78 18 11
Nigeria
Annex 4 E. Household surveys results, 20132015

DHS 2015 - 34 55 60 37 43 49 1 35 22 10 27 68 38 13
DHS 2013 - 41 66 75 60 - 74 12 - - - - - 93 30
Rwanda
DHS 2015 - 41 64 80 60 67 73 - - - 2 1 59 99 36
DHS 2013 - 27 57 66 39 - 43 13 - - 10 - - 18 -
Senegal DHS 2014 - 34 58 63 39 42 38 10 41 3 5 1 59 10 11
DHS 2015 - 39 66 71 50 55 51 5 42 8 8 0 51 14 18
Sierra Leone DHS 2013 - 14 38 93 41 - 52 5 - - 17 - - 77 40
Togo DHS 2014 - 32 49 61 33 42 40 - - 24 9 38 61 48 24
Uganda MIS 2015 - 60 79 77 67 73 75 5 63 28 5 19 83 87 36
Zambia DHS 2014 - 24 47 65 34 - 41 31 48 50 - - 77 90 49

WORLD MALARIA REPORT 2016


WESTERN PACIFIC
Cambodia DHS 2014 - - - - - - - - - - 3 - 89 63 14

ACT, artemisinin-based combination therapy; ANC, antenatal care; DHS, demographic and health survey; HH, households; IPT, intermittent preventive treatment;
IRS, indoor residual spraying; ITN, insecticide-treated mosquito net; MIS, malaria indicator survey

117
Annex 4 F. Estimated malaria cases and deaths, 20002015

WHO region 2000 2005


Country/area
Lower Point Upper Lower Point Upper

AFRICAN
cases <50 <10
Algeria
deaths <10 <10
cases 3 300 000 4 800 000 6 400 000 4 100 000 5 400 000 6 700 000
Angola
deaths 17 000 22 000 28 000 16 000 22 000 28 000
cases 1 700 000 2 700 000 3 900 000 2 400 000 3 400 000 4 400 000
Benin
deaths 5 600 7 400 9 500 6 600 8 600 11 000
cases 12 000 27 000 77 000 1 000 2 300 5 600
Botswana
deaths 1 70 240 <10
cases 5 500 000 7 200 000 9 000 000 5 700 000 7 400 000 9 100 000
Burkina Faso
deaths 36 000 39 000 55 000 25 000 32 000 49 000
cases 1 900 000 2 800 000 4 000 000 1 500 000 2 200 000 3 000 000
Burundi
deaths 7 300 10 000 12 000 3 600 6 800 7 600
cases 4 600 000 6 300 000 8 200 000 5 900 000 8 000 000 10 000 000
Cameroon
deaths 16 000 20 000 26 000 15 000 21 000 27 000
cases 210 490 1 400 97 220 590
Cabo Verde
deaths <10 <10
cases 1 100 000 1 600 000 2 300 000 1 200 000 1 900 000 2 700 000
Central African Republic
deaths 5 100 6 400 8 200 5 700 7 400 9 400
cases 810 000 1 700 000 2 800 000 870 000 2 200 000 3 900 000
Chad
deaths 4 400 6 200 9 000 3 800 7 400 11 000
cases 65 000 110 000 190 000 66 000 110 000 190 000
Comoros
deaths 9 280 620 9 280 650
cases 750 000 1 100 000 1 500 000 840 000 1 200 000 1 700 000
Congo
deaths 2 100 2 800 3 600 1 100 2 400 3 100
cases 6 500 000 8 700 000 11 000 000 6 800 000 9 600 000 13 000 000
Cte dIvoire
deaths 27 000 33 000 40 000 25 000 32 000 39 000
cases 17 000 000 24 000 000 31 000 000 20 000 000 29 000 000 38 000 000
Democratic Republic of the Congo
deaths 87 000 100 000 140 000 88 000 110 000 150 000
cases 120 000 190 000 270 000 180 000 250 000 310 000
Equatorial Guinea
deaths 540 680 870 570 790 1 000
cases 21 000 70 000 170 000 18 000 28 000 41 000
Eritrea
deaths 3 140 590 <100
cases 1 100 000 21 000 000 34 000 000 1 200 000 4 800 000 12 000 000
Ethiopia
deaths 450 47 000 74 000 280 9 300 29 000
cases 290 000 440 000 630 000 140 000 230 000 340 000
Gabon
deaths 330 460 590 78 310 430
cases 310 000 410 000 540 000 310 000 410 000 530 000
Gambia
deaths 520 740 990 160 570 820
cases 6 800 000 9 200 000 12 000 000 6 500 000 8 300 000 10 000 000
Ghana
deaths 15 000 19 000 25 000 8 400 16 000 20 000
cases 3 200 000 4 200 000 5 200 000 2 800 000 4 100 000 5 700 000
Guinea
deaths 12 000 15 000 20 000 8 800 12 000 16 000
cases 350 000 570 000 790 000 96 000 190 000 290 000
Guinea-Bissau
deaths 1 200 1 600 2 000 240 730 1 000
cases 5 500 000 7 200 000 9 300 000 3 700 000 5 200 000 6 800 000
Kenya
deaths 8 700 14 000 16 000 3 500 12 000 13 000
cases 950 000 1 400 000 2 100 000 980 000 1 500 000 2 000 000
Liberia
deaths 5 400 6 700 8 700 2 800 4 100 5 300
cases 69 000 1 700 000 5 600 000 22 000 1 300 000 3 500 000
Madagascar
deaths 9 4 400 18 000 5 3 300 12 000
cases 3 300 000 4 800 000 6 400 000 3 100 000 4 100 000 5 100 000
Malawi
deaths 12 000 16 000 20 000 4 800 9 700 13 000
cases 3 900 000 5 000 000 6 200 000 4 800 000 6 100 000 7 400 000
Mali
deaths 21 000 27 000 34 000 18 000 23 000 29 000
cases 31 000 250 000 730 000 44 000 310 000 890 000
Mauritania
deaths 510 920 1 200 280 1 000 1 400
cases 7 400 000 9 400 000 12 000 000 7 600 000 9 300 000 11 000 000
Mozambique
deaths 31 000 40 000 51 000 17 000 25 000 32 000
cases 47 000 84 000 150 000 45 000 70 000 110 000
Namibia
deaths 6 210 520 5 180 400
cases 1 900 000 3 700 000 5 700 000 2 400 000 4 600 000 7 000 000
Niger
deaths 11 000 14 000 20 000 9 100 13 000 19 000

118 WORLD MALARIA REPORT 2016


2010 2015 Method used

Lower Point Upper Lower Point Upper

<10 0 1
<10 0 1b
1 700 000 2 400 000 3 300 000 1 800 000 3 100 000 4 700 000 2
8 800 14 000 20 000 9 200 14 000 21 000 2
2 300 000 3 200 000 4 200 000 2 300 000 3 200 000 4 100 000 2
5 100 6 800 8 900 4 200 6 000 8 000 2
1 700 3 400 7 500 370 710 1 500 1
<10 <10 1c
7 300 000 9 400 000 11 000 000 4 500 000 7 000 000 10 000 000 2
22 000 29 000 45 000 10 000 15 000 29 000 2
1 100 000 1 900 000 2 800 000 890 000 1 400 000 2 000 000 2
2 000 5 300 5 700 1 500 5 200 5 600 2
4 200 000 5 700 000 7 300 000 3 500 000 5 300 000 7 700 000 2
6 500 11 000 15 000 4 900 9 200 13 000 2
66 140 300 <50 1
<10 <10 1a
980 000 1 600 000 2 500 000 770 000 1 400 000 2 300 000 2
3 700 5 000 6 400 2 500 3 600 4 600 2
850 000 1 900 000 3 500 000 720 000 1 900 000 3 400 000 2
3 400 7 400 11 000 3 200 7 500 11 000 2
96 000 140 000 210 000 2 000 2 900 4 500 1
12 350 720 <10 1c
530 000 880 000 1 400 000 490 000 800 000 1 200 000 2
390 1 700 2 300 260 1 600 2 400 2
6 900 000 9 000 000 11 000 000 5 900 000 7 900 000 10 000 000 2
17 000 22 000 28 000 9 800 14 000 17 000 2
21 000 000 28 000 000 35 000 000 14 000 000 19 000 000 24 000 000 2
60 000 82 000 110 000 26 000 42 000 65 000 2
80 000 150 000 220 000 75 000 180 000 310 000 2
180 350 460 160 340 450 2
59 000 93 000 140 000 38 000 65 000 100 000 1
11 180 380 7 130 290 1c
480 000 4 400 000 10 000 000 820 000 2 800 000 5 500 000 1
230 8 100 25 000 240 4 900 13 000 1c
100 000 230 000 420 000 140 000 400 000 710 000 2
69 320 460 100 390 530 2
310 000 410 000 550 000 320 000 420 000 520 000 1
120 570 870 110 630 960 2
7 600 000 9 600 000 12 000 000 4 800 000 7 300 000 10 000 000 2
7 300 16 000 20 000 4 600 13 000 17 000 2
3 400 000 4 500 000 5 900 000 3 600 000 4 600 000 5 700 000 2
8 000 11 000 14 000 6 700 9 900 12 000 2
95 000 170 000 250 000 55 000 160 000 330 000 2
170 670 970 150 680 1 000 2
2 500 000 3 300 000 4 200 000 3 800 000 6 500 000 11 000 000 2
2 100 11 000 11 000 2 500 12 000 12 000 2
1 100 000 1 300 000 1 700 000 670 000 1 100 000 1 600 000 2
1 400 2 400 3 100 970 2 000 2 600 2
380 000 650 000 980 000 1 500 000 2 400 000 4 000 000 1
49 1 700 3 500 180 6 000 13 000 1c
5 100 000 6 200 000 7 300 000 2 400 000 3 300 000 4 200 000 2
4 700 10 000 13 000 1 800 7 200 10 000 2
4 200 000 5 300 000 6 300 000 6 100 000 7 500 000 9 100 000 2
12 000 16 000 20 000 16 000 21 000 25 000 2
32 000 240 000 700 000 50 000 260 000 560 000 1
260 1 100 1 500 250 1 200 1 600 2
7 700 000 9 300 000 11 000 000 6 300 000 8 300 000 11 000 000 2
11 000 18 000 24 000 8 100 15 000 20 000 2
2 200 2 900 3 800 17 000 22 000 27 000 1
<10 <100 2
3 400 000 6 000 000 8 600 000 2 800 000 5 200 000 8 400 000 2
9 700 14 000 20 000 6 600 10 000 16 000 2

WORLD MALARIA REPORT 2016 119


Annex 4 F. Estimated malaria cases and deaths, 20002015

WHO region 2000 2005


Country/area
Lower Point Upper Lower Point Upper

AFRICAN
cases 41 000 000 54 000 000 66 000 000 46 000 000 59 000 000 74 000 000
Nigeria
deaths 160 000 200 000 260 000 140 000 190 000 240 000
cases 950 000 3 400 000 8 700 000 550 000 1 600 000 3 500 000
Rwanda
deaths 3 400 5 200 7 200 1 000 3 600 5 200
cases 40 000 47 000 55 000 24 000 30 000 39 000
Sao Tome and Principe
deaths 110 110 110 <100
cases 1 100 000 2 300 000 3 800 000 640 000 1 300 000 2 200 000
Senegal
deaths 4 600 6 500 8 400 1 400 4 600 6 400
cases 1 200 000 2 000 000 2 800 000 1 400 000 2 400 000 3 400 000
Sierra Leone
deaths 10 000 12 000 17 000 9 000 12 000 16 000
cases 23 000 39 000 65 000 13 000 17 000 21 000
South Africa
deaths 530 <100
cases 1 200 000 2 000 000 2 900 000 1 200 000 1 800 000 2 600 000
South Sudan1
deaths 5 600 6 100 9 600 2 500 4 000 7 400
cases 630 1 900 3 900 710 970 1 300
Swaziland
deaths <10 <10
cases 1 900 000 2 500 000 3 500 000 2 100 000 2 800 000 3 500 000
Togo
deaths 5 500 6 900 8 800 5 200 6 900 8 900
cases 9 300 000 12 000 000 16 000 000 10 000 000 13 000 000 17 000 000
Uganda
deaths 39 000 49 000 63 000 24 000 35 000 45 000

United Republic of Tanzania cases 8 400 000 12 000 000 15 000 000 7 400 000 9 700 000 12 000 000
deaths 22 000 30 000 38 000 7 800 20 000 26 000
cases 3 000 000 4 000 000 5 200 000 2 200 000 2 900 000 3 700 000
Zambia
deaths 11 000 14 000 18 000 3 400 7 900 10 000
cases 78 000 960 000 2 700 000 85 000 990 000 3 000 000
Zimbabwe
deaths 23 2 500 9 100 25 2 500 9 200
AMERICAS
cases 1 600 1 700 1 900 1 600 1 800 2 000
Belize
deaths 0 0

Bolivia (Plurinational State of) cases 33 000 49 000 110 000 21 000 30 000 62 000
deaths <50 <50
cases 950 000 1 200 000 1 600 000 710 000 820 000 930 000
Brazil
deaths 370 370 370 180 180 180
cases 200 000 320 000 470 000 140 000 190 000 240 000
Colombia
deaths <50 <50
cases 1 300 1 600 2 300 4 200 5 300 6 500
Dominican Republic
deaths <10 <50
cases 110 000 110 000 130 000 17 000 19 000 21 000
Ecuador
deaths 0 0
cases 770 820 920 68 73 82
El Salvador
deaths 0 0
cases 4 200 7 400 24 000 3 700 6 000 16 000
French Guiana
deaths <50 <10
cases 56 000 98 000 340 000 43 000 68 000 190 000
Guatemala
deaths <50 <50
cases 35 000 52 000 83 000 59 000 89 000 140 000
Guyana
deaths 7 78 160 12 120 240
cases 72 000 130 000 210 000 78 000 140 000 220 000
Haiti
deaths 9 330 740 10 370 780
cases 56 000 81 000 110 000 26 000 37 000 52 000
Honduras
deaths <50 <50
cases 7 500 8 100 9 100 3 000 3 200 3 600
Mexico
deaths 0 0
cases 38 000 49 000 62 000 10 000 13 000 17 000
Nicaragua
deaths <50 <10
cases 1 100 1 200 1 300 3 900 4 300 4 600
Panama
deaths <10 <10
cases 99 000 140 000 180 000 130 000 160 000 200 000
Peru
deaths <50 <10

120 WORLD MALARIA REPORT 2016


2010 2015 Method used

Lower Point Upper Lower Point Upper

47 000 000 59 000 000 71 000 000 42 000 000 61 000 000 82 000 000 2
94 000 130 000 170 000 78 000 110 000 150 000 2
730 000 1 100 000 1 500 000 2 800 000 3 500 000 4 600 000 1
530 3 000 4 600 320 3 000 4 600 1c
3 600 4 900 6 700 2 600 3 400 4 500 1
<100 <100 1a
1 100 000 1 800 000 2 700 000 950 000 1 400 000 2 100 000 1
800 4 100 6 000 640 4 400 6 500 2
2 000 000 2 800 000 3 700 000 1 200 000 2 000 000 2 800 000 2
8 300 11 000 15 000 4 000 5 800 8 900 2
14 000 17 000 22 000 9 000 12 000 15 000 1
<100 160 1a
970 000 1 800 000 2 800 000 970 000 1 900 000 3 200 000 2
1 800 3 200 7 100 1 400 2 800 7 400 2
370 530 790 190 260 380 1
<10 <10 1c
2 200 000 2 900 000 3 800 000 2 000 000 2 500 000 3 000 000 2
4 500 6 300 7 900 2 700 4 200 5 300 2
12 000 000 14 000 000 17 000 000 4 500 000 8 500 000 13 000 000 2
12 000 20 000 25 000 4 300 12 000 17 000 2

5 300 000 6 900 000 8 700 000 3 900 000 5 300 000 6 900 000 2
3 800 16 000 22 000 3 100 17 000 24 000 2
1 700 000 2 200 000 2 600 000 2 200 000 2 800 000 3 600 000 2
1 700 6 300 8 800 1 900 7 100 9 900 2
450 000 970 000 1 800 000 610 000 960 000 1 500 000 1
58 2 500 6 000 69 2 400 5 200 1c

160 180 190 <50 1


0 0 1a

15 000 20 000 36 000 7 300 9 900 20 000 1


<50 <10 1c
380 000 440 000 490 000 160 000 180 000 210 000 1
98 98 98 <50 1a
140 000 180 000 240 000 58 000 79 000 100 000 1
<50 <50 1c
3 800 4 700 5 800 700 870 1 100 1
<50 <10 1c
1 900 2 100 2 300 630 680 760 1
0 0 1b
<50 <50 <50 <10 <10 <10 1
0 0 1b
2 200 3 400 9 200 470 730 1 500 1
<10 <10 1c
7 800 12 000 32 000 7 500 11 000 25 000 1
<10 <10 1c
38 000 52 000 76 000 14 000 20 000 28 000 1
6 93 180 <50 1c
87 000 150 000 250 000 42 000 69 000 100 000 1
11 390 850 5 180 370 1c
16 000 21 000 28 000 5 400 7 200 9 600 1
<50 <10 1c
1 200 1 300 1 500 530 560 630 1
0 0 1b
1 100 1 400 1 700 3 500 4 600 5 800 1
<10 <10 1c
440 490 530 590 660 710 1
<10 0 1a
50 000 63 000 78 000 120 000 150 000 180 000 1
<10 <10 1a

WORLD MALARIA REPORT 2016 121


Annex 4 F. Estimated malaria cases and deaths, 20002015

WHO region 2000 2005


Country/area
Lower Point Upper Lower Point Upper

AMERICAS
cases 12 000 18 000 41 000 9 800 13 000 28 000
Suriname
deaths <50 <10
cases 40 000 78 000 230 000 49 000 78 000 210 000
Venezuela (Bolivarian Republic of)
deaths 11 60 180 12 52 140
EASTERN MEDITERRANEAN
cases 580 000 1 100 000 1 800 000 380 000 580 000 890 000
Afghanistan
deaths 170 540 1 100 86 280 540
cases 2 000 10 000 28 000 2 200 7 900 14 000
Djibouti
deaths <50 <50
cases 12 000 13 000 15 000 15 000 16 000 18 000
Iran (Islamic Republic of)
deaths <10 <10
cases 1 900 000 3 900 000 14 000 000 1 900 000 3 900 000 13 000 000
Pakistan
deaths 410 4 000 15 000 400 4 400 16 000
cases 4 800 5 200 5 800 210 220 250
Saudi Arabia
deaths 0 0
cases 330 000 610 000 1 100 000 740 000 1 100 000 1 400 000
Somalia
deaths 50 1 800 3 900 98 2 800 5 300
cases 1 600 000 2 400 000 3 500 000 1 600 000 2 200 000 2 900 000
Sudan
deaths 210 6 300 12 000 190 5 500 11 000
cases 290 000 730 000 1 900 000 260 000 600 000 2 100 000
Yemen
deaths 44 1 800 6 400 35 1 500 5 400
EUROPE
cases 19 000 21 000 23 000 2 400 2 500 2 800
Tajikistan
deaths 0 0
SOUTH-EAST ASIA
cases 71 000 110 000 150 000 76 000 120 000 170 000
Bangladesh
deaths 13 210 430 11 250 520
cases 6 000 6 500 7 300 1 900 2 000 2 200
Bhutan
deaths <50 <10

Democratic Peoples Republic of


Korea cases 40 000 150 000 300 000 6 800 7 400 8 200
deaths 0 0
cases 18 000 000 24 000 000 31 000 000 19 000 000 29 000 000 36 000 000
India
deaths 3 100 36 000 64 000 3 500 41 000 63 000
cases 2 200 000 4 000 000 6 600 000 3 600 000 5 100 000 7 300 000
Indonesia
deaths 600 4 600 9 900 660 7 200 14 000
cases 970 000 1 400 000 2 100 000 1 000 000 1 500 000 2 100 000
Myanmar
deaths 150 3 100 6 800 160 3 100 6 300
cases 71 000 110 000 160 000 50 000 82 000 130 000
Nepal
deaths 20 60 100 16 62 110
cases 45 000 220 000 1 000 000 33 000 120 000 500 000
Thailand
deaths 800 810 820 210 210 210
cases 130 000 250 000 500 000 190 000 270 000 370 000
Timor-Leste
deaths 22 470 1 300 30 530 1 000
WESTERN PACIFIC
cases 950 000 1 500 000 2 300 000 270 000 390 000 530 000
Cambodia
deaths 130 3 600 7 300 47 710 1 400
cases 23 000 29 000 36 000 21 000 23 000 25 000
China
deaths <50 <50
cases 180 000 260 000 360 000 34 000 50 000 71 000
Lao Peoples Democratic Republic
deaths 21 630 1 300 4 120 250
cases 12 000 13 000 15 000 5 300 5 600 6 300
Malaysia
deaths <50 <50
cases 1 000 000 1 400 000 1 900 000 1 000 000 1 400 000 1 800 000
Papua New Guinea
deaths 150 3 100 5 700 160 2 800 5 300
cases 79 000 110 000 160 000 96 000 140 000 210 000
Philippines
deaths 13 230 460 16 300 590

122 WORLD MALARIA REPORT 2016


2010 2015 Method used

Lower Point Upper Lower Point Upper

1 800 2 500 4 500 110 150 270 1


<10 0 1a
52 000 78 000 210 000 150 000 230 000 490 000 1
11 72 210 27 220 500 1c

250 000 340 000 480 000 300 000 390 000 510 000 1
58 200 340 66 190 330 1c
690 1 600 3 100 1 100 5 600 18 000 1
<10 <50 1c
1 900 2 000 2 300 170 180 200 1
<10 <10 1b
1 100 000 1 500 000 2 100 000 730 000 1 000 000 1 500 000 1
250 1 700 3 200 170 740 1 300 1c
<50 84 91 100 1
0 0 1b
190 000 280 000 390 000 310 000 700 000 1 300 000 1
26 740 1 400 52 2 100 4 800 1c
880 000 1 200 000 1 600 000 970 000 1 400 000 1 900 000 1
110 3 000 5 700 130 3 500 6 800 1c
320 000 510 000 810 000 200 000 310 000 460 000 1
42 1 300 2 800 24 770 1 600 1c

110 120 140 0 1


0 0 1b

69 000 84 000 100 000 7 100 8 400 10 000 1


8 200 360 <50 1c
440 480 530 <50 1
<10 0 1b

15 000 16 000 18 000 7 200 7 700 8 600 1


0 0 1b
16 000 000 21 000 000 31 000 000 9 900 000 13 000 000 18 000 000 1
2 800 33 000 63 000 1 500 24 000 47 000 1c
4 600 000 5 900 000 7 700 000 990 000 1 300 000 1 600 000 1
830 8 900 17 000 160 1 900 3 600 1c
1 100 000 1 600 000 2 200 000 170 000 240 000 340 000 1
180 3 000 6 100 27 490 980 1c
25 000 38 000 58 000 17 000 24 000 35 000 1
<50 <50 1c
36 000 120 000 370 000 16 000 52 000 150 000 1
100 100 100 <50 1a
90 000 110 000 150 000 97 120 160 1
14 220 420 <10 1c

140 000 180 000 220 000 95 000 120 000 150 000 1
22 320 560 17 120 200 1c
5 200 5 900 6 300 <50 1
<10 0 1b
48 000 69 000 97 000 68 000 88 000 110 000 1
6 170 350 <50 1c
5 900 6 400 7 100 1 900 2 000 2 300 1
<50 <10 1b
890 000 1 200 000 1 600 000 650 000 900 000 1 200 000 1
130 2 600 5 100 140 1 200 2 300 1c
35 000 53 000 75 000 9 200 13 000 17 000 1
5 110 240 <50 1c

WORLD MALARIA REPORT 2016 123


Annex 4 F. Estimated malaria cases and deaths, 20002015

WHO region 2000 2005


Country/area
Lower Point Upper Lower Point Upper

WESTERN PACIFIC
cases 4 200 4 500 5 100 1 300 1 400 1 600
Republic of Korea
deaths 0 0
cases 160 000 190 000 230 000 180 000 220 000 260 000
Solomon Islands
deaths 25 370 650 28 420 730
cases 17 000 23 000 31 000 19 000 26 000 34 000
Vanuatu
deaths <50 <50
cases 160 000 210 000 250 000 32 000 39 000 47 000
Viet Nam
deaths 24 430 780 5 79 140
REGIONAL SUMMARY
cases 146 716 840 225 899 390 308 872 300 154 924 807 216 738 490 290 668 490
African
deaths 588 411 787 840 1 064 830 458 152 667 360 903 200
cases 1 717 470 2 345 820 3 605 520 1 309 268 1 677 673 2 342 782
Americas
deaths 397 838 1 450 214 722 1 340
cases 4 718 800 8 768 200 22 348 800 4 897 410 8 404 120 20 322 250
Eastern Mediterranean
deaths 884 14 440 38 400 809 14 480 38 240
cases 19 000 21 000 23 000 2 400 2 500 2 800
European
deaths 0 0
cases 21 533 000 30 246 500 41 817 300 23 957 700 36 201 400 46 580 400
South-East Asia
deaths 4 705 45 250 83 350 4 587 52 352 85 140
cases 2 585 200 3 739 500 5 287 100 1 658 600 2 295 000 2 984 900
Western Pacific
deaths 363 8 360 16 190 260 4 429 8 410
cases 177 290 310 271 020 410 381 954 020 186 750 185 265 319 183 362 901 622
Total
deaths 594 760 856 728 1 204 220 464 022 739 343 1 036 330

1 South Sudan became an independent State on 9 July 2011 and a Member State of WHO on 27 September 2011. South Sudan and Sudan have distinct epidemiological profiles
comprising high-transmission and low-transmission areas respectively. For this reason, data up to June 2011 from the high-transmission areas of Sudan (10 southern states,
which correspond to contemporary South Sudan) and low-transmission areas (15 northern states which correspond to contemporary Sudan) are reported separately.
Cases: (1) Estimated from reported confirmed cases, (2) Estimated from parasite prevalence surveys
Deaths: (1a) Reported deaths adjusted for completeness of death reporting, (1b) Reported deaths adjusted for case reporting completeness (1c) Estimated by applying case
fatality rate to estimated cases, (2) Modelled from verbal autopsy data

124 WORLD MALARIA REPORT 2016


2010 2015 Method used

Lower Point Upper Lower Point Upper

1 300 1 400 1 600 1 300 1 400 1 600 1


<10 0 1b
58 000 70 000 83 000 32 000 39 000 45 000 1
10 130 230 6 51 88 1c
14 000 18 000 25 000 610 820 1 100 1
<50 <10 1c
21 000 25 000 29 000 11 000 13 000 14 000 1
3 50 88 <50 1c

156 963 936 209 461 870 268 111 090 129 499 160 191 386 270 265 182 880
313 679 498 340 683 660 216 456 391 330 560 830
798 400 1 032 070 1 465 720 570 730 764 350 1 173 370
126 653 1 338 32 400 870
2 742 590 3 833 600 5 385 400 2 511 354 3 805 871 5 688 300
486 6 940 13 440 442 7 300 14 830
110 120 140 0
0 0
21 935 440 28 868 480 41 596 530 11 107 397 14 632 220 20 143 760
3 932 45 420 86 980 1 687 26 390 51 580
1 218 400 1 628 700 2 144 000 869 010 1 177 220 1 541 000
176 3 380 6 568 163 1 371 2 588
183 658 876 244 824 840 318 702 880 144 557 651 211 765 931 293 729 310
318 399 554 733 791 986 218 780 426 791 630 698

WORLD MALARIA REPORT 2016 125


Annex 4 G. Population at risk and reported malaria cases
by place of care, 2015

WHO region Population


Country/area
At risk At risk Number of people living
UN population (low + high) (high) in active foci

AFRICAN
Algeria 39 666 519 - - -
Angola 25 021 974 25 021 974 25 021 974 -
Benin 10 879 829 10 879 829 10 879 829 -
Botswana 2 262 485 1 499 989 95 305 -
Burkina Faso 18 105 570 18 105 570 18 105 570 -
Burundi 11 178 921 11 178 921 11 178 921 -
Cabo Verde 520 502 - - 308 626
Cameroon 23 344 179 23 344 179 16 574 367 -
Central African Republic 4 900 274 4 900 274 4 900 274 -
Chad 14 037 472 13 883 825 9 454 923 -
Comoros 788 474 788 474 375 159 -
Congo 4 620 330 4 620 330 4 620 330 -
Cte d'Ivoire 22 701 556 22 701 556 22 701 556 -
Democratic Republic of the Congo 77 266 814 77 266 814 74 948 810 -
Equatorial Guinea 845 060 845 060 845 060 -
Eritrea 5 227 791 5 227 791 3 711 732 -
Ethiopia 99 390 750 67 585 709 27 034 284 -
Gabon 1 725 292 1 725 292 1 725 292 -
Gambia 1 990 924 1 990 924 1 990 924 -
Ghana 27 409 893 27 409 893 27 409 893 -
Guinea 12 608 590 12 608 590 12 608 590 -
Guinea-Bissau 1 844 325 1 844 325 1 844 325 -
Kenya 46 050 302 46 050 302 32 324 967 -
Liberia 4 503 438 4 503 438 4 503 438 -
Madagascar 24 235 390 24 235 390 21 271 015 -
Malawi 17 215 232 17 215 232 17 215 232 -
Mali 17 599 694 17 599 694 15 839 725 -
Mauritania 4 067 564 4 067 564 2 847 295 -
Mayotte 233 993 - - -
Mozambique 27 977 863 27 977 863 27 977 863 -
Namibia 2 458 830 1 951 686 1 135 022 -
Niger 19 899 120 18 705 173 10 546 534 -
Nigeria 182 201 962 182 201 962 139 161 989 -
Rwanda 11 609 666 11 609 666 11 609 666 -
Sao Tome and Principe 190 344 190 344 190 344 -
Senegal 15 129 273 15 129 273 14 524 102 -
Sierra Leone 6 453 184 6 453 184 6 453 184 -
South Africa 54 490 406 5 449 041 2 179 616 -
South Sudan1 12 339 812 12 339 812 12 339 812 -
Swaziland 1 286 970 360 352 0 -
Togo 7 304 578 7 304 578 7 304 578 -
Uganda 39 032 383 39 032 383 39 032 383 -
United Republic of Tanzania 53 470 420 53 470 420 52 884 689 -
Mainland 51 957 514 51 957 514 51 957 514 -
Zanzibar 1 512 906 1 512 906 927 175 -
Zambia 16 211 767 16 211 767 16 211 767 -
Zimbabwe 15 602 751 12 286 025 4 464 890 -
AMERICAS
Belize 359 287 - - 23 917
Bolivia (Plurinational State of) 10 724 705 4 865 489 267 944 -
Brazil 207 847 528 26 360 703 6 470 279 -
Colombia 48 228 704 10 182 444 4 875 710 -
Dominican Republic 10 528 391 5 072 515 97 337 -
Ecuador 16 144 363 - - 251 369
El Salvador 6 126 583 - - 22 000
French Guiana 268 606 268 606 229 658 -
Guatemala 16 342 897 12 539 759 4 069 177 -

126 WORLD MALARIA REPORT 2016


Public sector Private sector Community level

P C P C P C

0 747 - - - -
484 965 2 769 305 - - - -
227 028 1 268 347 - - 94 030 256 392
14 326 0 6 - -
1 271 007 7 015 446 - - - -
83 704 5 159 706 - - 0 269 004
- 28 - - - -
1 159 149 1 162 784 - - 29 162 30 497
354 702 598 833 - - - -
703 510 787 046 - - - -
217 1 300 15 848 584 - -
213 045 51 529 - - - -
230 821 3 375 904 0 73 800 0 94 078
- 11 627 473 - - 0 911 332
- 15 142 - - - -
4 938 19 372 - - 0 8 664
307 648 1 867 059 - - - -
193 420 23 867 - - - -
9 055 240 382 3 966 913 0 5 053
5 866 591 4 319 919 2 145 778 1 337 177 154 619 0
84 037 810 979 39 254 23 898 40 118 80 196
- - - - - -
6 177 953 1 499 027 208 556 460 109 0 82 141
850 006 931 086 - - 43 521 10 625
8 073 744 103 16 084 2 416 418 475 193 138
1 272 178 3 661 238 - - 1 165 029 197 354
1 021 390 2 295 611 - - 67 678 158 897
158 931 22 631 - - - -
- - - - - -
- 7 718 782 - - 84 172 504 032
0 12 050 - - - -
1 545 634 2 272 000 - - 0 120 108
7 881 839 6 850 782 494 445 968 551 - -
0 2 505 794 - - 259 188 772
0 2 058 - - - -
9 831 492 253 - - 93 231 74 580
86 230 1 483 376 3 338 10 541 467 748 0
4 619 4 357 - - 110 602
- - - - - -
456 195 0 300 - -
1 1 113 927 - - 0 394 088
6 284 142 7 137 662 161 371 275 085 - -
3 503 526 4 242 732 83 613 659 921 - -
3 502 326 4 239 490 83 613 658 721 - -
1 200 3 242 - 1 200 - -
909 462 4 184 661 - - - -
0 391 651 - - 0 90 728

0 13 5 0 - -
0 6 907 - - - -
113 143 049 - - - -
4 272 51 594 - - - -
0 661 0 129 277 0
0 686 - - - -
0 9 - - - -
0 434 - - - -
- 6 836 - - - -

WORLD MALARIA REPORT 2016 127


Annex 4 G. Population at risk and reported malaria cases
by place of care, 2015

WHO region Population


Country/area
At risk At risk Number of people living
UN population (low + high) (high) in active foci

AMERICAS
Guyana 767 085 713 389 268 480 -
Haiti 10 711 067 10 711 067 5 676 866 -
Honduras 8 075 060 5 117 453 376 477 -
Mexico 127 017 224 - - 4 466 571
Nicaragua 6 082 032 3 428 487 270 047 -
Panama 3 929 141 184 172 172 882 -
Peru 31 376 670 4 437 249 3 414 952 -
Suriname 542 975 85 247 85 247 -
Venezuela (Bolivarian Republic of) 31 108 083 6 193 641 4 977 960 -
EASTERN MEDITERRANEAN
Afghanistan 32 526 562 24 582 076 8 753 666 -
Djibouti 887 861 443 931 0 -
Iran (Islamic Republic of) 79 109 272 - - 692 020
Pakistan 188 924 874 185 733 706 54 631 264 -
Saudi Arabia 31 540 372 - - 42 995
Somalia 10 787 104 10 787 104 5 490 347 -
Sudan 40 234 882 40 234 882 34 964 112 -
Yemen 26 832 215 20 899 635 6 724 424 -
EUROPEAN
Tajikistan 8 481 855 - - -
SOUTH-EAST ASIA
Bangladesh 160 995 642 16 679 149 4 282 484 -
Bhutan 774 830 - - 36 042
Democratic People's Republic of Korea 25 155 317 - - -
India 1 311 050 527 1 193 055 980 183 547 074 -
Indonesia 257 563 815 67 296 487 30 311 412 -
Myanmar 53 897 154 32 078 320 8 521 440 -
Nepal 28 513 700 13 672 319 1 035 047 -
Thailand 67 959 359 33 979 680 5 436 749 -
Timor-Leste 1 184 765 1 062 868 398 960 -
WESTERN PACIFIC
Cambodia 15 577 899 11 016 604 7 497 002 -
China 1 383 924 532 - - 33 340
Lao People's Democratic Republic 6 802 023 6 299 338 2 125 078 -
Malaysia 30 331 007 - - -
Papua New Guinea 7 619 321 7 619 321 7 162 162 -
Philippines 100 699 395 61 409 115 6 637 429 -
Republic of Korea 50 293 439 - - -
Solomon Islands 583 591 577 755 577 755 -
Vanuatu 264 652 264 652 230 048 -
Viet Nam 93 447 601 68 869 834 6 352 108 -
REGIONAL SUMMARY
African 985 902 466 857 774 467 716 045 227 308 626
Americas 536 180 401 90 160 221 31 253 017 4 763 857
Eastern Mediterranean 410 843 142 282 681 334 110 563 812 735 015
European 8 481 855 0 0 0
South-East Asia 1 907 095 109 1 357 824 801 233 533 166 36 042
Western Pacific 1 689 543 460 156 056 619 30 581 582 33 340
Total 5 538 046 433 2 744 497 442 1 121 976 804 5 876 880
C = Confirmed
P = Presumed
1 In May 2013, South Sudan was reassigned to the WHO African Region (WHA resolution 66.21, http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R21-en.pdf)

128 WORLD MALARIA REPORT 2016


Public sector Private sector Community level

P C P C P C

0 9 984 - - - -
0 17 583 - - 0 343
0 3 564 0 58 - -
0 551 0 7 - -
0 2 307 - - - -
0 562 0 3 - -
0 66 609 0 463 - -
0 376 - - - -
0 136 402 - - - -

263 149 86 895 - - 0 16 482


- - - - - -
0 799 - - - -
3 574 231 202 013 - - - -
0 2 620 - - - -
18 216 20 953 - - - -
515 359 586 827 - - - -
26 305 68 982 - - - -

- 5 - - - -

0 6 608 0 119 0 32 992


0 104 0 21 - -
387 7 022 - - - -
0 1 169 261 - - - -
0 217 025 - - - -
- 77 842 - - 0 104 925
19 509 1 112 - - - 725
620 14 135 - - 0 9 405
0 80 - - 0 21

- 33 930 0 17 809 0 16 370


28 3 088 - - - -
- 36 056 0 5 561 0 9 107
0 2 311 0 48 - -
255 316 297 787 - - 19 038 48 644
13 5 122 22 716 0 2 428
0 699 0 662 - -
26 918 23 998 - - - -
274 423 - - 0 148
9 921 9 331 - - - -

40 908 122 88 681 470 3 172 253 3 813 301 2 658 152 3 670 281
4 385 448 127 5 660 277 343
4 397 260 969 089 0 0 0 16 482
0 5 0 0 0 0
20 516 1 493 189 0 140 0 148 068
292 470 412 745 22 24 796 19 038 76 697
45 622 753 92 004 625 3 172 280 3 838 897 2 677 467 3 911 871

WORLD MALARIA REPORT 2016 129


Annex 4 H. Reported malaria cases by method of confirmation,
20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Presumed and confirmed 541 299 408 191 887 603 266 747
Microscopy examined 27733 18392 12224 11974 15790 12762 8690 8000
Confirmed with microscopy 541 299 408 191 887 603 266 747
Algeria
RDT examined - - - - - - - 0
Confirmed with RDT - - - - - - - 0
Imported cases 506 297 396 187 828 587 260 729
Presumed and confirmed 2080348 2329316 3687574 3501953 3031546 3144100 3180021 3254270
Microscopy examined - - 1947349 1765933 2245223 3025258 3398029 3345693
Confirmed with microscopy - 889572 1324264 1147473 1056563 1462941 1431313 1396773
Angola
RDT examined - - 639476 833753 1069483 1103815 1855400 3009305
Confirmed with RDT - - 358606 484809 440271 536927 867666 1372532
Imported cases - - - - - - - -
Presumed and confirmed - 803462 1432095 1424335 1513212 1670273 1509221 1495375
Microscopy examined - - - 88134 243008 291479 155205 296264
Confirmed with microscopy - - - 68745 - 99368 108714 108061
Benin
RDT examined - - - 475986 825005 1158526 1335582 1486667
Confirmed with RDT - - - 354223 705839 979466 935521 1160286
Imported cases - - - - - - - -
Presumed and confirmed 71555 11242 12196 1141 308 506 1485 340
Microscopy examined - - - - - - - -
Confirmed with microscopy - - 1046 432 - - - -
Botswana
RDT examined - - - - - - - 1284
Confirmed with RDT - - - - 193 456 1346 326
Imported cases - - - - - - - 48
Presumed and confirmed - 1615695 5723481 5024697 6970700 7146026 8278408 8286453
Microscopy examined - 73262 177879 400005 223372 183971 198947 222190
Confirmed with microscopy - 21335 88540 83857 90089 82875 83259 92589
Burkina Faso
RDT examined - - 940985 450281 4516273 4296350 6224055 8290188
Confirmed with RDT - - 715999 344256 3767957 3686176 5345396 6922857
Imported cases - - - - - - - -
Presumed and confirmed 3252692 2334067 4255301 3298979 2570754 4469007 4831758 5243410
Microscopy examined 484249 903942 2825558 2859720 2659372 4123012 4471998 3254670
Confirmed with microscopy 308095 327464 1599908 1485332 1484676 2366134 2718391 1964862
Burundi
RDT examined - - 273324 181489 1148965 2933869 2903679 5076107
Confirmed with RDT - - 163539 86542 666400 1775253 1866882 3194844
Imported cases - - - - - - - -
Presumed and confirmed 144 68 47 36 36 46 46 28
Microscopy examined 6843 7902 - - 8715 10621 6894 3117
Confirmed with microscopy 144 68 47 - 36 46 46 28
Cabo Verde
RDT examined - - - 26508 - - - -
Confirmed with RDT - - - 36 - - - -
Imported cases - - - 29 35 24 20 21
Presumed and confirmed - 277413 1845691 1829266 1589317 1824633 1369518 2321933
Microscopy examined - - - 1110308 1182610 1236306 1086095 1024306
Confirmed with microscopy - - - - - - - 592351
Cameroon
RDT examined - - - 120466 93392 591670 1254293 1128818
Confirmed with RDT - - - - - - - 570433
Imported cases - - - - - - - -
Presumed and confirmed 89614 131856 66484 221980 459999 407131 495238 953535
Microscopy examined - - - - - 63695 55943 139241
Central African Confirmed with microscopy - - - - - 36943 41436 106524
Republic RDT examined - - - - 55746 136548 369208 724303
Confirmed with RDT - - - - 46759 79357 253652 492309
Imported cases - - - - - - - -
Presumed and confirmed 437041 501846 544243 528454 660575 1272841 1513772 1490556
Microscopy examined 45283 37439 89749 - 69789 - - -
Confirmed with microscopy 40078 31668 75342 86348 - 206082 160260 149574
Chad
RDT examined - - 309927 114122 - 621469 1137455 937775
Confirmed with RDT - - 125106 94778 - 548483 753772 637472
Imported cases - - - - - - - -

130 WORLD MALARIA REPORT 2016


WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Presumed and confirmed 801784 29554 103670 76661 65139 62565 2465 1517
Microscopy examined - - 87595 63217 125030 154824 93444 89634
Confirmed with microscopy - 6086 35199 22278 45507 46130 1987 963
Comoros
RDT examined - - 5249 20226 27714 21546 9839 11479
Confirmed with RDT - - 1339 2578 4333 7026 216 337
Imported cases - - - - - - - -
Presumed and confirmed 15751 67 446656 277263 120319 183026 248159 264574
Microscopy examined - - - - - 69375 88764 87547
Confirmed with microscopy - - - 37744 120319 43232 54523 51529
Congo
RDT examined - - - - - 0 19746 0
Confirmed with RDT - - - - - 0 11800 0
Imported cases - - - - - - - -
Presumed and confirmed - 1280914 1721461 2588004 2795919 4708425 4658774 3606725
Microscopy examined - - - 49828 195546 395914 568562 811426
Confirmed with microscopy - - 62726 29976 107563 215104 306926 478870
Cte d'Ivoire
RDT examined - - - - 1572785 3384765 4904066 4174097
Confirmed with RDT - - - - 1033064 2291849 3405905 2897034
Imported cases - - - - - - - -
Presumed and confirmed 964623 6334608 9252959 9442144 9128398 11363817 9968983 11627473
Microscopy examined 3758 5531 3678849 4226533 4329318 4126129 3533165 2877585
Democratic Confirmed with microscopy 897 2971 2374930 2700818 2656864 2611478 2126554 1902640
Republic of the
Congo RDT examined - - 54728 2912088 3327071 6096993 11114215 13574891
Confirmed with RDT - - 42850 1861163 2134734 4103745 7842429 9724833
Imported cases - - - - - - - -
Presumed and confirmed - - 78095 37267 20890 25162 20417 15142
Microscopy examined - - 42585 23004 33245 27039 47322 21831
Equatorial Confirmed with microscopy - - 39636 20601 13196 11235 17685 8564
Guinea RDT examined - - 16772 2899 6826 5489 9807 46227
Confirmed with RDT - - 14177 1865 1973 1894 2732 6578
Imported cases - - - - - - - -
Presumed and confirmed - 24192 53750 39567 42178 34678 35725 24310
Microscopy examined - 48937 79024 67190 84861 81541 63766 59268
Confirmed with microscopy - 9073 13894 15308 11557 10890 10993 8332
Eritrea
RDT examined - - - 25570 33758 39281 53032 47744
Confirmed with RDT - - 22088 19540 10258 10427 19775 11040
Imported cases - - - - - - - -
Presumed and confirmed - 3901957 4068764 3549559 3876745 3316013 2513863 2174707
Microscopy examined - 1364194 2509543 3418719 3778479 8573335 7062717 5679932
Confirmed with microscopy - 538942 1158197 1480306 1692578 2645454 2118815 1867059
Ethiopia
RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - - - - - - -
Presumed and confirmed 127024 235479 185105 178822 188089 185196 185996 217287
Microscopy examined - 129513 54714 - 66018 90185 90275 79308
Confirmed with microscopy 50810 70644 12816 - 18694 26432 27687 20390
Gabon
RDT examined - - 7887 - 4129 10132 11812 12761
Confirmed with RDT - - 1120 - 1059 2550 4213 3477
Imported cases - - - - - - - -
Presumed and confirmed - 329426 194009 261967 300363 279829 166229 249437
Microscopy examined - - 290842 172241 156580 236329 286111 272604
Confirmed with microscopy - - 52245 71588 29325 65666 66253 49649
Gambia
RDT examined - - 123564 - 705862 614128 317313 609852
Confirmed with RDT - - 64108 190379 271038 175126 99976 190733
Imported cases - - - - - - - -
Presumed and confirmed 3349528 3452969 3849536 4154261 10676731 7200797 8453557 10186510
Microscopy examined - - 2031674 1172838 4219097 1394249 1987959 2023581
Confirmed with microscopy - 655093 1029384 624756 2971699 721898 970448 934304
Ghana
RDT examined - - 247278 781892 1438284 1488822 3610453 5478585
Confirmed with RDT - 0 42253 416504 783467 917553 2445464 3385615
Imported cases - - - - - - - -

WORLD MALARIA REPORT 2016 131


Annex 4 H. Reported malaria cases by method of confirmation,
20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Presumed and confirmed 816539 850309 1092554 1189016 1220574 775341 1595828 895016
Microscopy examined - - - 43549 - - 116767 78377
Confirmed with microscopy 4800 50452 20936 5450 191421 63353 82818 52211
Guinea
RDT examined - - - 139066 - - - 1092523
Confirmed with RDT - - - 90124 125779 147904 577389 758768
Imported cases - - - - - - - -
Presumed and confirmed 246316 185493 140143 174986 129684 132176 98952 -
Microscopy examined - 33721 48799 57698 61048 58909 106882 -
Confirmed with microscopy - 14659 30239 21320 23547 17733 35546 -
Guinea-Bissau
RDT examined - - 56455 139531 97047 102079 197536 -
Confirmed with RDT - - 20152 50662 26834 36851 57885 -
Imported cases - - - - - - - -
Presumed and confirmed 4216531 9181224 6071583 11120812 9335951 9750953 9655905 7676980
Microscopy examined - - 2384402 3009051 4836617 6606885 7444865 7772329
Confirmed with microscopy - - 898531 1002805 1426719 2060608 2415950 1025508
Kenya
RDT examined - - - - 164424 655285 850884 1965661
Confirmed with RDT - - - - 26752 274678 392981 473519
Imported cases - - - - - - - -
Presumed and confirmed - 44875 2675816 2480748 1800372 1483676 1066107 1781092
Microscopy examined - 8718 335973 728443 772362 818352 1318801 509062
Confirmed with microscopy - 5025 212927 577641 507967 496269 302708 305981
Liberia
RDT examined - 57325 998043 1593676 1276521 1144405 912382 947048
Confirmed with RDT - 39850 709246 1338121 899488 747951 561496 625105
Imported cases - - - - - - - -
Presumed and confirmed 1392483 1229385 293910 255814 395149 387045 433101 752176
Microscopy examined 31575 37943 24393 34813 38453 42573 37362 39604
Confirmed with microscopy 6946 6753 2173 3447 3667 4947 3853 4748
Madagascar
RDT examined - - 604114 739572 906080 1026110 926998 1488667
Confirmed with RDT - - 200277 221051 355753 380651 374110 739355
Imported cases - - - - - - - 1167
Presumed and confirmed 3646212 3688389 6851108 5338701 4922596 3906838 5065703 4933416
Microscopy examined - - - 119996 406907 132475 198534 216643
Confirmed with microscopy - - - 50526 283138 44501 77635 75923
Malawi
RDT examined - - - 580708 2763986 3029020 5344724 7030084
Confirmed with RDT - - - 253973 1281846 1236391 2827675 3585315
Imported cases - - - - - - - -
Presumed and confirmed 546634 962706 2171542 1961070 2171739 2327385 2590643 3317001
Microscopy examined - - - - - - - -
Confirmed with microscopy - - - - 97995 190337 219637 243151
Mali
RDT examined - - 1380178 974558 - 1889286 - 3389449
Confirmed with RDT - - 227482 307035 788487 1176881 1820216 2052460
Imported cases - - - - - - - -
Presumed and confirmed - 223472 244319 154003 169104 128486 172326 181562
Microscopy examined - - 5449 3752 1865 5510 - -
Confirmed with microscopy - - 909 1130 255 957 - -
Mauritania
RDT examined - - 2299 7991 3293 3576 47500 60253
Confirmed with RDT - - 1085 1796 1633 630 15835 22631
Imported cases - - - - - - - -
Presumed and confirmed - 500 396 92 72 82 15 -
Microscopy examined - - 2023 1214 1463 - - -
Confirmed with microscopy - 500 396 92 72 82 15 -
Mayotte
RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - 236 51 47 71 14 -
Presumed and confirmed - - 3381371 3344413 3203338 3924832 7117648 7718782
Microscopy examined - - 1950933 2504720 2546213 2058998 2295823 2313129
Confirmed with microscopy - - 644568 1093742 886143 774891 1009496 735750
Mozambique
RDT examined - - 2287536 2966853 2234994 5215893 9944222 11928263
Confirmed with RDT - - 878009 663132 927841 2223983 6108152 6983032
Imported cases - - - - - - - -

132 WORLD MALARIA REPORT 2016


WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Presumed and confirmed - 339204 25889 14406 3163 4911 15914 12050
Microscopy examined - - 14522 13262 7875 1507 1894 -
Confirmed with microscopy - 23339 556 335 194 136 222 -
Namibia
RDT examined - - - 48599 - 32495 185078 207612
Confirmed with RDT - - - 1525 - 4775 15692 12050
Imported cases - - - - - - - 2888
Presumed and confirmed - 817707 3643803 3157482 4592519 4288425 3222613 3817634
Microscopy examined - 107092 165514 130658 1781505 1799299 2872710 295229
Confirmed with microscopy - 46170 49285 68529 1119929 1176711 0 206660
Niger
RDT examined - 21230 7426774 1130514 1781505 1799299 2872710 2657057
Confirmed with RDT - 9873 570773 712347 1119929 1176711 1953309 2065340
Imported cases - - - - - - - -
Presumed and confirmed 2476608 3532108 3873463 4306945 6938519 12830911 16512127 14732621
Microscopy examined - - - 672185 1953399 1633960 1681469 851183
Confirmed with microscopy - - 523513 - - - 1233654 569036
Nigeria
RDT examined - - 45924 242526 2898052 7194960 9188933 8655024
Confirmed with RDT - - 27674 - - - 6593300 6281746
Imported cases - - - - - - - -
Presumed and confirmed - 1654246 638669 208858 483470 962618 1610812 2505794
Microscopy examined - 1438603 2708973 1602271 2904793 2862877 4010202 5811267
Confirmed with microscopy - 683769 638669 208858 422224 879316 1528825 2354400
Rwanda
RDT examined - - - - 190593 201708 168004 281847
Confirmed with RDT - - - - 61246 83302 81987 151394
Imported cases - - - - - - - -
Presumed and confirmed 32149 22370 3346 8442 12550 9243 1754 2058
Microscopy examined 66076 68819 48366 83355 103773 73866 33355 11941
Sao Tome and Confirmed with microscopy 31975 18139 2233 6373 10706 6352 569 140
Principe RDT examined - - 9989 33924 23124 34768 58090 72407
Confirmed with RDT - - 507 2069 1844 2891 1185 1918
Imported cases - - - - - - - 2
Presumed and confirmed 1123377 1346158 707772 604290 634106 772222 628642 502084
Microscopy examined 56169 105093 27793 18325 19946 24205 19343 26556
Confirmed with microscopy 44959 33160 17750 14142 15612 20801 12636 17846
Senegal
RDT examined - - 651737 555614 524971 668562 697175 1384834
Confirmed with RDT - - 325920 263184 265468 325088 252988 474407
Imported cases - - - - - - - 352
Presumed and confirmed 460881 233833 934028 856332 1945859 1715851 1898852 1569606
Microscopy examined - 10605 718473 46280 194787 185403 66277 75025
Confirmed with microscopy - 3702 218473 25511 104533 76077 39414 37820
Sierra Leone
RDT examined - 3452 1609455 886994 1975972 2377254 2056722 2176042
Confirmed with RDT - 1106 715555 613348 1432789 1625881 1335062 1445556
Imported cases - - - - - - - -
Presumed and confirmed 64624 7755 8060 9866 6846 8851 13988 8976
Microscopy examined - - - 178387 121291 364021 300291 13917
Confirmed with microscopy - 7755 3787 5986 1632 2572 4101 785
South Africa
RDT examined - - 276669 204047 30053 239705 240622 17446
Confirmed with RDT - - 4273 3880 3997 6073 7604 3572
Imported cases - - - - - - - 3568
Presumed and confirmed - 337582 900283 795784 1125039 1855501 - -
Microscopy examined - - - - - - - -
Confirmed with microscopy - - 900283 112024 225371 262520 - -
South Sudan1
RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - - - - - - -
Presumed and confirmed 29374 6066 1722 797 626 962 711 651
Microscopy examined - 4587 - - - - - -
Confirmed with microscopy - 279 87 130 345 488 711 43
Swaziland
RDT examined - - - - - - - -
Confirmed with RDT - - 181 419 217 474 - 152
Imported cases - - - 170 153 234 322 282

WORLD MALARIA REPORT 2016 133


Annex 4 H. Reported malaria cases by method of confirmation,
20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Presumed and confirmed - 437662 983430 519450 768287 882430 1130251 1113928
Microscopy examined - - 478354 502977 579507 560096 621119 621119
Confirmed with microscopy - - 224087 237305 260535 272855 310207 305727
Togo
RDT examined - - 575245 390611 660627 882475 1135581 1135581
Confirmed with RDT - - 393014 282145 436839 609575 820044 808200
Imported cases - - - - - - - -
Presumed and confirmed 3552859 9867174 13208169 12173358 13591932 16541563 13724345 13421804
Microscopy examined - 2107011 3705284 385928 3466571 3718588 2048185 3684722
Confirmed with microscopy - 1104310 1581160 134726 1413149 1502362 578289 1248576
Uganda
RDT examined - - - 194819 2449526 7387826 7060545 12126996
Confirmed with RDT - - - 97147 1249109 - 3053650 5889086
Imported cases - - - - - - - -
Presumed and confirmed 45643 11466713 12893535 10164967 8477435 8585482 7403562 7746258
Microscopy examined 53533 8037619 3637659 5656907 6931025 6804085 727130 673223
United Republic Confirmed with microscopy 17734 2764049 1277024 1813179 1772062 1481275 572289 412702
of Tanzania RDT examined - - 136123 1628092 1091615 813103 17740207 16620299
Confirmed with RDT - - 1974 337582 214893 71169 107728 3830030
Imported cases - - - - - - - 2550
Presumed and confirmed - 11441681 12819192 10160478 8474278 8582934 7399316 7741816
Microscopy examined - 7993977 3573710 5513619 6784639 6720141 592320 532118
Confirmed with microscopy - 2756421 1276660 1812704 1771388 1480791 571598 411741
Mainland
RDT examined - - - 1315662 701477 369444 17566750 16416675
Confirmed with RDT - - - 333568 212636 69459 106609 3827749
Imported cases - - - - - - - -
Presumed and confirmed 45643 25032 74343 4489 3157 2548 4246 4442
Microscopy examined 53533 43642 63949 143288 146386 83944 134810 141105
Confirmed with microscopy 17734 7628 364 475 674 484 691 961
Zanzibar
RDT examined - - 136123 312430 390138 443659 173457 203624
Confirmed with RDT - - 1974 4014 2257 1710 1119 2281
Imported cases - - - - - - - 2550
Presumed and confirmed 3337796 4121356 4229839 4607908 4695400 5465122 5972933 5094123
Microscopy examined - - - - - - - -
Confirmed with microscopy - - - - - - - -
Zambia
RDT examined - - - - - - 5964354 7207500
Confirmed with RDT - - - - - - 4077547 4184661
Imported cases - - - - - - - -
Presumed and confirmed - 1494518 648965 - - - 535983 391651
Microscopy examined - - - 10004 - - - -
Confirmed with microscopy - - - - - - - -
Zimbabwe
RDT examined - - 513032 470007 727174 1115005 1420894 1384893
Confirmed with RDT - - 249379 319935 276963 422633 535931 391651
Imported cases - - - - - - - 180
AMERICAS
Presumed and confirmed 1486 1549 150 79 37 26 19 13
Microscopy examined 18559 25119 27366 22996 20789 25351 24122 26367
Confirmed with microscopy 1486 1549 150 79 37 26 19 13
Belize
RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - - 7 4 4 0 4
Presumed and confirmed 31469 21442 13769 7143 7415 7342 7401 6907
Microscopy examined 143990 202021 133463 143272 121944 133260 124900 159167
Bolivia Confirmed with microscopy 31469 20142 12252 6108 6293 6272 7401 6907
(Plurinational
State of) RDT examined - 6000 7394 7390 10960 10789 - -
Confirmed with RDT - 1300 1517 1035 1122 1070 - -
Imported cases - - - - - - - -
Presumed and confirmed 613241 606067 334668 267146 242758 178546 143415 143162
Microscopy examined 2562576 2660539 2711432 2476335 2325775 1873518 1658976 1488072
Confirmed with microscopy 613241 606067 334667 266713 237978 174048 142031 139844
Brazil
RDT examined - - - 1486 23566 19500 11043 14655
Confirmed with RDT - - - 433 4780 3719 1384 3205
Imported cases - - - - - - - 4949

134 WORLD MALARIA REPORT 2016


WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AMERICAS
Presumed and confirmed 144432 121629 117650 64436 60179 51722 40768 55866
Microscopy examined 478820 493562 521342 396861 346599 284332 325713 316451
Confirmed with microscopy 144432 121629 117637 60121 50938 44293 36166 48059
Colombia
RDT examined - - - 21171 70168 42723 77819 11983
Confirmed with RDT - - 13 4188 9241 7403 4602 3535
Imported cases - - - - - - - 532
Presumed and confirmed 1233 3837 3414 1616 952 579 496 661
Microscopy examined 427297 397108 469052 421405 415808 431683 362304 316947
Dominican Confirmed with microscopy 1233 3837 2482 1616 952 579 496 661
Republic RDT examined - - 26585 56150 90775 71000 54425 50220
Confirmed with RDT - - 932 - - - - -
Imported cases - - - - - - - 30
Presumed and confirmed 104528 17050 1888 1233 558 378 241 686
Microscopy examined 544646 358361 481030 460785 459157 397628 370825 261824
Confirmed with microscopy 104528 17050 1888 1233 558 378 241 686
Ecuador
RDT examined - - 7800 - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - - 14 14 10 - 68
Presumed and confirmed 753 67 24 16 19 7 8 9
Microscopy examined 279072 102479 115256 100883 124885 103748 106915 89267
Confirmed with microscopy 753 67 24 15 19 7 8 9
El Salvador
RDT examined - - - 1 - - - 0
Confirmed with RDT - - - 1 - - - 0
Imported cases - - 7 6 6 1 2 6
Presumed and confirmed 3708 3414 1632 1209 900 875 448 434
Microscopy examined 48162 32402 14373 14429 13638 22327 14651 11558
Confirmed with microscopy 3708 3414 688 505 401 324 187 272
French Guiana
RDT examined - - - - - - - -
Confirmed with RDT - - 944 704 499 551 261 162
Imported cases - - - - - - - -
Presumed and confirmed 53311 39571 7384 6817 5346 6214 4931 6836
Microscopy examined 246642 178726 235075 195080 186645 153731 264269 295246
Confirmed with microscopy 53311 39571 7384 6817 5346 6214 4931 5538
Guatemala
RDT examined - - 2000 - 0 0 50025 6500
Confirmed with RDT - - 0 - 0 0 754 1298
Imported cases - - - - - - - 2
Presumed and confirmed 24018 38984 22935 29506 31656 31479 12354 9984
Microscopy examined 209197 210429 212863 201693 196622 205903 142843 132941
Confirmed with microscopy 24018 38984 22935 29471 31601 31479 12354 9984
Guyana
RDT examined - - - 0 - 0 0 0
Confirmed with RDT - - - 35 55 0 0 0
Imported cases - - - - - - - -
Presumed and confirmed 16897 21778 84153 32969 25423 26543 17696 17583
Microscopy examined 21190 3541506 270427 184934 167726 165823 134766 69659
Confirmed with microscopy 16897 21778 84153 32969 25423 20957 10893 5224
Haiti
RDT examined - - - - 46 5586 126637 233081
Confirmed with RDT - - - - - - 6803 12359
Imported cases - - - - - - - -
Presumed and confirmed 35125 15943 9685 7618 6439 5428 3380 3564
Microscopy examined 175577 153474 152961 152451 155165 144436 151420 150854
Confirmed with microscopy 35125 15943 9685 7465 6439 5364 3380 3555
Honduras
RDT examined - 2500 4000 4000 4000 237 1427 3052
Confirmed with RDT - - - 45 10 64 102 20
Imported cases - - - - - - - 0
Presumed and confirmed 7390 2967 1226 1130 842 499 664 551
Microscopy examined 2003569 1559076 1192081 1035424 1025659 1017508 900578 867853
Confirmed with microscopy 7390 2967 1226 1130 842 499 664 551
Mexico
RDT examined - - - - - 0 0 0
Confirmed with RDT - - - - - 0 0 0
Imported cases - - 7 6 9 4 8 34

WORLD MALARIA REPORT 2016 135


Annex 4 H. Reported malaria cases by method of confirmation,
20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AMERICAS
Presumed and confirmed 23878 6642 692 925 1235 1194 1163 2307
Microscopy examined 509443 516313 535914 521904 536278 519993 605357 604418
Confirmed with microscopy 23878 6642 692 925 1235 1196 1163 2307
Nicaragua
RDT examined - - 18500 14201 16444 19029 15620 -
Confirmed with RDT - - 0 - 0 - 0 -
Imported cases - - - - - - - 29
Presumed and confirmed 1036 3667 418 354 844 705 874 562
Microscopy examined 149702 208582 141038 116588 107711 93624 80701 64511
Confirmed with microscopy 1036 3667 418 354 844 705 874 562
Panama
RDT examined - - - 0 0 0 0 0
Confirmed with RDT - - - 0 0 0 0 0
Imported cases - - - - - - - 16
Presumed and confirmed 68321 87699 31546 25039 31570 43139 65252 66609
Microscopy examined 1483816 1438925 744627 702894 758723 863790 864413 865980
Confirmed with microscopy 68321 87699 31545 25005 31436 48719 65252 66609
Peru
RDT examined - - 23 58 562 858 1634 0
Confirmed with RDT - - 1 34 - - - -
Imported cases - - - - - - - -
Presumed and confirmed 11361 9131 1771 795 569 729 400 376
Microscopy examined 63377 59855 16533 15135 17464 13693 17608 15083
Confirmed with microscopy 11361 9131 1574 751 306 530 98 345
Suriname
RDT examined - - 541 1025 4008 6043 15489 153
Confirmed with RDT - - 138 20 50 199 303 31
Imported cases - - - - - - - 274
Presumed and confirmed 29736 45049 45155 45824 52803 78643 90708 136402
Microscopy examined 261866 420165 400495 382303 410663 476764 522617 625174
Venezuela Confirmed with microscopy 29736 45049 45155 45824 52803 78643 90708 136402
(Bolivarian
Republic of) RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - - - - - - 1594
EASTERN MEDITERRANEAN
Presumed and confirmed 203911 326694 392463 482748 391365 319742 290079 350044
Microscopy examined 257429 338253 524523 531053 511408 507145 1028932 538789
Confirmed with microscopy 94475 116444 69397 77549 54840 39263 122724 86895
Afghanistan
RDT examined - - - 0 0 0 155919 138026
Confirmed with RDT - - - 0 0 0 22558 16482
Imported cases - - - - - - - -
Presumed and confirmed 4667 2469 1010 230 27 1684 9439 -
Microscopy examined - 1913 - 124 1410 7189 39284 -
Confirmed with microscopy - 413 1010 - 22 1684 9439 -
Djibouti
RDT examined - - - - - - - -
Confirmed with RDT - - - - 3 - - -
Imported cases - - - - - - - -
Presumed and confirmed 19716 18966 3031 3239 1629 1373 1243 799
Microscopy examined 1732778 1674895 614817 530470 479655 385172 468513 610337
Iran (Islamic Confirmed with microscopy 19716 18966 3031 3239 1629 1373 1243 799
Republic of) RDT examined - - - - 0 - - 20549
Confirmed with RDT - - - - 0 - - 579
Imported cases 7422 4570 1184 1529 842 853 867 632
Presumed and confirmed 3337054 4022823 4281356 4065802 4285449 3472727 3666257 3776244
Microscopy examined - 4776274 4281346 4168648 4497330 3933321 4343418 4619980
Confirmed with microscopy 82526 127826 220870 287592 250526 196078 193952 137401
Pakistan
RDT examined - - 279724 518709 410949 628504 779815 691245
Confirmed with RDT - - 19721 46997 40255 85677 81197 64612
Imported cases - 290 - - - - - -
Presumed and confirmed 6608 1059 1941 2788 3406 2513 2305 2620
Microscopy examined - 715878 944723 1062827 1186179 1309783 1249752 1306700
Confirmed with microscopy 6608 1059 1941 2788 3406 2513 2305 2620
Saudi Arabia
RDT examined - - - - 0 - - -
Confirmed with RDT - - - - 0 - - -
Imported cases 1872 855 1912 2719 3324 2479 2254 2537

136 WORLD MALARIA REPORT 2016


WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

EASTERN MEDITERRANEAN
Microscopy examined - 47882 20593 26351 - - - -
Confirmed with microscopy - 12516 5629 1627 - - - -
RDT examined - - 200105 35236 37273 67464 64480 100792
Somalia
Confirmed with RDT - - 18924 1724 6817 7407 11001 20953
Imported cases - - - - - - - -
Presumed and confirmed 4332827 2515693 1465496 1214004 964698 989946 1207771 1102186
Microscopy examined - - - - - - - -
Confirmed with microscopy 368557 628417 625365 506806 526931 592383 579038 586827
RDT examined - - 1653300 2222380 2000700 1800000 788281 -
Sudan
Confirmed with RDT - - 95192 - - - 489468 -
Imported cases - - - - - - - -
Presumed and confirmed 1394495 200560 198963 142147 165678 149451 97089 95287
Microscopy examined - 472970 645463 645093 685406 723691 643994 529932
Confirmed with microscopy 1394495 44150 78269 60207 68849 63484 51768 38254
RDT examined - - 97289 108110 150218 157457 141519 111787
Yemen
Confirmed with RDT - - 28428 30203 41059 39294 34939 30728
Imported cases - - - - - - - -
Imported cases - - - - - - - -
EUROPEAN
Presumed and confirmed 233785 216197 112 78 33 14 7 5
Microscopy examined 233785 216197 173523 173367 209239 213916 200241 -
Confirmed with microscopy 19064 2309 112 78 33 14 7 5
Tajikistan
RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - 1 13 15 7 5 4
SOUTH-EAST ASIA
Presumed and confirmed 437838 290418 91227 51773 29518 3864 10216 6608
Microscopy examined 360300 220025 308326 270253 253887 74755 78719 69093
Confirmed with microscopy 55599 48121 20519 20232 4016 1866 3249 1612
Bangladesh
RDT examined - - 152936 119849 35675 19171 46482 53713
Confirmed with RDT - - 35354 31541 5885 1998 6967 4996
Imported cases - - - - - - - 129
Presumed and confirmed 5935 1825 487 207 82 45 48 104
Microscopy examined 76445 60152 54709 44481 42512 31632 33586 26149
Confirmed with microscopy 5935 1825 436 194 82 45 48 84
Bhutan
RDT examined - - - - - - - 47938
Confirmed with RDT - - - - - - - 20
Imported cases - - - - 0 23 29 70
Presumed and confirmed 204428 11507 13520 16760 23537 15673 11212 7409
Microscopy examined - - 25147 26513 39238 71453 38201 29272
Democratic Confirmed with microscopy 90582 11315 13520 16760 21850 14407 10535 7010
People's Republic
of Korea RDT examined - - - - 0 0 0 61348
Confirmed with RDT - - - - 0 0 0 12
Imported cases - - - - 0 0 0 205
Presumed and confirmed 2031790 1816569 1599986 1310656 1067824 881730 1102205 1169261
Microscopy examined 86790375 104120792 108679429 108969660 109033790 113109094 124066331 121141970
Confirmed with microscopy 2031790 1816569 1599986 1310656 1067824 881730 1102205 1169261
India
RDT examined - - 10600000 10500384 13125480 14782104 14562000 19699260
Confirmed with RDT - - - - - - - -
Imported cases - - - - - - - -
Presumed and confirmed 256993 315394 465764 422447 417819 1833256 252027 217025
Microscopy examined 1752763 1178457 1335445 962090 1429139 1447980 1300835 1224504
Confirmed with microscopy 245612 315394 465764 422447 417819 343527 252027 217025
Indonesia
RDT examined - - 255734 250709 471586 260181 249461 342946
Confirmed with RDT - - - - - - - -
Imported cases - - - - - - - -

WORLD MALARIA REPORT 2016 137


Annex 4 H. Reported malaria cases by method of confirmation,
20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

SOUTH-EAST ASIA
Presumed and confirmed 581560 516041 693124 567452 480586 315509 152195 77842
Microscopy examined 381610 437387 275374 312689 265135 138473 93842 52076
Confirmed with microscopy 120083 165737 103285 91752 75220 25215 11952 6569
Myanmar
RDT examined - - 729878 795618 1158831 1162083 797071 661999
Confirmed with RDT - - 317523 373542 405366 226058 140243 71273
Imported cases - - - - - - - 345
Presumed and confirmed 48686 178056 96383 71752 70272 38113 26526 20621
Microscopy examined 100063 188930 102977 95011 152780 100336 127130 63946
Confirmed with microscopy 7981 5050 3115 1910 1659 1197 1469 1112
Nepal
RDT examined - - 17887 25353 22472 32989 48444 49649
Confirmed with RDT - - 779 1504 433 777 - 725
Imported cases - - - - - - 667 517
Presumed and confirmed 78561 29782 32480 24897 32569 41362 37921 14755
Microscopy examined 4403739 2524788 1695980 1354215 1130757 1830090 1756528 1358953
Confirmed with microscopy 78561 29782 22969 14478 32569 33302 37921 14135
Thailand
RDT examined - - 81997 96670 - - - 10888
Confirmed with RDT - - 9511 10419 - - - 0
Imported cases - - - - - - - 9890
Presumed and confirmed 15212 130679 119072 36064 6148 1042 342 80
Microscopy examined - 97781 109806 82175 64318 56192 30515 30275
Confirmed with microscopy 15212 43093 40250 19739 5211 1025 342 80
Timor-Leste
RDT examined - - 85643 127272 117599 121991 86592 90835
Confirmed with RDT - - 7887 - - - 0 0
Imported cases - - - - - - - -
WESTERN PACIFIC
Presumed and confirmed 203164 67036 49356 57423 45553 24130 26278 33930
Microscopy examined 122555 88991 90175 86526 80212 54716 48591 49357
Confirmed with microscopy 51320 26914 14277 13792 10124 4598 5288 7423
Cambodia
RDT examined 18167 58791 103035 130186 108974 94600 92525 114323
Confirmed with RDT 11122 22522 35079 43631 30352 16711 19864 26507
Imported cases - - - - - - - -
Presumed and confirmed - 100106 7855 4498 2678 4121 2921 3116
Microscopy examined - 3814715 7115784 9189270 6918657 5554960 4403633 4052588
Confirmed with microscopy - 21936 4990 3367 2603 4086 2921 3088
China
RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - 2632 - - 2399 4007 2864 3055
Presumed and confirmed 279903 30359 23047 17904 46819 41385 48071 36056
Microscopy examined 256273 156954 150512 213578 223934 202422 133916 110084
Lao People's Confirmed with microscopy 40106 13615 4524 6226 13232 10036 8018 4167
Democratic
Republic RDT examined - - 127790 7743 145425 133337 160626 173919
Confirmed with RDT - - 16276 11609 32970 28095 40053 31889
Imported cases - - - - - - - 0
Presumed and confirmed 874894 573788 6650 5306 4725 3850 3923 2311
Microscopy examined 1832802 1425997 1619074 1600439 1566872 1576012 1443958 1066470
Confirmed with microscopy 12705 5569 6650 5306 4725 3850 3923 2311
Malaysia
RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - 831 1142 924 865 766 435
Presumed and confirmed 1751883 1788318 1379787 1151343 878371 1125808 644688 553103
Microscopy examined 225535 267132 198742 184466 156495 139972 83257 112864
Papua New Confirmed with microscopy 79839 92957 75985 70603 67202 70658 68114 64719
Guinea RDT examined - - 20820 27391 228857 468380 475654 541760
Confirmed with RDT - - 17971 13457 82993 209336 213068 233068
Imported cases - - - - - - - -
Presumed and confirmed 36596 46342 19106 9617 8154 7720 4903 5135
Microscopy examined - 581871 301031 327060 332063 317360 286222 224843
Confirmed with microscopy - - 18560 9552 7133 5826 3618 4988
Philippines
RDT examined - 12125 - - - 1523 28598 35789
Confirmed with RDT - - - - - 688 1285 134
Imported cases - - - - - - - 18

138 WORLD MALARIA REPORT 2016


WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

WESTERN PACIFIC
Presumed and confirmed 4183 1369 1772 838 555 443 638 699
Microscopy examined - - - - - - - -
Republic of Confirmed with microscopy - - 1772 838 555 443 638 699
Korea RDT examined - - - - - - - -
Confirmed with RDT - - - - - - - -
Imported cases - - 56 64 47 50 78 65
Presumed and confirmed 368913 393288 95006 80859 57296 53270 51649 50916
Microscopy examined 300806 316898 212329 182847 202620 191137 173900 124376
Confirmed with microscopy 68107 76390 35373 23202 21904 21540 13865 14793
Solomon Islands
RDT examined - - 17300 17457 13987 26216 26658 40750
Confirmed with RDT - - 4331 3455 2479 4069 4539 9205
Imported cases - - - - - - - -
Presumed and confirmed 33779 34912 16831 5764 3435 2381 982 697
Microscopy examined 31668 61092 29180 19183 16981 15219 18135 4870
Confirmed with microscopy 6768 9834 4013 2077 733 767 190 15
Vanuatu
RDT examined - - 10246 12529 16292 13724 17435 9794
Confirmed with RDT - - 4156 2743 2702 1614 792 408
Imported cases - - - - - - - 0
Presumed and confirmed 274910 84473 54297 45588 43717 35406 27868 19252
Microscopy examined 2682862 2728481 2760119 2791917 2897730 2684996 2357536 2204409
Confirmed with microscopy 74316 19496 17515 16612 19638 17128 15752 9331
Viet Nam
RDT examined - - 7017 491373 514725 412530 416483 459332
Confirmed with RDT - - - - - - - -
Imported cases - - - - - - - -
REGIONAL SUMMAR Y
(presumed and confirmed malaria cases)
African 33178671 75645235 103145240 99885087 110636435 124035580 127886819 129589592
Americas 1171923 1046486 678160 493855 469545 434048 390218 452512
Eastern Mediterranean 9309642 7116668 6368813 5952125 5847964 4946571 5300357 5366349
European 233785 216197 112 78 33 14 7 5
South-East Asia 3661003 3290271 3112043 2502008 2128355 3130594 1592692 1513705
Western Pacific 3828225 3119991 1653707 1379140 1091303 1298514 811921 705215
Total 51383249 90434848 114958075 110212293 120173635 133845321 135982014 137627378

RDT, rapid diagnostic test


* The table indicates cases reported at health facilities and excludes cases at community level.
1 In May 2013, South Sudan was reassigned to the WHO African Region (WHA resolution 66.21, http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R21-en.pdf)

WORLD MALARIA REPORT 2016 139


Annex 4 I. Reported malaria cases by species, 20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Suspected 27733 18392 12224 11974 15790 12762 8690 8000
No Pf 261 242 7 4 48 14 0 0
Algeria
No Pv 277 57 4 0 11 2 0 0
No other - - 1 0 - 0 0 0
Suspected 2080348 2329316 4591529 4469357 4849418 5273305 6134471 6839963
No Pf - - - - - - - -
Angola
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 803462 1432095 1565487 1875386 2041444 1955773 2009959
No Pf - - - 68745 0 - - -
Benin
No Pv - - - 0 0 - - -
No other - - - 0 0 - - -
Suspected 71555 11242 12196 1141 308 506 1485 1298
No Pf - - 1046 432 193 456 1346 326
Botswana
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 1667622 6037806 5446870 7852299 7146026 8278408 8286453
No Pf - 0 - - - - - -
Burkina Faso
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 3428846 2910545 5590736 4768314 4228015 7384501 7622162 8414481
No Pf - - - - - - - -
Burundi
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 6843 7902 47 26508 8715 10621 6894 3117
No Pf 144 68 47 7 1 22 26 7
Cabo Verde
No Pv 0 0 0 0 0 0 0 0
No other - - 0 0 0 0 0 0
Suspected - 277413 1845691 3060040 2865319 3652609 3709906 3312273
No Pf - - - - - - - 592351
Cameroon
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 89614 131856 66484 221980 468986 491074 625301 1218246
Central African No Pf - - - - - - 295088 598833
Republic No Pv - - - - - - 0 -
No other - - - - - - 0 -
Suspected 442246 507617 743471 528454 730364 1272841 1737195 1641285
No Pf 20977 14770 - - - - - -
Chad
No Pv 19101 16898 - - - - - -
No other - - - - - - - -
Suspected - 29554 159976 135248 168043 185779 103545 101330
No Pf - - 33791 21387 43681 46032 2203 1300
Comoros
No Pv - - 528 334 637 72 0 0
No other - - 880 557 - 0 0 0
Suspected - - 446656 277263 117640 209169 290346 300592
No Pf - - - 37744 120319 43232 66323 51529
Congo
No Pv - - - 0 0 0 0 0
No other - - - - - 0 0 0
Suspected - 1280914 1721461 2607856 3423623 5982151 6418571 5216344
No Pf - - - - - 2506953 3712831 3375904
Cte d'Ivoire
No Pv - - - - - 0 0 0
No other - - - - - 0 0 0
Suspected 967484 6337168 10568756 12018784 11993189 14871716 14647380 16452476
Democratic No Pf 889 2844 - - - - - -
Republic of the
Congo No Pv - 110 - - - - - -
No other - - - - - - - -
Suspected - - 83639 40704 45792 44561 57129 68058
Equatorial No Pf - - 53813 22466 15169 13129 17452 -
Guinea No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 64056 96792 97479 138982 134183 121755 111950
No Pf - 7506 9848 10357 12467 13873 23953 14580
Eritrea
No Pv - 1567 3989 4932 9204 7361 6780 4780
No other - - 57 19 - 83 35 12

140 WORLD MALARIA REPORT 2016


WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Suspected - 4727209 5420110 5487972 5962646 9243894 7457765 5987580
No Pf - 374335 806577 814547 946595 1687163 1250110 1188627
Ethiopia
No Pv - 158658 390252 665813 745983 958291 868705 678432
No other - - 0 - - - - -
Suspected 127024 294348 233770 178822 238483 256531 256183 285489
No Pf 50810 70644 2212 - - 26432 26117 -
Gabon
No Pv - - 720 - - 0 0 -
No other - - 2015 - - 0 1570 -
Suspected - 329426 492062 261967 862442 889494 603424 891511
No Pf - - 64108 190379 271038 240792 99976 240382
Gambia
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 3349528 3452969 5056851 5067731 12578946 8444417 8453557 10186510
No Pf - - 926447 593518 3755166 1629198 3415912 4319919
Ghana
No Pv - - 0 0 0 0 0 0
No other - - 102937 31238 0 0 0 0
Suspected 816539 850309 1092554 1276057 1220574 775341 1595828 1254937
No Pf 4800 50452 20936 5450 191421 63353 660207 810979
Guinea
No Pv - - - - - 0 - -
No other - - - - - 0 - -
Suspected 246316 204555 195006 300233 237398 238580 309939 -
No Pf - - - - - - - -
Guinea-Bissau
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 4216531 9181224 7557454 13127058 12883521 14677837 15142723 15915943
No Pf - - 898531 1002805 1453471 2335286 2808931 1499027
Kenya
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 66043 3087659 2887105 2441800 2202213 2433086 2306116
No Pf - 44875 212927 577641 1407455 1244220 864204 931086
Liberia
No Pv - - 0 - - 0 0 0
No other - - 0 - - 0 0 0
Suspected 1417112 1260575 719967 805701 980262 1071310 977228 1536344
No Pf - - - - - - - -
Madagascar
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 3646212 3688389 6851108 5734906 6528505 5787441 7703651 8518905
No Pf - - - - 1564984 1280892 2905310 3585315
Malawi
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 546634 962706 3324238 2628593 2171739 2849453 2590643 4410839
No Pf - - - - - - - -
Mali
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 223472 250073 162820 172374 135985 203991 219184
No Pf - - - - - - - -
Mauritania
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 500 2023 1214 1463 82 15 -
No Pf - - 169 38 25 9 1 -
Mayotte
No Pv - - 3 2 2 0 0 -
No other - - 19 0 - - 0 -
Suspected - - 6097263 7059112 6170561 8200849 12240045 14241392
No Pf - - 878009 663132 927841 2998874 7117648 7718782
Mozambique
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 339204 39855 74407 10844 34002 186972 207612
No Pf - - 556 335 194 136 15914 12050
Namibia
No Pv - - 0 0 0 0 0 0
No other - - 0 0 0 0 0 0
Suspected - 889986 10616033 3637778 5915671 5533601 7014724 4497920
No Pf - 74129 618578 778819 2207459 2352422 3906588 2267867
Niger
No Pv - - 0 0 0 0 0 0
No other - - - - - - - 4133

WORLD MALARIA REPORT 2016 141


Annex 4 I. Reported malaria cases by species, 20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AFRICAN
Suspected 2476608 3532108 3873463 5221656 11789970 21659831 19555575 17388046
No Pf - - 523513 - - - - -
Nigeria
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 2409080 2708973 1602271 3095386 3064585 4178206 6093114
No Pf - - 638669 208858 483470 962618 1623176 -
Rwanda
No Pv - - - - 0 0 0 -
No other - - - - 0 0 0 -
Suspected 66250 73050 58961 117279 126897 108634 91445 84348
Sao Tome and No Pf - - 2219 6363 10700 9242 1754 2057
Principe No Pv - - 14 4 1 1 0 0
No other - - 0 6 - 0 0 1
Suspected 1134587 1418091 1043632 900903 897943 1119100 1079536 1421221
No Pf 44959 38746 343670 277326 281080 345889 265624 492253
Senegal
No Pv - - - - 0 0 0 0
No other - - - - - 0 0 -
Suspected 460881 243082 2327928 1150747 2579296 2576550 2647375 2337297
No Pf - 3702 218473 25511 1537322 1701958 1374476 1483376
Sierra Leone
No Pv - 0 - - - - 0 0
No other - - - - - - 0 0
Suspected 64624 7755 276669 382434 152561 603932 543196 35982
No Pf - - 2193 6906 4565 8645 11563 555
South Africa
No Pv - - 0 14 5 0 0 0
No other - - 5 15 - 0 0 0
Suspected - 337582 900283 795784 1125039 1855501 - -
No Pf - - - 112024 - - - -
South Sudan1
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 29374 10374 1722 797 626 669 711 651
No Pf 0 279 87 130 345 487 710 157
Swaziland
No Pv - 0 0 0 0 0 1 0
No other - - 0 0 0 1 0 0
Suspected - 437662 1419928 893588 1311047 1442571 1756700 1756701
No Pf - - 224080 237282 260526 272855 1130234 1113910
Togo
No Pv - - 0 0 0 0 0 0
No other - - 7 23 - 8 17 17
Suspected 3552859 10869875 15332293 12522232 16845771 26145615 19201136 22095860
No Pf - 1082223 1612783 231873 2662258 1502362 3631939 7137662
Uganda
No Pv - - 15812 0 0 0 0 0
No other - - 0 0 0 0 0 0
Suspected 81442 16740283 15388319 15299205 14513120 7617188 25190092 -
United Republic No Pf 17734 7628 2338 4489 2730 - - -
of Tanzania No Pv 0 0 0 0 0 - - -
No other - - - - 201 - - -
Suspected - 16679237 15116242 14843487 13976370 14122269 24880179 20451119
No Pf - - - - 212636 69459 106609 411741
Mainland
No Pv - - - - - - - -
No other - - - - - - - -
Suspected 81442 61046 272077 455718 536750 527957 310703 345929
No Pf 17734 7628 2338 4489 2931 1725 2390 2049
Zanzibar
No Pv - - 0 0 0 0 0 0
No other - - 0 0 0 0 0 0
Suspected 3337796 4121356 4229839 4607908 4695400 5465122 7859740 8116962
No Pf - - - - - - - -
Zambia
No Pv - - - - - - - -
No other - - - - - - - -
Suspected - 1494518 912618 480011 727174 1115005 1420946 1384893
No Pf - - 249379 319935 276963 422633 535931 391651
Zimbabwe
No Pv - - - - - - - -
No other - - - 0 - - - -
AMERICAS
Suspected 18559 25119 27366 22996 20789 25351 24122 26367
No Pf 20 32 1 0 0 0 0 0
Belize
No Pv 1466 1517 149 72 33 20 18 9
No other - - 0 0 0 0 0 0

142 WORLD MALARIA REPORT 2016


WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AMERICAS
Suspected 143990 208021 140857 150662 132904 144049 124900 159167
Bolivia No Pf 2536 1080 1592 543 396 996 341 96
(Plurinational
No Pv 28932 19062 13694 7635 8141 6346 7060 6811
State of)
No other - - 0 0 0 0 0 0
Suspected 2562576 2660539 2711433 2477821 2349341 1893797 1670019 1502840
No Pf 131616 155169 51048 35706 40159 34685 24654 16793
Brazil
No Pv 478212 450687 283435 231368 203018 143050 118724 126211
No other 932 211 183 143 105 32 37 45
Suspected 478820 493562 521342 418159 416767 327081 403532 332706
No Pf 51730 43472 34334 15404 17778 18340 20634 30870
Colombia
No Pv 92702 78157 83255 44701 51467 33345 20129 20724
No other - - 48 16 9 11 5 0
Suspected 427297 397108 495637 477555 506583 502683 416729 367167
Dominican No Pf 1226 3829 2480 1614 950 576 491 631
Republic No Pv 7 8 2 2 2 3 5 0
No other - - 0 0 0 0 0 0
Suspected 544646 358361 488830 460785 459157 397628 370825 261824
No Pf 48974 2212 258 296 80 161 49 227
Ecuador
No Pv 55624 14836 1630 937 478 217 199 459
No other - - 0 0 0 0 0 0
Suspected 279072 102479 115256 100884 124885 103748 106915 89267
No Pf 9 2 0 3 0 0 0 0
El Salvador
No Pv 744 65 17 12 15 6 6 3
No other - - 0 0 0 0 0 0
Suspected 48162 32402 14373 14429 13638 22327 14651 11558
No Pf 3265 1777 1548 1080 763 744 348 205
French Guiana
No Pv 657 1637 476 339 257 337 98 227
No other 214 71 5 5 2 345 2 0
Suspected 246642 178726 237075 195080 186645 153731 314294 301746
No Pf 1474 1062 35 67 68 152 92 51
Guatemala
No Pv 50171 38641 7163 6707 5278 6062 5593 5487
No other 36 48 - - 0 0 0 0
Suspected 209197 210429 212863 201693 196622 205903 142843 132941
No Pf 12324 16438 14401 20309 20329 17425 5140 3950
Guyana
No Pv 11694 21255 8402 9066 11244 13953 7173 6002
No other - 1291 132 96 83 101 41 32
Suspected 21190 3541506 270427 184934 167772 20586 258817 302740
No Pf 16897 21778 84153 32969 25423 20957 17696 17583
Haiti
No Pv 0 0 0 0 0 0 0 0
No other - - 0 0 0 0 0 0
Suspected 175577 153474 152961 152604 155165 144673 151420 153906
No Pf 1446 998 986 619 584 1159 601 933
Honduras
No Pv 33679 15011 8759 7044 5865 4269 2881 2642
No other - - 0 0 0 0 0 0
Suspected 2003569 1559076 1192081 1035424 1025659 1017508 900578 867853
No Pf 131 22 0 0 0 0 0 0
Mexico
No Pv 7259 2945 1226 1124 833 495 656 517
No other - - 0 0 0 0 0 0
Suspected 509443 516313 554414 536105 552722 536170 620977 604418
No Pf 1369 1114 154 150 236 208 157 342
Nicaragua
No Pv 22645 5498 538 775 999 954 985 1937
No other - - 0 0 0 0 0 0
Suspected 149702 208582 141038 116588 107711 93624 80701 64511
No Pf 45 766 20 1 1 6 8 6
Panama
No Pv 991 2901 398 353 843 699 866 556
No other - - 0 0 0 0 0 0
Suspected 1483816 1438925 744650 702952 759285 864648 866047 865980
No Pf 20631 15058 2374 3018 3501 8103 10684 13682
Peru
No Pv 47690 72611 29169 21984 28030 40829 54819 52919
No other 13 - 3 3 7 11 17 8
Suspected 63377 59855 17133 16184 21685 19736 26964 15236
No Pf 10648 6931 721 331 126 407 323 145
Suriname
No Pv 1673 1611 817 382 167 322 78 231
No other 811 589 36 17 2 0 0 0

WORLD MALARIA REPORT 2016 143


Annex 4 I. Reported malaria cases by species, 20002015

WHO region 2000 2005 2010 2011 2012 2013 2014 2015
Country/area

AMERICAS
Suspected 261866 420165 400495 382303 410663 476764 522617 625174
Venezuela No Pf 5491 5725 10915 10633 13302 27659 27843 35509
(Bolivarian
Republic of) No Pv 24829 38985 32710 34651 39478 50938 62850 100880
No other 1 38 60 6 23 46 15 13
EASTERN MEDITERRANEAN
Suspected 366865 548503 847589 936252 847933 787624 743183 801938
No Pf 5115 5917 6142 5581 1231 1877 8983 4004
Afghanistan
No Pv 89240 110527 63255 71968 53609 43369 136299 82891
No other - 0 0 0 0 0 0 -
Suspected - 3969 - 354 1412 - 39276 -
No Pf - 413 1010 - 20 0 - -
Djibouti
No Pv - 0 0 - 0 0 - -
No other - 0 0 - 0 0 - -
Suspected - - - - - - - -
Iran (Islamic No Pf 2546 2219 191 208 44 94 25 9
Republic of) No Pv - 16747 1656 1502 711 426 351 157
No other - 0 0 0 0 0 - 0
Suspected - 8671271 8601835 8418570 8902947 7752797 8514341