Alarm from WHO: Malaria recrudescence

 

In 2017, the 11 most affected countries accounting for approximately 70% of malaria cases (151 million) and deaths (274.000) were located10 in Africa and one in India. In 2017 there were about 3.5 million more malaria cases in these 10 African countries compared to the previous year, while in India the incidence of the disease was reduced. According to the world report on malaria 2018, just published by the WHO, the reduction in malaria cases has come to a halt after several years of global decline. In fact, the report highlights that, after an unprecedented period of success in global disease control, progress has stopped. Data and information from 2015-2017 indicate that no significant progress has been made in reducing cases of global malaria during this period.
In 2017 there were a total of 219 million cases and 435,000 related deaths with an increase of 2 million cases compared to the previous year. In the previous years, the number of people who contracted malaria in the world was constantly decreasing: from 239 million in 2010 to 214 million in 2015.


The global report is based on data from 91 countries and areas endemic for malaria. The information is supplemented by data from national household surveys and databases of other organizations.

A new approach to cope with this disease will be led by the 11 countries with the highest incidence of disease (Burkina Faso, Cameroon, Democratic Republic of Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda and the United Republic of Tanzania).

The key elements of this strategy include:

- political willingness in reducing the incidence of malaria,- strategic information,- better guidelines, policies and strategies, and- a well coordinated national response  to the disease.


Malaria is also increasing in South America; cases of malaria in Venezuela have increased significantly over the past three years: 136,000 in 2015, 240,000 in 2016 and 411,000 in 2017.

The increase is largely related to the unreliability of antimalarial drugs, the weakness    of vector control programs and the movement of infected people in the mining areas of the state of Bolivar and other areas of the country with weak ecosystems.
 
The increase in malaria cases in Nicaragua (2200 in 2015, 6200 in 2016 and 10900 in 2017) is mainly due to the increase of malaria transmission in a specific area of ​​the Atlantic region of the country. In this area the migrations of infected people, associated with environmental and socio-economic factors, created the optimal conditions for the proliferation of the mosquitoes responsible for the transmission of the disease. The main vector for malaria transmission in Nicaragua is the Anopheles albimanus mosquito, which is widely distributed throughout the country, with the Anopheles pseudopunctipennis mosquito also responsible to a lesser degree.

 

It is interesting to highlight how Brazil, has recorded a significant increase in malaria cases in the last two years, from 124000 in 2016 to 189000 in 2017. This increase was concentrated in some endemic states of the Amazon region, including those territories that had previously achieved significant reductions in transmission of the disease. An important challenge was to reach populations living in remote and vulnerable areas, to provide them with tools for the prevention and control of malaria, such as diagnostic tests and medical treatment. 

In 2018 WHO certified Paraguay free from malaria. Paraguay is the first country in the Americas to receive this status in 45 years. Three other countries - Algeria, Argentina and Uzbekistan - have applied for the same official certification from the WHO.

 

One of the main problems for malaria control is the one linked to Plasmodium resistance to drugs. The WHO considers this problem very seriously and implements constant monitoring in all endemic countries on the effectiveness of antimalarial drugs based on Artemisia annua.

Resistance to insecticides is a more widespread and complex problem. In 68 countries of the 80 endemic to malaria that provided data for the period 2010-2017, an increase in resistance to at least one of the four classes of insecticides was detected in a malaria vector compared to 2016. This increase is partly due to the improvement in the reporting and partly due to the presence of three new countries that for the first time have communicated data and information. Moreover, resistance to two or more classes of insecticides was reported in 57 countries.

 

 

Further information:

http://www.quotidianosanita.it/allegati/create_pdf.php?all=1367368.pdf

 
 
 

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