Scaling up impact of malaria control programmes: a tale of events in Sub-Saharan Africa and People's Republic of China

Abstract

This review aims at providing synthetic information with scientific evidence on the trends in the malaria events from 1960 to 2011, with the hope that it will help policy makers to take informed decisions on public health issues and intervention designs on malaria control towards elimination in both Sub-Sahara Africa and in the People's Republic of China by highlighting the achievements, progress and challenges in research on moving malaria from epidemic status towards elimination. Our findings showed that since 1960, malaria control programmes in most countries have been disjointed and not harmonized. Interestingly, during the last decade, the causal factors of the unprecedented and substantial decline in malaria morbidity and mortality rates in most vulnerable groups in these endemic areas are multifaceted, including not only the spread of malaria and its related effects but also political and financial willingness, commitment and funding by governments and international donors. The benefits of scaling up the impact of malaria coverage interventions, improvement of health system approaches and sustained commitment of stakeholders are highlighted, although considerable efforts are still necessary in Sub-Sahara Africa. Furthermore, novel integrated control strategies aiming at moving malaria from epidemic status to control towards elimination, require solid research priorities both for sustainability of the most efficient existing tools and intervention coverage, and in gaining more insights in the understanding of the epidemiology, pathogenesis, vector dynamics, and socioeconomic aspects of the disease. In conclusion, political commitment and financial investment of stakeholders in sustaining the scaling up impact of malaria control interventions, networking between African and Chinese scientists, and their Western partners are urgently needed in upholding the recent gains, and in translating lessons learnt from the Chinese malaria control achievements and successes into practical interventions in malaria endemic countries in Africa and elsewhere.

Figure 1

a: Trend in malaria incidence rate Log₁₀ (1/10.000) in selected African countries and P.R. China from 1960–2011: (Figure i: Substantial Scaling Up Impact on malaria incidence in P.R. China and some African countries and Figure ii: Scaling up impact on malaria incidence in P.R. China and low/moderate outcomes in some African countries). b: Overall Scaling up Impact on incidence and mortality rate, and life expectancy in selected African countries and P.R. China in 2011. (CAR: Central Africa Republic).

Figure 2

Malaria distribution worldwide: 1960 and 2011. 1960: (Red square) Transmission, (Yellow-green square) No transmission, (light-blue square) Planning for elimination or eliminating. 2011: (Red square) Transmission; (Yellow-green square) No transmission; (light-blue square) Planning for elimination or eliminating. Source: Malaria Elimination Initiative (2011), UCSF Global Health Group.

Figure 3

Malaria parasite endemicity in Africa and P.R. China, 2011.