Focusing care on pregnant women and children will help accelerate progress toward malaria elimination
A statement from PATH's Director of Malaria and Neglected Tropical Diseases, Center for Malaria Control and Elimination, Kammerle Schneider:
This week, the World Health Organization (WHO) released the 2019 World Malaria Report on the state of malaria control and elimination across the globe. For the first time, this annual report features data on the impact of malaria on pregnant women and children. This addition makes clear what we have long known – malaria burden reduction and elimination efforts need to prioritize pregnant women and children.
The report also underscores PATH’s approach to malaria elimination. To reduce the burden, we must deploy the best currently available tools—including ITNs, indoor residual spraying, diagnostics, and treatment—and use high-quality program and surveillance data to inform program action. These strategies are not possible without a strong investment in research and development of new tools: drugs, diagnostics, surveillance methods, vaccines, and vector control that build on the progress already achieved.
The report cited only marginal progress toward targets set in the WHO Global Technical Strategy, and the burden of malaria has been relatively stable in recent years. According to the report, malaria killed an estimated 405,000 people in 2018, a figure basically unchanged from the previous year. The rate of reduction of malaria mortality from 2016 to 2018 has slowed compared to 2010 to 2015. The report also finds that there were an estimated 228 million cases of malaria globally, again similar to estimates for recent years.
But, malaria disproportionately affects pregnant women and children. Malaria in pregnancy poses substantial risk for the mother, her fetus, and newborn child. In 2018, an estimated 11 million pregnant women in sub-Saharan Africa were infected with malaria. An estimated 872,000 children in Africa were born with a low birth weight due to malaria in pregnancy; notably, low birthweight babies are at increased risk of neonatal and infant mortality. Children under five also accounted for two-thirds of all malaria deaths in 2018. These data emphasize the critical importance of prioritizing malaria prevention and control efforts for women and children.
For pregnant women living in endemic areas, WHO recommends taking preventive antimalarial medicines and sleeping under insecticide-treated bed nets (ITNs). The report shows encouraging progress on both fronts. Nonetheless, nearly 40 percent of pregnant woman did not use an ITN in 2018, and two-thirds did not receive the recommended three or more doses of preventive therapy during their pregnancies.
These gaps in prevention must be filled. All people at risk of malaria—particularly pregnant women and children—must have access to the health care they need to prevent, diagnose, and treat this deadly disease. The solution is universal health coverage. Zambia, Ghana, and Sierra Leone provide important examples of countries that have achieved significant levels of coverage of ITNs and preventive therapy for pregnant and newly delivered women.
Last year, the World Health Organization launched the High Burden to High Impact response with the RBM Partnership to End Malaria and partners to focus efforts in countries with the highest malaria burden. To date, 9 of the 11 targeted countries have developed detailed action plans to address their challenges. For national malaria control and elimination programs, strengthened use of data and analytics will play a critical role in developing strategic information to tailor interventions and drive impact.
The increasing number of countries outside Africa that have already or will soon eliminate malaria provide clear evidence of progress toward Global Technical Strategy for Malaria 2020 elimination milestones. At the same time, setbacks in countries with a high disease burden serve as a reminder that the global community needs to fund and scale existing control efforts, as well as invest in research and development of new interventions.