Malarial transmission substantially reduced in endemic Africa

Image: PD 

1. African populations residing in hyperendemic and holoendemic areas were reduced from 218.6 million in 2000 to 183.5 million 2010. 

2. Despite progress, about 57% of the population still lived in areas with moderate to high risks of infection. 

Evidence Rating Level: 2 (Good) 

Study Rundown: The need for malaria control in sub-Saharan African has become increasingly appreciated over the past two decades, with US monetary support rising to nearly $2 billion in 2013. Unfortunately, current methodologies to estimate malaria prevalence are limited in their ability to assess the benefits of any interventions. In the current study, Noor et al coupled infection prevalence data over 8 years with an adapted mathematical approach to estimate the proportion of 2-10 year olds infected with Plasmodium falciparum (PfPR_2-10) in 2000 and 2010. The number of people living in hyperendemic (>50% PfPR_2-10) or holoendemic areas (>75% PfPR_2-10) have decreased from 218.6 million in 2000 to 183.5 million in 2010. Nevertheless, 10 countries contributed 87.1% of the population living in areas of hyperendemic or holoendemic transmission. Additionally, a majority (57%) of the population continues to live in areas where transmission was greater than 10% PfPR_2-10. These remaining challenges highlight the need for further efforts.

The study was funded by Wellcome Trust. 

Click to read the study, published today in The Lancet

Relevant Reading: Global malaria mortality between 1980 and 2010: a systematic analysis

In-Depth [retrospective cohort]: In this pioneering study to understand how Plasmodium falciparum malaria burden in Africa has shifted over the decade 2000-10, Noor and colleagues have combined a wealth of malaria prevalence surveys with adapted mathematical algorithms to estimate the proportion of 2-10 year olds infected with Plasmodium falciparum (PfPR_2-10) at 1×1 km spatial resolutions. These PfPR_2-10 calculations were collectively utilized to stratify regions according to the degree of malaria endemicity. Regions were designated as hyperendemic (>50% to 75% PfPR_2-10), holoendemic (> 75% PfPR_2-10), mesoendemic (>10% to 50% PfPR_2-10) or hypoendemic (1-10% PfPR_2-10). “Endemicity maps” were then generated for 2000 and 2010 to determine how malaria burden had changed.

The number of people living in hyperendemic and holoendemic areas have decreased from 218.6 million (34.4%) in 2000 to 183.5 million (22.5%) in 2010, despite the population increase from 635.7 million to 815.7 million. The population living in mesoendemic areas increased from 178.6 million in 2000 to 280.1 million in 2010. This was attributed to a population influx from hyperendemic and holoendemic areas. Only ten countries contributed 87.1% of the population living in areas of hyperendemic or holoendemic transmission in 2010.  Overall, 57% of the population still lived in areas where transmission was greater than 10% PfPR_2-10 by 2010_.

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