Findings from new malaria database are 'wake-up call'

Researchers have compiled and analysed 115 years of malaria data in Africa, providing the most detailed picture yet of where efforts to control malaria infection are being won and lost across the continent. 

A child looks at rainwater on a flooded street in Mozambique.
A Mozambique street flooded with rainwater. This is a typical breeding ground for malaria-carrying mosquitoes.
Credit: Fernando Moleres/Panos

The largest data repository of any parasitic disease in the world, it includes 7.8 million blood samples from more than 30,000 locations in 43 countries.

The open access dataset was collected and analysed by KEMRI-Wellcome Trust researchers Professor Bob Snow, Abdisalan Noor and colleagues based in Kenya, and is the result of over 20 years of research funded by Wellcome.

Declines in malaria have not been uniform

The study shows that sub-Saharan Africa has experienced a decline in malaria rates from 40% prevalence in children aged 2-10 years old between 1900 and 1929 to 24% in the same age group between 2010 and 2015.

This trend has been interrupted by periods of rapidly increasing and decreasing transmission, thought to be the result of several contributing factors.

Reductions in malarial infection have not been uniform across the continent. Large parts of West and Central Africa still experience high transmission rates.

    New tools needed to tackle malaria in high burden regions

    The researchers argue that new tools are needed for African areas with low income and a high malaria burden, where gains in malaria reduction have stalled.

    They identify several challenges to malaria control, including:

    • emerging insecticide and drug resistance
    • inadequate funding plans for replacing long-lasting insecticide-treated nets.

    Professor Bob Snow, Principal Investigator at the KEMRI Wellcome Trust Research Programme and the University of Oxford, said: "Focusing just on elimination at the margins of Southern Africa, runs the risk that high burden countries in Africa get ignored and left behind. If insecticide and drug resistance becomes established, or excessive rainfall hits Africa again, malaria will revert in large parts of Africa to the high levels we saw in the 1990s.

    "This is a real wake-up call, we need new drugs and insecticides or the gains we’ve seen will be lost."
    Professor Bob Snow

    Mary De Silva, Wellcome’s Head of Population Health, says: "This incredibly comprehensive study, the result of 21 years of research and hundreds of people's contributions, is importantly now openly available for others to use. Working together, scientists can use this data to help us make sense of the changing nature of malaria in Africa and inform future responses."

    A history of malaria in Africa since 1900

    • One of the biggest historical drops in malaria followed the Second World War with the discovery of DDT and chloroquine.
    • Malaria prevalence was low during the late 1960s, through the 1970s and early 1980s. This was a period when, despite low investment in malaria control in Africa, chloroquine use was widespread with repeated dosing available to the general population. Together with drought across the Sahel, this produced a lull in malaria transmission. 
    • Chloroquine resistance expanded across Africa in the 1980s, and in the late 1990s unprecedented rainfall led to flooding and major malaria epidemics. Ministries of Health across the continent woke up to the perfect storm without any significant mosquito vector control in place. Malaria prevalence returned to the levels seen before the Second World War. 
    • The financial response by the Global Fund and the technical revisions to policy by the World Health Organization after 2005 led to one of the largest drops in malaria infection prevalence witnessed since 1900. This saw the rolling out of insecticide treated bed nets and new drugs to treat malaria.
    • Between 2010 and 2015 the decline in malaria prevalence has stalled. 

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