Nigeria accounted for about 25 per cent of the global burden of malaria in 2018, a new malaria report by the World Health Organisation has shown.

The report, however, noted a global drop in malaria cases last year.

The World malaria report 2019 released on Wednesday showed that though there was a dip in the number of malaria cases reported in 2018 as compared to the previous year, there is a need for more efforts and funds to fight the disease.

According to the report, 228 million malaria cases were reported in 2018, which is marginally lower than the number of cases in 2017 (231 million). Nigeria, 18 other countries in sub-Saharan Africa, and India accounted for about 85 per cent of the global burden of the disease in 2018.

The prevalence of malaria remains a major concern among countries, international health organisations and donor partners who have been working tirelessly to eliminate the disease.

Malaria Report

Malaria is mostly caused by plasmodium falciparum vivax parasites. This is usually transmitted through the female anopheles mosquito.

According to the WHO report, six African countries - Nigeria (25 per cent), the Democratic Republic of the Congo (12 per cent), Uganda (5 per cent), and Côte d'Ivoire, Mozambique and Niger (4 per cent each) - accounted for more than half of all malaria cases worldwide.

Pregnant women still vulnerable

Though the report showed that the number of pregnant women and children in sub-Saharan Africa sleeping under insecticide-treated bed nets and benefiting from preventive medicine for malaria has increased significantly in recent years, there is still a need for accelerated efforts to reduce infections and deaths in the hardest-hit countries.

Pregnancy reduces a woman's immunity to malaria, making her more susceptible to infection and at greater risk of illness, severe anaemia, and death.

WHO said maternal malaria also interferes with the growth of the fetus, increasing the risk of premature delivery and low birth weight - a leading cause of child mortality.

WHO Director-General, Tedros Ghebreyesus, said "pregnant women and children are the most vulnerable to malaria, and we cannot make progress without focusing on these two groups."

"We're seeing encouraging signs, but the burden of suffering and death caused by malaria is unacceptable, because it is largely preventable. The lack of improvement in the number of cases and deaths from malaria is deeply troubling."

The report estimated that in 2018, 11 million pregnant women were infected with malaria in areas of moderate and high disease transmission in sub-Saharan Africa. As a result, nearly 900,000 children were born with low birth weight.

Despite the encouraging signs seen in the use of preventive tools in pregnant women and children, there was no improvement in the global rate of malaria infections in the period 2014 to 2018.

Inadequate funding remains a major barrier to future progress. In 2018, total funding for malaria control and elimination reached an estimated $2.7 billion, falling far short of the $5 billion funding target of the global strategy.

Partners agree

Reacting to the report, the RBM Partnership to End Malaria in a statement made available to PREMIUM TIMES welcomed the publication of the World Malaria Report 2019.

The group said the report demonstrates that global investments and action against malaria are making a big difference, yet half the world - overwhelmingly the most vulnerable - are still at the greatest risk of dying from a mosquito bite.

The Chief Executive Officer, RBMPartnership to End Malaria, Abdourahmane Diallo, said "Continued global investment and commitment towards a world free of malaria have been critical to sustaining the progress the malaria community has made to date - without these global efforts, malaria cases and deaths would be significantly higher."

"Now, it is essential we step up global action and financing to close the annual $2 billion funding gap to reach those at risk with sustainable access to life-saving tools. We must also prioritise developing and scaling-up new, transformative tools to stay ahead of the evolving parasite, as highlighted in two landmark reports on malaria eradication published earlier this year. It is crucial that we act now to hold leaders accountable and work together to achieve vital reduction targets save millions more lives and end malaria for good," he said.

A separate statement by Malaria Consortium echoed that two groups most at risk from malaria are pregnant women and children under five - and that more needs to be done to prioritise support for these groups. It also called for increased commitment to put an end to the disease.

According to the WHO report, there are currently only 31 per cent of pregnant women in Africa who receive the WHO-recommended three doses of intermittent preventive treatment in pregnancy (IPTp), which protects them from malaria.

This means that more than two-thirds of pregnant women in Africa are not receiving the treatment they need to protect themselves and their unborn child.

Malaria Consortium's Technical Director, James Tibenderana, said there is an urgent need to increase access to and use of IPTp for pregnant women in malaria-endemic countries if the world wants to come close to achieving the WHO's malaria targets over the next decade.

"In every country where Malaria Consortium works (Nigeria inclusive), we strive to embed strategies to combat malaria in pregnancy into all national malaria control programmes. It is crucial that this vulnerable group is not forgotten.

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"We also urgently need to find a chemoprevention treatment that is safe for pregnant women to take in their first trimester. Currently IPTp is only approved for use in the second and third trimesters, thus leaving pregnant women vulnerable and risks for the life of the unborn baby. Artemisinin-based combination therapy should also be provided to pregnant women who have been diagnosed with malaria in their first trimester," he said

Success stories

Globally, although malaria cases declined from 2010 to 2018, the rate of change slowed dramatically between 2014 to 2018.

The WHO report also identified several global malaria success stories, with more than half of all countries now malaria-free and another 49 countries registering less than 10,000 cases.

"Timor- Leste, Iran and Malaysia recorded zero cases of malaria for the first time in 2018, an achievement China and El Salvador also attained for the second consecutive year".

WHO said over the past two years, four countries have been certified as malaria free, and more countries than ever are now within reach of elimination.

This progress puts the world on track for at least 10 countries to reach the 2020 elimination milestone of the global malaria strategy.