Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015, and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542–753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies.
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The authors acknowledge assistance from M. Renshaw in providing information from the Roll Back Malaria Harmonization Working Group Programmatic Gap Analysis and other guidance in the interpretation of our results. We thank members of the Roll Back Malaria Monitoring and Evaluation Reference Group and the World Health Organization Surveillance Monitoring and Evaluation Technical expert Group for their feedback and suggestions. We thank C. Burgert of the DHS (Demographic and Health Surveys) Program for her assistance with DHS Survey access and interpretation. P.W.G. is a Career Development Fellow (no. K00669X) jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and receives support from the Bill and Melinda Gates Foundation (BMGF; nos OPP1068048, OPP1106023). These grants also support E.C., S.B., B.M., U.D., D.J.W., D.B. and A.H. The Swiss TPH component was supported through the project no. OPP1032350 funded by the BMGF. D.L.S. is funded by the BMGF (OPP1110495). S.I.H. is funded by a Senior Research Fellowship from the Wellcome Trust (no. 095066), which also supports K.E.B., and grants from the BMGF (nos. OPP1119467, OPP1106023 and OPP1093011). S.I.H. and D.L.S. also acknowledge funding support from the RAPIDD program of the Science & Technology Directorate, Department of Homeland Security, and the Fogarty International Center, National Institutes of Health. J.T.G. is funded by an MRC Fellowship (no. G1002284). E.A.W. and P.A.E. are funded by the Global Good Fund.
Extended data figures
This file contains Supplementary Text and Data, Supplementary Figures 1-5, Supplementary Tables 1-4 and Supplementary References.
About this article
Malaria Journal (2019)