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Background
Since 2000, the world has seen unprecedented progress against the burden of malaria following massive investments to provide effective prevention and treatment interventions to populations at risk in malaria endemic countries.
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The incidence of malaria cases decreased by 30%, from 80 per 1000 inhabitants in 2000 to 57 per 1000 in 2018. During the same period, the incidence rate of malaria mortality decreased by 60%, from 25 to 10 per 100,000 inhabitants at risk. By far the majority of these achievements have been due to reductions in the burden of malaria in sub-Saharan Africa.SSA), a region that still represents more than 90% of malaria cases and deaths worldwide. These massive gains have been made despite significant gaps in prevention and access to treatment, along with periods of conflict and other humanitarian emergencies. By all indications, however, the current COVID-19The 19 pandemic is likely to be the greatest threat facing global efforts to reduce the burden of malaria, especially in SSA where health systems are fragile.
the who World Program Against Malaria (GMP) maintains a platform to track and analyze potential threats to malaria control and elimination (http://apps.who.int/ malaria / maps / threats /), including resistance to drugs and insecticides, deletions of Plasmodium falciparum histidine-rich protein (pfhrp2) and the spread of new invasive mosquito species. GMP It has also used modeling as a tool to guide potential interventions in response to these threats, including during public health emergencies.
For example, during the humanitarian crisis in Borno state, Nigeria, modeling was used to estimate the potential impact of different types of interventions. Based on this analysis, four rounds of mass drug delivery targeting age (MDA) were delivered by the local health authority and the who Polio equipment and health emergencies, reaching more than 1.2 million children under 5 years of age. It was estimated that MDA The campaign prevented about 10,000 children from dying of malaria. A similar analysis conducted after the Ebola crisis in West Africa demonstrated the utility of modeling both the threats to malaria service delivery and the impact of potential mitigation strategies for planning and decision-making, as well as for creating awareness among policy makers.
the COVID-19-19 pandemic represents a new threat to the provision of malaria services. As the virus begins to spread in malaria endemic countries, even in SSA (3), their fragile health systems are likely to be overwhelmed. In fact, the recent Ebola outbreak in West Africa demonstrated that a surge in demand for health services can lead to substantial increases in morbidity and mortality from other diseases, including malaria. In response to this threat, who GMP has recently published a guide to help countries ensure the maintenance of their malaria services in the context of COVID-19-19 pandemic.
GMP He has also been working with various modeling teams to analyze the potential impact on malaria burden of different service interruption scenarios. The results of these modeling exercises reinforce the message that country programs and ministries of health must ensure the continuity of malaria prevention and treatment services during the response to COVID-19-19. The results of these analyzes are presented in this document. It is important to note that this analysis does not consider the impact of interruptions on indoor residual spraying (IRS) and chemoprevention of seasonal malaria (SMC)
Analysis
Seasonality of malaria transmission
Using the modeling framework previously used in whoIn the global technical strategy for malaria 2016–2030 (5), the normalized incidence of malaria in cases per person per year was calculated for SSA countries, assuming 35 days between maximum precipitation and maximum incidence of malaria (Fig. 1). The resulting information can be used to understand the timing of COVID-19-19 service interruptions related to malaria transmission seasons and can help programs determine the optimal time for mitigation activities with respect to COVID-19-19 related service interruptions.
The analysis shows a clear seasonality that varies by country, but with a broad regional signal. Peak transmission of malaria begins later in the year in West Africa than in Eastern and Central African countries. For many of the Sahel countries in West Africa that implement SMC, transmission peak is likely to be reached in September. If the spread of COVID-19-19 continues throughout its current trajectory, the high season for malaria in these countries is likely to overlap with COVID-19-19 related interruptions.
Distributed by APO Group on behalf of the World Health Organization (who)
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