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Mosquito-borne diseases remain a major cause of morbidity and mortality across the tropical regions. Despite much progress in the control of malaria, malaria-associated morbidity remains high, whereas arboviruses—most notably dengue—are responsible for a rising burden of disease, even in middle-income countries that have almost completely eliminated malaria. Here I discuss how new interventions offer the promise of considerable future reductions in disease burden. However, I emphasize that intervention programmes need to be underpinned by rigorous trials and quantitative epidemiological analyses. Such analyses suggest that the long-term goal of elimination is more feasible for dengue than for malaria, even if malaria elimination would offer greater overall health benefit to the public.

Background Since 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund. Methods Global Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models. Results By end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic falciparum malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented. Conclusions These results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems.

In this randomized, placebo-controlled trial, azithromycin was assessed as an adjuvant agent for malaria prevention in children in Burkina Faso and Mali. No survival or antimalarial benefit associated with azithromycin was observed.

Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000–15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival. We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1–59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation. In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935–1·179]), pneumonia (0·921 million [0·812 −1·117]), and intrapartum-related events (0·691 million [0·598 −0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000–15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR. In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target. Bill & Melinda Gates Foundation, WHO.

Substantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control. Using an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents. We estimated 215·2 (95% uncertainty interval 143·7–311·6) million cases and 386·4 (307·8–497·8) thousand deaths across malaria-endemic African countries in 2020 in our baseline scenario of undisrupted intervention coverage. With greater reductions in access to effective antimalarial drug treatment, our model predicted increasing numbers of cases and deaths: 224·1 (148·7–326·8) million cases and 487·9 (385·3–634·6) thousand deaths with a 25% reduction in antimalarial drug coverage; 233·1 (153·7–342·5) million cases and 597·4 (468·0–784·4) thousand deaths with a 50% reduction; and 242·3 (158·7–358·8) million cases and 715·2 (556·4–947·9) thousand deaths with a 75% reduction. Halting planned 2020 ITN mass distribution campaigns and reducing routine ITN distributions by 25%–75% also increased malaria burden to a total of 230·5 (151·6–343·3) million cases and 411·7 (322·8–545·5) thousand deaths with a 25% reduction; 232·8 (152·3–345·9) million cases and 415·5 (324·3–549·4) thousand deaths with a 50% reduction; and 234·0 (152·9–348·4) million cases and 417·6 (325·5–553·1) thousand deaths with a 75% reduction. When ITN coverage and antimalarial drug coverage were synchronously reduced, malaria burden increased to 240·5 (156·5–358·2) million cases and 520·9 (404·1–691·9) thousand deaths with a 25% reduction; 251·0 (162·2–377·0) million cases and 640·2 (492·0–856·7) thousand deaths with a 50% reduction; and 261·6 (167·7–396·8) million cases and 768·6 (586·1–1038·7) thousand deaths with a 75% reduction. Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19. Bill and Melinda Gates Foundation; Channel 7 Telethon Trust, Western Australia.

Background Ghana is a malaria-endemic country with the entire population at risk. The Northern region of the country recorded the highest malaria case fatality rate (CFR) for two consecutive years: 1.11% in 2013 and 1.07% in 2014. Even though the National Malaria Elimination Programme (NMEP) has achieved a reduction in malaria mortality, the existence of high case fatality in the Northern region was alarming. This study, therefore, aimed to determine the factors associated with malaria mortality in the northern region of Ghana to institute control measures. Methods An unmatched case control study was conducted from July 2015 to August 2015. The study population consisted of patients admitted to health facilities for severe malaria in the Northern region of Ghana. A case was defined as a patient diagnosed with severe malaria at an eligible health facility who died as a result of malaria. A control was a patient diagnosed with severe malaria admitted to an eligible health facility who did not die. Health facilities that recorded CFRs of 1.0% and above were randomly sampled for this study, after which, 10 cases and 20 controls were recruited from each health facility. Information on cases and controls was then abstracted from hospital records using an electronically deployed abstraction tool. Continuous variables were expressed as means and medians, and categorical variables as frequencies and proportions. Multivariable logistic regression was used to assess the strength of the association between malaria mortality and factors predictive of malaria mortality. A p-value of < 0.05 was considered statistically significant. Results In all, a total of 95 cases and 190 controls participated in this study. The median ages of cases and controls were 4.1 years (IQR = 21.6) and 5.7 years (IQR = 18.2), respectively. Fifty-four (56.8%) cases were females, while 93 (49.0%) of the controls were females. Factors associated with malaria mortality included: duration of hospital stay less than 24 h [aOR: 12.0, 95% CI (5.9–24.6)], severe pallor [aOR: 2.3, 95% CI (1.1–4.6)], children under 5 years [aOR: 2.8, 95% CI (1.4–5.6)], oral Artesunate/Amodiaquine administration [aOR: 0.4, 95% CI (0.2–0.9)] and sepsis as an additional diagnosis [aOR: 4.1, 95% CI (1.8–9.5)]. Conclusion Predictors of malaria mortality in the Northern region include children under 5 years, severe pallor, sepsis as an additional diagnosis, and use of oral anti-malarial. Patients with severe pallor and sepsis as co-morbidities should receive proactive management. The NMEP and its partners should implement measures to strengthen the referral system, anaemia prevention and management, and retrain health workers on malaria case management. Malaria control interventions targeted at under five children in the region should be reviewed and enhanced.

Background The global malaria burden is characterized by economic, geographical, and climatic disparities, especially in sub-Saharan Africa (SSA). Moreover, meteorological factors have become increasingly important to understand the malaria burden in SSA in the context of climate change. Methods Value of Statistical Life Year (VSL) and machine learning are proposed to jointly assess the weather-induced economic burden of malaria in SSA from 2000 to 2022. Geographic information systems (GIS) are employed to examine the spatial autocorrelation of malaria burden and address the issues of spatiotemporal heterogeneity. Finally, the uncertainty in the relationship between weather patterns and malaria burden was tested for robustness using Bayesian statistics. Results Malaria mortality in SSA has decreased by 30 per 100,000 incidences annually from 2000 to 2022. The macroeconomic burden of malaria accounts for 1.58% of the total GDP in SSA, equating to USD 497.06 billion (95% CI, [418.38, 553.56]), with weather conditions contributing 60% of the economic burden. The climate-related macroeconomic burden of malaria mortality varies dramatically across regions, with East Africa bearing the highest cost at USD 195.90 billion, followed by Central Africa (57.36 billion), West Africa (30.43 billion), and Southern Africa (1.81 billion). Besides, there is notable autocorrelation and spatial heterogeneity in malaria patterns. East Africa has a high malaria burden and is climate vulnerable. For every 1 °C increase in temperature in SSA, the number of malaria incidences will rise by 16.30 [95% Credible Interval (CrI), (13.88, 18.61)] per 1,000 incidences, while malaria-related deaths per 100,000 incidences will increase by 5.79 [95% CrI, (4.90, 6.74)]. Conclusions Rising temperatures have increased the burden of malaria, especially in East and Central Africa. Climate change also indirectly increases the economic burden associated with malaria, which could put enormous pressure on government health budgets. Therefore, local governments in East Africa should adopt measures to cope with climate warming and allocate resources rationally to achieve the goal of malaria elimination by 2030.

Malaria is a major disease in Africa and is among the leading causes of mortality among children. The disease is highly sensitive to climate change. Prior studies have established a link between climatic factors and malaria mortality, but the evidence specifically related to children in sub-Saharan Africa remains inconsistent and requires further investigation. This study examined the impact of climate variables on malaria mortality in the Iganga and Mayuge districts, a malaria-prone area in Uganda. We used weekly malaria mortality data from a population-based cohort in the Iganga Mayuge Health Demographic Surveillance Site (IMHDSS). In this study, we employed a time series model using a distributed lag non-linear approach to assess the association of weekly climatic factors on malaria mortality across all ages, including children under 5 years and children aged between 5 and 14 years. We also conducted a subgroup analysis based on sex to determine whether susceptibility to climate-related malaria mortality differs between females and males. We found an increased mortality risk across all ages at a lag of 11 to 12 weeks following exposure to rainfall above 646 mm. Higher risks of malaria mortality were also observed at a lag of 5 to 11 weeks when temperatures ranged between 25.2 °C and 29.9 °C. Notably, the relative risk of malaria mortality in children under 5 years and children aged between 5 and 14 years was more sensitive to temperature than to rainfall. We found that male children aged between 5 and 14 years were more vulnerable to temperature-related malaria mortality compared to females in that age group and children under 5 years. Rainfall did not have a significant association with malaria mortality in children. A nuanced understanding of climate-malaria relationships has the potential to inform the implementation of malaria prevention and control strategies through early warnings of climate-driven risks, ultimately reducing premature deaths due to malaria in this vulnerable age group.

Background Malaria remains a leading cause of morbidity and mortality among children under five in Nigeria, with pronounced subnational disparities. This study analyzed the temporal and spatial inequalities in malaria incidence and mortality among children aged 0–4 years across Nigeria’s 36 states and the Federal Capital Territory from 2010 to 2019. Methods Estimates from the Institute for Health Metrics and Evaluation (IHME) were analyzed using the WHO Health Equity Assessment Toolkit (HEAT). Subnational inequalities were quantified using five metrics: coefficient of variation (COV), difference (D), ratio (R), population-attributable risk (PAR), and population-attributable fraction (PAF). Results From 2010 to 2019, national malaria incidence declined from 103 to 74.5 cases (27.7% reduction), while mortality fell from 477.3 to 237.6 deaths per 100,000 (50.2% reduction). However, progress was uneven. Northern states such as Zamfara, Kano, and Katsina had the highest baseline burden in 2010 (incidence > 150 per 1000; mortality > 700 per 100,000) and, despite declines, remained among the most affected in 2019. Southern states including Lagos, Delta, and Anambra consistently recorded lower burdens (incidence < 60 per 1000; mortality < 300 per 100,000). Subnational inequality narrowed over time, with incidence COV peaking at 46.3% in 2013 before falling to 28.1% in 2019, and mortality COV declining from a 2013 peak of 42.9% to 22.3% in 2019. Conclusion Nigeria’s malaria incidence and mortality among under-five children have decreased, but subnational disparities persist, particularly in northern states, although a reduction in D and R values indicates modest progress in equity, necessitating geographically targeted interventions.

Malaria is the largest contributor to morbidity and mortality in Uganda. Severe malaria accounts for 15–20% of hospital admissions and an average of 6% of malaria cases were hospitalized in 2023. Delayed treatment of uncomplicated malaria cases is a major contributor to disease progression to severe form that may result in complications or death. The ‘24,2 Hours Initiative” highlights the need for timely access to and use of quality-assured case management services to maximize impact within the critical “golden” timeframe. It aimed at ensuring that uncomplicated malaria cases receive treatment within 24 h and that severe cases get urgently necessary pre-referral treatment followed by immediate referral, or injectable treatment and supportive care within 2 h of arrival at a health facility. Besides, it highlights importance of starting post discharge malaria services within 24 h after severe malaria cases are discharged from hospital. The initiative emphasizes a patient-centered approach for malaria case management and continuity of care for severe malaria cases across pre-referral care, after-referral treatment, and post-discharge follow-up. Moreover, providing free, community-based malaria case management (CMCM) for all age groups is a key strategic shift proposed by the initiative. This measure aims to improve affordability and accessibility for low-income households while enhancing equity in access to primary health care. The initiative is designed in line with a results-based management approach, supported by a robust monitoring and evaluation system to ensure quality assurance of case management, effective service coverage, and the translation of interventions into practice.This paper introduces the “24.2 Hours Initiative”, which was launched in Uganda, it outlines its components and discusses evidence from the literature on malaria case management gaps in Uganda as well as relevant solutions. The principles guiding this initiative may be applicable to other high endemic regions, including sub-Saharan Africa, if adapted to the local context and aligned with national malaria treatment policies.