FREETOWN, SIERRA LEONE, 13 December 2016 - The World Health Organization’s (WHO) World Malaria Report 2016 reveals that Sierra Leone has one of the world’s highest burdens of malaria cases, but has experienced significant progress in reducing malaria deaths and transmission.

The country is one of just seven countries in sub-Saharan Africa where more than a quarter of the population is infected with malaria, the report shows, with nearly three in ten Sierra Leoneans having the disease. This is an acute public health problem for the country and causes immense sickness and loss of life. Malaria contributes to an estimated twenty percent of child mortality and is the cause of nearly four in ten hospital consultations country-wide.

However the report reveals significant progress in malaria control, with the country achieving a vast decline in malaria deaths between 2010 and 2015, the highest reduction in West Africa, and there has been an almost 30 percent reduction in new cases. 

“Sierra Leone has experienced substantive progress in reducing the burden and impact of malaria but there remains much more to be done to prevent new cases and save lives,” said Anders Nordström, WHO Country Representative for Sierra Leone. “From government to communities and partners, everyone has a role to play in reducing risks of transmission and securing timely, life-saving treatment for all.”

Over the last five years, the Ministry of Health and Sanitation, together with partners, has supported a range of interventions to reduce the toll of malaria including: mass distribution of insecticide treated nets, which are among the most effective and proven means of preventing malaria; targeted nationwide anti-malaria campaigns, and increased availability of free diagnostic tests and treatments at health centers.

“We must all act now to ‘tap’ malaria, which is one of the biggest killers in Sierra Leone,” Nordström added. “This means making sure people use treated nets every night; keep their environment clean from mosquitos, and seek early treatment and care as soon as they have any symptoms of the disease, which include fever, headache, chills and loss of appetite.”

Malaria is an acute disease caused by protozoa of the genus Plasmodium, which is transmitted to humans through the bite of an infected female anopheline mosquito. Plasmodium falciparum is the predominant cause of severe malaria in Sierra Leone, accounting for more than 90 percent of all malaria infections. Without prompt treatment, Plasmodium falciparum malaria can progress to severe illness and death.

Global findings of the World Malaria Report

The World Malaria Report reveals that children and pregnant women in sub-Saharan Africa have greater access to effective malaria control. Across the region, a steep increase in diagnostic testing for children and preventive treatment for pregnant women has been reported over the last five years. Among all populations at risk of malaria, the use of insecticide-treated nets has expanded rapidly.

But in many countries in the region, substantial gaps in programme coverage remain. Funding shortfalls and fragile health systems are undermining overall progress, jeopardizing the attainment of global targets.

Scale-up in malaria control

Sub-Saharan Africa carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths. Children under five are particularly vulnerable, accounting for an estimated 70% of all malaria deaths.

Diagnostic testing enables health providers to rapidly detect malaria and prescribe life-saving treatment. New findings presented in the report show that, in 2015, approximately half (51%) of children with a fever seeking care at a public health facility in 22 African countries received a diagnostic test for malaria compared to 29% in 2010. To protect women in areas of moderate and high malaria transmission in Africa, WHO recommends “intermittent preventive treatment in pregnancy” (ITPp) with sulfadoxine-pyrimethamine. The treatment, administered at each scheduled antenatal care visit after the first trimester, can prevent maternal and infant mortality, anaemia and the other adverse effects of malaria in pregnancy.

According to available data, there was a five-fold increase in the percentage of women receiving the recommended three or more doses of this preventive treatment in 20 African countries. Coverage reached 31% in 2015, up from 6% in 2010.

Insecticide-treated nets are the cornerstone of malaria prevention efforts in Africa. The report found that more than half (53%) of the population at risk in sub-Saharan Africa slept under a treated net in 2015 compared to 30% in 2010.

Last month, WHO released the findings of a major five-year evaluation in five countries. The study showed that people who slept under long-lasting insecticidal nets (LLINs) had significantly lower rates of malaria infection than those who did not use a net, even though mosquitoes showed resistance to pyrethroids (the only insecticide class used in LLINs) in all of these areas.

An unfinished agenda

Malaria remains an acute public health problem, particularly in sub-Saharan Africa. According to the report, there were 212 million new cases of malaria and 429 000 deaths worldwide in 2015.

There are still substantial gaps in the coverage of core malaria control tools. In 2015, an estimated 43% of the population in sub-Saharan Africa was not protected by treated nets or indoor spraying with insecticides, the primary methods of malaria vector control.

In many countries, health systems are under-resourced and poorly accessible to those most at risk of malaria. In 2015, a large proportion (36%) of children with a fever were not taken to a health facility for care in 23 African countries.

“We are definitely seeing progress,” notes Dr Pedro Alonso, Director of the WHO Global Malaria Programme. “But the world is still struggling to achieve the high levels of programme coverage that are needed to beat this disease.”

Global targets

At the 2015 World Health Assembly, Member States adopted the Global Technical Strategy for Malaria 2016-2030. The Strategy set ambitious targets for 2030 with milestones every five years to track progress.

Eliminating malaria in at least 10 countries is a milestone for 2020. The report shows that prospects for reaching this target are bright: In 2015, 10 countries and territories reported fewer than 150 indigenous cases of malaria, and a further 9 countries reported between 150 and 1000 cases.

Countries that have achieved at least 3 consecutive years of zero indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination. In recent months, the WHO Director-General certified that Kyrgyzstan and Sri Lanka had eliminated malaria. But progress towards other key targets must be accelerated. 

The Strategy calls for a 40% reduction in malaria case incidence by the year 2020, compared to a 2015 baseline. According to the report, less than half (40) of the 91 countries and territories with malaria are on track to achieve this milestone. Progress has been particularly slow in countries with a high malaria burden.

An urgent need for more funding

Sustained and sufficient funding for malaria control is a serious challenge. Despite a steep increase in global investment for malaria between 2000 and 2010, funding has since flat-lined. In 2015, malaria funding totalled US$ 2.9 billion, representing only 45% of the funding milestone for 2020 (US$6.4 billion).

Governments of malaria-endemic countries provided about 31% of total malaria funding in 2015. The United States of America is the largest international malaria funder, accounting for about 35% of total funding in 2015, followed by the United Kingdom of Great Britain and Northern Ireland (16%).

If global targets are to be met, funding from both domestic and international sources must increase substantially.

Note to editors

RTS,S/AS01 malaria vaccine Last month, WHO announced that the world’s first malaria vaccine would be rolled out through pilot projects in 3 countries in sub-Saharan Africa. Vaccinations will begin 2018. The vaccine, known as RTS,S, acts against P. falciparum, the most deadly malaria parasite globally, and the most prevalent in Africa. Advanced clinical trials have shown RTS,S to provide partial protection against malaria in young children. For more information, please visit: http://www.who.int/mediacentre/news/releases/2016/funding-malaria-vaccine/en/

WHO multi-country evaluation on LLINs On 16 November 2016, WHO released the findings of a five-year evaluation conducted in 340 locations across five countries: Benin, Cameroon, India, Kenya and Sudan. The findings of this study reaffirm the WHO recommendation of universal LLIN coverage for all populations at risk of malaria. For more on the study, please visit: http://www.who.int/malaria/news/2016/llins-effective-tool-malaria-fight/en/

The report is available here

Sierra Leone contacts

Saffea Gborie, gboriesa [at] who.int, +232 76 777 878

Laura Keenan, keenanl [at] who.int, +232 78 633 952