Malaria Situation in South East Asia Region · 1 | Malaria Unit, Department of Communicable...

Malaria Unit, Department of Communicable Diseases 1 |

Regional Office For South-East Asia

Malaria Situation in South East Asia Region

Leonard I. Ortega, MD, MSc(Epid), DTM&H, BSMT

Regional Adviser, Malaria

SEARO



Milestones and trend of malaria in South East Asia,1948-2011

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

9000000

10000000

11000000

12000000

1948 1970 1975 1980 1985 1990 1995 2000 2005 2010

110- 115* Million Cases

(Estimated)

7.2 million Cases

Eradication Era Control PhaseRevised Malaria

Control Strategy

ControlPre-Control

Reported cases

* Source: A decade of Health Development in South-East Asia, 1968-77, WHO / SEARO



API, Mortality and Case Fatality Rate,

South East Asia Region, 1994-2011

Source: Country Reports, 2010; * Incomplete information for mortality from Indonesia; ** Provisional Information

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

1994

1996

1998

2000

2002

2004

2006

2008

2010

Year

AP

I

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

MM

R /

CF

R

API/1000MMR/100000CFR%

API = Annual parasite incidence/

Malaria Morbidity

MMR= Malaria mortality rate

CFR= Case fatality rate



Global Distribution of Malaria Burden by Region, 2010

MALARIA CASES

Africa

74.5%

Europe

0.003%

Western Pacific

1.4%

South-East Asia

15.2%

Eastern

Mediterranean

5.7%Americas

3.2%

MALARIA DEATHS

Africa

95.1%

Western Pacific

0.9%

Eastern

Mediterranean

1.3%

Europe

0.002%

Americas

0.1%

South-East Asia

2.7%

Source : WMR 2011



Overview of Malaria Situation in SEA Region

Endemic in 10 of 11 member countries; 1.33 billion people at risk (2011)

Numerous vectors; complex epidemiology

Mainly rural disease; also occurs in urban areas in India

28 million cases and 38,000 deaths in 2010 (WHO estimate)

Pf (61%) and Pv are most common (2011)

95% reported cases and deaths are from India, Indonesia and Myanmar (2011)



Enabling Factors

Political support and increased funding

Scaled up key interventions based as per National Strategic

Plan; improved surveillance, monitoring and evaluation

Active involvement of NGOs and community participation

Technical and management support by WHO

Dedicated staff - general health services and National Malaria

Control Programmes



Cumulative Availability of Effective LLINs/ITNs

SEA Region, 2003-2011

0.91

3.354.22

5.31

11.14

14.26

17.29 17.05

28.49

0

5

10

15

20

25

30

2003 2004 2005 2006 2007 2008 2009 2010 2011

Millio

ns

Year

# o

f E

ffe

cti

ve

Be

dn

ets

Source: Country Reports, 2011



RDTs Distributed in SEA Region, 2005 - 2011

0

2

4

6

8

10

12

14

16

2005 2006 2007 2008 2009 2010 2011

Millio

ns

Year

# o

f R

DT



Distribution of ACTs and Reported Malaria Deaths

SEA Region, 2004-2011

5260

959 1,0701,267

2,992

3914

1,768

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

2004 2005 2006 2007 2008 2009 2010 2011

Th

ou

san

ds

Year

# A

CT

dis

trib

ute

d

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

No.of ACT Courses Distributed Malaria Deaths

Source ; Country Reports, 2011



Many challenges…. but none is insurmountable

Political and global cooperation Commitment:

Sustained financing Financial:

Scaling up access to interventions, reaching the unreached people,

improving programme implementation Programmatic:

Surveillance, M&E, responsiveness Health system:

Drug resistance, insecticide resistance, P.vivax Biological:

Disease epidemiology, new tools and delivery mechanisms Research:

Diagnostics and drugs quality, rational use, monotherapy ban Regulatory:

Multi-sectoral, private sector, Healthy Public Policies Collaboration:

Water management, climate change impact Environment:

Awareness and active participation Community:



Key challenge: reaching the unreached populations

WHO:

– Migrants, ethnic, forest workers, etc

WHERE:

– Difficult areas, forests

WHY:

– Critical for malaria elimination

HOW:

– Strengthen commitment, programme

and health system

– Involve communities



Phuoc Long

Eastern Shan

Key challenge: artemisinin resistance

from 2010 report

Latest data



Key challenge: sustaining the gains and preventing resurgence

Malaria in Sri Lanka : 1931 - 2011

0

1000000

2000000

3000000

4000000

5000000

6000000

1931

1934

1937

1940

1943

1946

1949

1952

1955

1958

1961

1964

1967

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003

2006

2009

Year

No.

of p

ositi

ve c

ases



Moving Forward: Strategic Objectives

1. To scale up key interventions in countries and areas with high burden of malaria

2. To re-orient national malaria control programmes towards pre-elimination / elimination in countries with very low burden of malaria

3. To prevent emergence of artemisinin-resistance and contain it in areas where it has already emerged

4. To strengthen managerial and technical capacities for malaria control and elimination

5. To strengthen partnership, multi-sector participation and international collaboration in malaria control and elimination

6. To improve strategic information for policy and strategy development, operational planning and decision making



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