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8.6).
However, the Islamic Republic of Iran has reported no indigenous malaria cases in 2018 and 2019, and Saudi Arabia has reduced case incidence by more than 40%.
Although not on track for the GTS 2020 case incidence milestones, Pakistan and Somalia have reduced case incidence, but by less than 40% in 2020 compared with 2015.
Djibouti and Sudan were both off track, with malaria case incidence higher by more than 40% in 2020 compared with 2015. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Afghanistan and Yemen’s case incidence was higher in 2020 than in 2015, but by less than 25% in Afghanistan and by 25% to less than 40% in Yemen (Fig.
8.3).
Malaria mortality rate had decreased by less than 25% in Afghanistan and Somalia, and by between 25% and 40% in Pakistan in 2020 compared with 2015.The WHO South-East Asia Region is on track for both the mortality and morbidity milestones (Fig.
8.2, Fig.
8.3, Fig.
8.7).
Sri Lanka was certified malaria free in 2015 and remains malaria free. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Timor-Leste reported zero malaria cases and deaths in 2019.
All other countries reduced malaria case incidence by 40% or more, and mortality rate by more than 40%, except Indonesia where the rate reduced by between 25% and less than 40% in 2020 compared with 2015 (Fig.
8.2, Fig.
8.3).
FIG.
8.6.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
8.2, Fig.
8.3).
FIG.
8.6.FIG.
8.7.Comparison of progress in malaria: a) case incidence and b) mortality rate in the WHO Eastern Mediterranean Region considering two scenarios: current trajectory maintained (blue) and GTS targets achieved (green) Source: WHO estimates.Comparison of progress in malaria: a) case incidence and b) mortality rate in the WHO South-East Asia Region considering two scenarios: current trajectory maintained (blue) and GTS targets achieved (green) Source: WHO estimates. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
)ksirltanoitaupop0001rep(ecnedcniiesacairaaMl14121086420■ Current estimates of regional case incidence (WMR 2020)■ ■ GTS milestones (baseline of 2015) ■ ■ Forecasted trend if current trajectory is maintained 910106510291201020112012201320142015201620172018201920202021202220232024202520262027202820292030a))ksirltanoitaupop0001rep(ecnedcniiesacairaaMl181614121086420b)4.0ksirltanoitaupop000001repshtaedairaamlforebmuN3.53.02.52.01.51.00.50■ Current estimates of regional mortality rate (WMR 2020)■ ■ GTS milestones (baseline of 2015) ■ ■ Forecasted trend if current trajectory is maintained 1.72.02.11.21.02.20.42.40.2201020112012201320142015201620172018201920202021202220232024202520262027202820292030b)3.0ksirltanoitaupop000001repshtaedairaamlforebmuN2.52.01.51.00.50■ Current estimates of regional case incidence (WMR 2020)■ ■ GTS milestones (baseline of 2015) ■ ■ Forecasted trend if current trajectory is maintained 964532120102011201220132014201520162017201820192020202120222023202420252026202720282029■ Current estimates of regional mortality rate (WMR 2020)■ ■ GTS milestones (baseline of 2015) ■ ■ Forecasted trend if current trajectory is maintained 1.51.10.60.90.40.40.1201020112012201320142015201620172018201920202021202220232024202520262027202820291020300.2020307978GTS: Global technical strategy for malaria 2016–2030; WHO: World Health Organization; WMR: world malaria report.GTS: Global technical strategy for malaria 2016–2030; WHO: World Health Organization; WMR: world malaria report.WORLD MALARIA REPORT 2020 8Global progress towards the GTS milestones8.6 WHO WESTERN PACIFIC REGIONOverall, the WHO Western Pacific Region was off track for both the malaria morbidity and mortality 2020 GTS milestones by 50%, and at the current trajectory the burden could increase through to 2030 (Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
8.8).
However, most of this increase in burden is attributable to Papua New Guinea, which accounts for about 80% of the burden of malaria in the region.
Malaria case incidence was higher by 25% or less in Vanuatu, by between 25% and 40% in Papua New Guinea and the Philippines, and by 40% or more in the Solomon Islands (Fig.
8.2).
However, China and Malaysia both reported zero malaria cases in 2019 and were expected to maintain this into 2020. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Case incidence reduced by 40% or more from the 2015 baseline in Cambodia and Lao People’s Democratic Republic, and by between 5% and 25% in the Republic of Korea and Viet Nam.
When Papua New Guinea is excluded from analysis, the projections suggest that the region is almost on track for the 2020 GTS incidence milestones (Fig.
8.8).FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
8.8.Comparison of progress in malaria: a) case incidence and b) mortality rate in the WHO Western Pacific Region considering two scenarios: current trajectory maintained (blue) and GTS targets achieved (green) Source: WHO estimates.a)4)ksirltanoitaupop0001rep(ecnedcniiesacairaaMl3210■ Current estimates of regional case incidence (WMR 2020)■ ■ GTS milestones (baseline of 2015) ■ ■ Forecasted trend if current trajectory is maintained■ ■ GTS milestones (baseline of 2015) – without Papua New Guinea ■ ■ Forecasted trend if current trajectory is maintained – without Papua New Guinea222120120b)1.0ksirltanoitaupop000001repshtaedairaamlforebmuN0.80.60.40.20■ Current estimates of regional mortality rate (WMR 2020)■ ■ GTS milestones (baseline of 2015) ■ ■ Forecasted trend if current trajectory is maintained0.40.40.40.30.20.30.10.30201020112012201320142015201620172018201920202021202220232024202520262027202820292030201020112012201320142015201620172018201920202021202220232024202520262027202820292030GTS: Global technical strategy for malaria 2016–2030; WHO: World Health Organization; WMR: world malaria report.GTS: Global technical strategy for malaria 2016–2030; WHO: World Health Organization; WMR: world malaria report.8081WORLD MALARIA REPORT 2020 9 Biological threatsPlasmodium lactate dehydrogenase [pLDH]) are limited; in particular, there are currently no WHO-prequalified non-HRP2 combination tests that can detect and distinguish between P. falciparum and P. vivax.9.1 DELETIONS IN P. FALCIPARUM HISTIDINE‑RICH PROTEIN 2 AND PROTEIN 3 GENESHistidine-rich protein 2 (HRP2) is the predominant target of the 345 million P. falciparum-detecting malaria RDTs sold annually. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Parasites that no longer express HRP2 may not be detectable by RDTs based on HRP2, and those that no longer express HRP2 and histidine-rich protein 3 (HRP3) are completely in the undetectable by these RDTs.
Deletions P. falciparum genes for HRP2 (pfhrp2) and HRP3 (pfhrp3) in clinical isolates were first identified in 2010 in the Peruvian Amazon basin, by researchers characterizing blood samples that were negative by HRP2-based RDTs but positive by microscopy (71). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In recent years, pfhrp2/3-deleted parasites have been documented outside of South America, including in Asia, the Middle East, and Central, East, Southern and West Africa.
Prevalence estimates vary widely both within and between countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The examples of Eritrea and Peru – where the prevalence of dual pfhrp2 and pfhrp3 deleted parasites among symptomatic patients reached as high as 80% – demonstrate that these parasites can become dominant in the population, posing a serious global threat to patients and to the efficacy of HRP2-based RDTs.WHO is tracking published reports of pfhrp2/3 deletions using the Malaria Threats Map mapping tool (100, 133), and is encouraging a harmonized approach to mapping and reporting of pfhrp2/3 deletions through publicly available survey protocols. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Among the 39 reports published by 39 countries, 32 (82%) reported pfhrp2 deletions, but variable methods in sample selection and laboratory analysis mean that the scale and scope of clinically significant pfhrp2/3 deletions is still unclear.
Between 2019 and September 2020, investigations for pfhrp2/3 deletions were reported in 16 publications from 15 countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Pfhrp2/3 deletions were confirmed in 12 reports from 11 countries: China, Equatorial Guinea, Ethiopia, Ghana, Myanmar, Nigeria, Sudan, Uganda, United Kingdom (imported from various malaria endemic countries), the United Republic of Tanzania and Zambia. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
No deletions were identified in France (among returning travellers), Haiti, Kenya and Mozambique.WHO has published guidance on investigating suspected pfhrp2/3 deletions (132), and recommends that countries that have reports of pfhrp2/3 deletions, and their neighbouring countries, should conduct representative baseline surveys among suspected malaria cases, to determine whether the prevalence of pfhrp2/3 deletions causing false negative RDT results has reached a threshold for RDT change (>5% pfhrp2 deletions causing false negative RDT results). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Alternative RDT options (e.g.
based on detection of the 82The WHO Global Response Plan for pfhrp2/3 deletions outlines several areas for action beyond scaling up surveillance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The plan includes identifying new biomarkers, improving the performance of non-HRP2-based RDTs, market forecasting and strengthening laboratory networks to support the demands of molecular characterization to determine the presence or absence of these gene deletions.9.2 THERAPEUTIC EFFICACY OF ACTsEffective treatment for malaria is a critical component of malaria control and elimination. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The emergence of multidrug resistance, including resistance to artemisinin and partner drugs, threatens the global effort to reduce the burden of malaria.
The GTS calls on countries and global malaria partners to monitor the efficacy of antimalarial medicines, to ensure that the most appropriate and effective treatments are selected for national treatment policies (4).Therapeutic efficacy studies (TES) track clinical and parasitological outcomes in patients after they have received antimalarial treatment. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
When conducted according to the WHO protocol, TES offer a consistent measure of treatment efficacy over time.
These studies provide NMPs with the data required to evaluate their treatment policies and make changes where necessary.
In areas of malaria elimination, the routine surveillance system incorporates the treatment and follow-up of all malaria cases. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In this context, the data generated on patient outcomes become part of integrated drug efficacy surveillance (iDES) (135).This section summarizes TES findings from studies conducted on patients infected with P. falciparum and P. vivax for each WHO region between 2010 and 2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Given that ACTs are currently the recommended first-line treatment in all malaria endemic countries, and artesunate (injectable) is the main treatment for severe malaria, Section 9.3 summarizes the prevalence of PfKelch13 molecular mutations associated with artemisinin partial resistance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The latest available information and references can be found online in the Malaria Threats Map, which provides a geographical representation of drug efficacy and resistance data.1 The data from the most recent TES are also summarized in reports available online.29.2.1 WHO African RegionIn the WHO African Region, the first-line treatments for P. falciparum include artemether-lumefantrine (AL), artesunate-amodiaquine (AS-AQ) and dihydro arte-misinin-piperaquine (DHA-PPQ). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The overall average efficacy rates for P. falciparum – 98.0% for AL, 98.4% for AS-AQ and 99.4% for DHA-PPQ – remained consistent over time (Fig.
9.1).
Treatment failure rates of more than 10% were observed in four studies of AL but can be considered statistical outliers.
There is no evidence of confirmed lumefantrine resistance in Africa. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
For all other medicines, treatment failure rates remain below 10%.1 See https://www.who.int/malaria/maps/threats-about/en/.2 See https://www.who.int/malaria/areas/drug_resistance/drug_efficacy_database/en/.FIG.
9.1.Treatment failure rates among patients with P. falciparum malaria, WHO African Region, 2010–2019 Source: WHO Global database on antimalarial drug efficacy and resistance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
)%(eruliaftnemtaerT2520151050AL(302 studies)AS+SP(3 studies)AS-AQ(183 studies)AS-MQ(1 study)AS-PY(8 studies)DHA-PPQ(65 studies)AL: artemether-lumefantrine; AS-AQ: artesunate-amodiaquine; AS-MQ: artesunate-mefloquine; AS-PY: artesunate-pyronaridine; AS+SP: artesunate-sulfadoxine-pyrimethamine; DHA-PPQ: dihydroartemisinin-piperaquine; P. falciparum: Plasmodium falciparum; WHO: World Health Organization.83WORLD MALARIA REPORT 2020WORLD MALARIA REPORT 2020 9 Biological threatsP. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
vivax is only endemic in a few countries in the WHO African Region.
In Ethiopia, the AL efficacy rate was low in one study, probably due to lumefantrine’s short half-life, which does not protect against early relapse.
In most studies of CQ in Ethiopia, treatment failure rates were consistently below 10% except in one study that had a treatment failure of 22.0%. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
No treatment failures were observed in TES of AS-AQ in Madagascar and CQ in Mauritania.9.2.2 WHO Region of the AmericasThe first-line treatments for P. falciparum in the WHO Region of the Americas include AL (in Bolivia [Plurinational State of], Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Paraguay, Suriname and Venezuela [Bolivarian Republic of]), AS-MQ (in Brazil, Peru and Venezuela [Bolivarian Republic of]) and CQ (in Dominican Republic, Guatemala, Haiti, Honduras and Nicaragua). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Efficacy of AL and AS-MQ remains high in Brazil, Colombia and Suriname.In all malaria endemic countries in the WHO Region of the Americas, the first-line treatment policy for P. vivax is CQ but some ACTs were tested.
Countries conducted studies of CQ alone or of CQ combined with primaquine (PQ) (Fig.
9.2). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
9.2).
One study of CQ from Bolivia (Plurinational State of) in 2011 detected a treatment failure rate of 10.4%.9.2.3 WHO South-East Asia RegionThe first-line treatments for P. falciparum in the WHO South-East Asia Region include AL (in Bangladesh, Bhutan, India, Myanmar, Nepal and Timor-Leste), AS-MQ (in Myanmar), AS+SP (in India) and DHA-PPQ (in Bangladesh, Indonesia, Myanmar and Thailand). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
TES of AL demonstrated high treatment efficacy in Bhutan, India, Myanmar, Nepal and Timor-Leste, with treatment failure of less than 10% in all studies (Fig.
9.3).
AL treatment failure rates exceeded 10% in three studies: one in Thailand (11.3% in 2012) and two in Bangladesh (11.1% in 2013 and 14.3% in 2017).
Both of the studies in Bangladesh had small sample sizes (n<10).
All TES of AS+SP were conducted in India. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
All TES of AS+SP were conducted in India.
Following high rates of treatment failure in the north-eastern provinces, in 2013, India changed its treatment policy in those provinces to AL; AS+SP remains effective elsewhere in the country.
TES of AS-AQ were conducted in Indonesia in 2011 and 2012, with a treatment failure rate of 16.7% observed in the 2012 study of 24 patients. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
TES of AS-MQ were conducted in Myanmar, where the treatment remains effective, and in Thailand, where high rates of treatment failure were observed.
TES findings in Thailand led to the adoption of DHA-PPQ as the first-line treatment in 2015.
Among the four TES of AS-PY in Myanmar, no treatment failures were observed.
Studies of DHA-PPQ were conducted in Indonesia, Myanmar and Thailand. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
All results from Indonesia and Myanmar demonstrated high rates of treatment efficacy, with treatment failure rates of less than 5%.
In Thailand, high rates of treatment failure were observed with DHA-PPQ in two of five studies: 86.7% in a study of 15 patients and 100% in a study of two patients. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Both studies were completed in 2018 in the eastern part of the country; Thailand is currently recommending treatment with AS-PY in this area.The first-line treatments for P. vivax are CQ (in Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Myanmar, Nepal, Sri Lanka and Thailand), AL (in Timor-Leste) and DHA-PPQ (in Indonesia). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
High treatment efficacy was found in studies of CQ conducted in Bangladesh, Bhutan, the Democratic People’s Republic of Korea, India, Myanmar and Nepal except in two studies from Myanmar (11.9% in 2010 and 21.7% in 2012) and one from Timor-Leste (17.5% in 2011).
There was high efficacy of AL in the Democratic People’s Republic of Korea and Timor-Leste, AS-PY in Myanmar and DHA-PPQ in Indonesia.FIG.
9.2.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
9.2.FIG.
9.3.Treatment failure rates among patients with P. vivax malaria, WHO Region of the Americas, 2010–2019 Source: WHO Global database on antimalarial drug efficacy and resistance.Treatment failure rates among patients with P. falciparum malaria, WHO South-East Asia Region, 2010–2019 Source: WHO Global database on antimalarial drug efficacy and resistance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
)%(eruliaftnemtaerT20151050)%(eruliaftnemtaerT100806040200CQ(7 studies)CQ+PQ(12 studies)CQ: chloroquine; CQ+PQ: chloroquine plus primaquine; P. vivax: Plasmodium vivax; WHO: World Health Organization.AL(88 studies)AS+SP(56 studies)AS-AQ(2 studies)AS-MQ(23 studies)AS-PY(4 studies)DHA-PPQ(33 studies)AL: artemether-lumefantrine; AS-AQ: artesunate-amodiaquine; AS-MQ: artesunate-mefloquine; AS+SP: artesunate+sulfadoxine-py-rimethamine; AS-PY: artesunate-pyronaridine; DHA-PPQ: dihydroartemisinin-piperaquine; P. falciparum: Plasmodium falciparum; WHO: World Health Organization.8485WORLD MALARIA REPORT 2020 9 Biological threats9.2.4 WHO Eastern Mediterranean RegionThe first-line treatments for P. falciparum in the WHO Eastern Mediterranean Region are AL (in Afghanistan, Pakistan, Somalia and Sudan) and AS+SP (in Iran [Islamic Republic of], Saudi Arabia and Yemen). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The TES of AL from Afghanistan, Pakistan, Somalia, Sudan and Yemen all demonstrated good treatment efficacy, with treatment failure rates below 10% (Fig.
9.4).
The TES of AS+SP from Somalia and Sudan, conducted from 2011 to 2016, found low efficacy, with treatment failure rates as high as 22.2% in Somalia in 2011 and 18.1% in Sudan in 2014 (Fig.
9.4).
This prompted a subsequent change in treatment policy to the use of AL in both countries. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Elsewhere, TES of AS+SP from Afghanistan, Iran (Islamic Republic of), Pakistan and Yemen all demonstrated high treatment efficacy, with fewer than 5% of patients failing treatment.
The first-line treatments for P. vivax are AL (in Somalia and Sudan) and CQ in all other countries.
TES of CQ were conducted in Afghanistan (n=1), Iran (Islamic Republic of) (n=1) and Pakistan (n=1), all of which showed high treatment efficacy. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In addition, TES of AL in Afghanistan (n=4), Somalia (n=1) and Sudan (n=1) demonstrated high treatment efficacy.
9.2.5 WHO Western Pacific RegionThe first-line treatments for P. falciparum in the WHO Western Pacific Region are AL (in Lao People’s Democratic Republic, Malaysia, Papua New Guinea, Philippines, Solomon Islands and Vanuatu), AS-MQ (in Cambodia), DHA-PPQ (in China and Viet Nam) and AS-AQ (in China) (Fig. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
9.5).TES of AL were conducted in Cambodia, Lao People’s Democratic Republic, Malaysia, Papua New Guinea, Philippines, Solomon Islands and Viet Nam.
Treatment failure rates were 10% or less in four studies in Lao People’s Democratic Republic but those studies did not have the recommended sample sizes.
A study with an adequate number of patients is currently underway to further investigate these high rates of treatment failure.
All other studies of AL in the region demonstrated high treatment efficacy. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
TES of AS-MQ conducted in Cambodia, Lao People’s Democratic Republic, Malaysia and Viet Nam showed that the treatment efficacy of AS-MQ has remained high over the past 10 years, except in one 2019 study from Cambodia, where treatment failed in two of 16 patients.
TES of AS-PY were conducted in Cambodia, Lao People’s Democratic Republic and Viet Nam. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
High rates of treatment failure were observed in two studies from Cambodia in 2014, of 10.2% and 18.0%, but subsequent studies have found treatment failure rates below 5.0%.
In one study in Viet Nam from 2017, treatment failed in three of 19 patients; all other studies in Viet Nam and Lao People’s Democratic Republic found treatment failure rates of 5.0% or less.
Studies of DHA-PPQ were conducted in Cambodia, China, Lao People’s Democratic Republic, Papua New Guinea and Viet Nam. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Following high rates of treatment failure, Cambodia removed DHA-PPQ from its treatment policy.
High rates of failure for treatment with DHA-PPQ were also observed in Lao People’s Democratic Republic and Viet Nam. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
AS-PY has become the first-line treatment in the Viet Nam provinces where treatment failures with DHA-PPQ were observed.The first-line treatments for P. vivax in the WHO Western Pacific Region are AL (in Lao People’s Democratic Republic, Malaysia, Papua New Guinea, Solomon Islands and Vanuatu), AS-MQ (in Cambodia) and CQ (in China, Philippines, Republic of Korea and Viet Nam).
TES of AL were conducted in Papua New Guinea, Solomon Islands and Vanuatu between 2011 and 2014. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
High failure rates for treatment with AL were observed in each country: 35.0% in Papua New Guinea, 31.6% in Solomon Islands and 12.1% in Vanuatu.
These high failure rates are probably due to the short half-life of lumefantrine, which does not protect against early relapse.
TES of AS-MQ conducted in Cambodia, Lao People’s Democratic Republic and Malaysia demonstrated 100% efficacy.
TES of AS-PY in Cambodia and Lao People’s Democratic Republic found treatment failure rates below 5%.FIG.
9.4.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
9.4.FIG.
9.5.Treatment failure rates among patients with P. falciparum malaria, WHO Eastern Mediterranean Region, 2010–2019 Source: WHO Global database on antimalarial drug efficacy and resistance.Treatment failure rates among patients with P. falciparum malaria, WHO Western Pacific Region, 2010–2019 Source: WHO Global database on antimalarial drug efficacy and resistance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
)%(eruliaftnemtaerT2520151050AL(32 studies)AS+SP(42 studies)DHA+PPQ(8 studies))%(eruliaftnemtaerT100806040200AL(33 studies)AS-AQ(2 studies)AS-MQ(33 studies)AS-PY(15 studies)DHA-PPQ(84 studies)AL: artemether-lumefantrine; AS+SP: artesunate+sulfadoxine-pyrimethamine; DHA-PPQ: dihydroartemisinin-piperaquine; P. falciparum: Plasmodium falciparum; WHO: World Health Organization.AL: artemether-lumefantrine; AS-AQ: artesunate-amodiaquine; AS-MQ: artesunate-mefloquine; AS-PY: artesunate-pyronaridine; DHA-PPQ: dihydroartemisinin-piperaquine; P. falciparum: Plasmodium falciparum; WHO: World Health Organization.8687WORLD MALARIA REPORT 2020 9 Biological threatsFIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
9.6.Number of classes to which resistance was confirmed in at least one malaria vector in at least one monitoring site, 2010–2019 Source: national health institutes, national implementation partners, NMPs, research institutions and scientific publications.9.3 THE GLOBAL PREVALENCE OF PFKELCH13 MOLECULAR MUTATIONSMolecular marker studies help to identify and track the prevalence of molecular mutations associated with drug resistance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
WHO has established the following list of validated PfKelch13 markers of partial resistance to artemisinin: F446I, N458Y, M476I, Y493H, R539T, I543T, P553L, R561H, P574L and C580Y.
The candidate markers are P441L, G449A, C469F/Y, A481V, R515K, P527H, N537I/D, G538V, V568G, R622I and A675V. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In some areas, there is evidence of a clonal expansion of PfKelch13 mutations associated with artemisinin partial resistance, as discussed below.Artemisinin partial resistance emerged independently in several foci in the GMS.
WHO continues to monitor the situation, which has evolved rapidly since the first detections of PfKelch13 mutations in the GMS.
Some mutations have disappeared, whereas the prevalence of others has increased. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Currently, the most prevalent markers west of Bangkok (western Thailand and Myanmar) are F446I, M476I and R561H.
The most prevalent markers east of Bangkok (eastern Thailand, Cambodia, Lao People’s Democratic Republic and Viet Nam) are Y493H and P553L.
Two markers, R539T and C580Y, are also highly prevalent in both areas. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The change in treatment policy in Cambodia from DHA-PPQ to AS-MQ resulted in a reduction in the prevalence of strains carrying both C580Y and PPQ resistance.Rwanda has detected an increasing prevalence of the R561H mutation, a validated marker that emerged independently in the GMS between 2012 and 2015. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The presence of this mutation was confirmed in Rwanda in 2018, but so far it seems that delayed clearance associated with this mutation has not affected the efficacy of the ACTs that are currently among those tested and used in Rwanda.
The R622I mutation seems to be appearing independently in Africa, having been found in Eritrea, Ethiopia, Somalia and Sudan, and with increasing frequency in the Horn of Africa.
The ACTs used in these four countries remain effective, despite the presence of the mutation. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Further investigation of delayed parasite clearance is needed in this region.In Guyana, the C580Y mutation also emerged independently between 2010 and 2017. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
However, in recent studies (including surveys and TES), 100% of samples were found to be wild type, indicating that the mutation may be disappearing in Guyana.9.4 VECTOR RESISTANCE TO INSECTICIDESResistance of malaria vectors to pyrethroid insecticides that are commonly used for malaria vector control – namely, pyrethroids, organophosphates, carbamates and the rarely used organochlorine dichloro diphenyl-trichloroethane (DDT) – threatens malaria control and elimination efforts.9.4.1 Update on the status of data reportingFrom 2010 through 2019, a cumulative total of 82 countries reported data. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The extent and frequency of insecticide resistance monitoring continues to vary considerably between countries, despite continued increases in the number of sites from which standard resistance monitoring data were reported, from 3143 in 2010–2018 to 3559 in 2010–2019.
The number of sites per country for which resistance monitoring data were reported between 2010 and 2019 varied widely, from 1 to 287. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Pyrethroids continue to be the most frequently monitored insecticide class.A total of 66 countries reported insecticide resistance monitoring data at least once over the past 3 years and 16 did not report such data.
Among 82 countries, only 28 have reported on their insecticide resistance status consistently every year for the past 3 years.
Low reporting in 2019 was probably due to competing priorities arising from the COVID-19 pandemic. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Although 29% of the countries that used IRS reported the status of insecticide resistance for every insecticide class used in the year of implementation or the preceding year, concerningly, 57% of countries did not report the status for at least one of the insecticide classes used and 14% did not report the status for any insecticide class used. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Although this may reflect a gap in data reporting to WHO, malaria endemic countries are highly encouraged to ensure adequate monitoring of resistance to insecticide classes that are either in use or under consideration for use in malaria vector control interventions, and to prioritize monitoring of these classes.9.4.2 Update on the status of insecticide resistanceOf the 82 countries that reported resistance monitoring data to WHO, 73 confirmed resistance to at least one insecticide in one malaria vector species from one mosquito collection site in 2010–2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The number of countries that reported insecticide resistance to all four main insecticide classes in at least one malaria vector species increased from 26 in 2010–2018 to 28 in 2010–2019, and among those 28, 17 reported resistance to three of the four classes between 2010 and 2019 (Fig.
9.6). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Of those countries that reported insecticide resistance monitoring data to WHO, the proportion of 88icmedneairaamltoNlebacilppatoN■■sessaclynaotdetcetedecnatsiseroNssacliedcitcesnienOdetroperatadoN■■■sessacliedcitcesnieerhTsessacliedcitcesniruoFsessacliedcitcesniowT■■■:otecnatsiserdemrfinoC.emmargorpairaamllanoitan:PMN89WORLD MALARIA REPORT 2020 9 Biological threatscountries that confirmed resistance to these insecticide classes was as follows: 86.4% for pyrethroids, 80.6% for organochlorines, 68.8% for carbamates and 58.8% for organophosphates. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Only nine countries that reported data did not confirm resistance to any insecticide class.Resistance to the four main insecticide classes was detected in all WHO regions except the WHO European Region.
Globally, resistance to pyrethroids was detected in at least one malaria vector in 69.9% of the sites for which data were available, while resistance to organochlorines was reported in 63.4% of the sites. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Resistance to carbamates and to organophosphates was less prevalent, being detected in 31.7% and 24.9%, respectively, of the sites that reported monitoring data.
However, the geographical extent of confirmed resistance insecticide class differed considerably across regions (Fig.
9.7). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
9.7).
Maps showing the status of insecticide resistance to different insecticides at each site are available on the Malaria Threats Map website (100).to each There is continued improvement in the collection and reporting of data to guide deployment of recently prequalified vector control tools covered by WHO policy recommendations. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The number of countries that monitored the involvement of metabolic resistance mechanisms by means of PBO pre-exposure bioassays increased from 23 in 2010–2018 to 30 in 2010–2019.
All 30 countries detected partial or full involvement of metabolic resistance mechanism in phenotypic resistance to pyrethroids in at least one monitoring site for at least one vector species and one pyrethroid insecticide. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The number of sites where the involvement of metabolic resistance mechanisms in pyrethroid resistance was monitored by means of PBO pre-exposure bioassays increased by more than twofold, reaching 438 by 2019. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Full or partial involvement of metabolic resistance mechanisms for at least one vector species and one pyrethroid insecticide was reported in 392 sites.Results of biochemical and molecular assays conducted to detect metabolic resistance mechanisms were available for 35 countries and 308 sites for 2010–2019.
Of the sites for which reports were available, mono-oxygenases were detected in 66.9%, glutathione-S-transferases in 74.6%, esterases in 74.8% and acetylcholinesterases in 73.2%. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Results of assays conducted to detect target-site resistance mechanisms were available for 39 countries and 539 sites.
Kdr L1014F was detected in 76.3% of the sites and Kdr L1014S in 48.9% of the sites.a total of 1326 test results from 323 sites in 23 countries from the WHO regions of Africa and the Western to establish Pacific.
A formal WHO process discriminating dosages and test procedures for these two insecticide classes is ongoing. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The data reported so far to WHO on mosquito mortality after exposure to neonicotinoid and pyrrole insecticides will be assessed against these discriminating dosages once they have been fully defined.
Also, WHO test procedures for insecticide resistance monitoring will be updated to incorporate the new discriminating dosages and potential changes to the methodology. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Until that time, Member States are discouraged from using data generated by means of non-validated procedures to arrive at conclusions regarding the resistance status of their local vector populations to these insecticide classes.All the standard insecticide resistance data reported to WHO are included in the WHO global insecticide resistance database (136) and are available for exploration via the online interactive data visualization tool Malaria Threats Map (100). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The latest version of this tool, launched in 2020, provides a summary table with the status of phenotypic resistance and resistance mechanisms for each country; presents maps to inform discussions on the deployment of pyrethroid-PBO nets; allows for download of selected datasets; and includes an animation of the evolution of insecticide resistance, as per reports received by WHO.9.4.3 Mitigating and managing insecticide resistanceThe selection of effective vector control interventions needs to be based in part on representative data on the susceptibility of local vectors to insecticides that are covered by a policy recommendation and prequalified by WHO. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
In addition, insecticide resistance data are crucial for assessing the potential impact that resistance may have on the effectiveness of malaria vector control, an area that continues to be poorly understood. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
To meet these data needs, countries and their implementing partners are advised to conduct regular insecticide resistance monitoring following the WHO-recommended Test procedures for insecticide resistance monitoring in malaria vector mosquitoes (137), and to report and share results in a timely manner. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
To facilitate reporting, WHO has developed data reporting templates (138) and DHIS2 modules (139) for use by its Member States and their implementing partners, and is supporting the rollout of these tools.Recently, WHO Member States and their implementing partners have started to explore insecticide dosages to monitor resistance to neonicotinoid and pyrrole insecticides using two assays: the WHO tube test and the US CDC bottle bioassay. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
To date, WHO has received The impact of insecticide resistance on the effectiveness of malaria vector control interventions continues to be poorly understood; however, it is highly likely that such resistance reduces the efficacy of currently available interventions.
Countries should therefore not delay in 90implementing effective policies and practices for the prevention, mitigation and management of resistance. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Two relatively new vector control options that should be considered as part of an insecticide resistance management strategy – pyrethroid-PBO nets and neonicotinoid insecticides for IRS – have been recommended by WHO, and a number of prequalified products that fall into these classes are available. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Based on insecticide resistance monitoring data reported to WHO by Member States, and considering recent data from each site, a total of 330 areas in 33 countries currently meet WHO-recommended criteria for pyrethroid-PBO net deployment. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Maps showing these sites, along with higher level maps highlighting areas and countries where these sites are present, have been incorporated into the Malaria Threats Map to inform discussions on the deployment of pyrethroid-PBO nets.To guide resistance management, WHO recommends that countries develop and implement national insecticide resistance monitoring and management plans, drawing on the WHO Framework for a national plan for monitoring and management of insecticide resistance in malaria vectors (140). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Up to the end of 2019, countries have made considerable progress in developing such plans, with 53 countries having completed plans for resistance monitoring and management, and 28 currently in the process of developing such plans.
Further effort and support will be required to ensure that every malaria endemic country has such a plan in place, updates it regularly and has the necessary resources to implement it.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
9.7.Reported insecticide resistance status as a proportion of sites for which monitoring was conducted, by WHO region, 2010–2019: pyrethroids, organochlorines, carbamates and organophosphates Status was based on mosquito mortality, where <90% = confirmed resistance, 90–97% = possible resistance and ≥98% = susceptibility.
Where multiple insecticide classes or types, mosquito species or time points were tested at an individual site, the highest resistance status was considered. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Numbers above bars indicate the total number of sites (n) for which data were reported. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Sources: national health institutes, national implementation partners, NMPs, research institutions and scientific publications.n=1911n=211n=373n=3n=393n=322n=1112n=50PyrethroidsOrganochlorinesn=0n=196n=140n=115■ Confirmed resistance ■ Possible resistance ■ Susceptiblen=1354n=46Carbamatesn=0n=187n=130n=14n=1282n=91n=176n=2n=120n=67OrganophosphatesAFRAMREMREURSEARWPRAFRAMREMREURSEARWPRsetisnoitcellocotiuqsomfoegatnecreP100806040200100806040200AFR: WHO African Region; AMR: WHO Region of the Americas; EMR: WHO Eastern Mediterranean Region; EUR: WHO European Region; n: number; NMP: national malaria programme; SEAR: WHO South-East Asia Region; WHO: World Health Organization; WPR: WHO Western Pacific Region.91WORLD MALARIA REPORT 2020 10Malaria response during the COVID-19 pandemicIn several high-income countries, health systems have become overwhelmed with the efforts required to stop the transmission of the coronavirus, and hospitals have struggled to cope with increasing numbers of severe COVID-19 cases. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This led to global concerns about the potential consequences of the pandemic, including disruptions of essential health services, especially in LMICs, where the population was already dealing with a considerable burden of other infectious diseases.FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
10.1.Trends in COVID-19 cases and deaths in malaria endemic countries globally and by WHO region (as of 23 November 2020) Source: WHO Coronavirus disease (COVID-19) dashboard (143).200 000■ AFR ■ AMR ■ EMR ■ SEAR ■ WPR ■ Deaths10 00010.1 THE 2020 COVID‑19 PANDEMICOn 31 December 2019, Chinese authorities alerted WHO to an outbreak of pneumonia cases of unknown cause in Wuhan City, Hubei Province, China. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
These cases were later confirmed as cases of COVID-19; by the end of January 2020, China had more than 7700 confirmed cases, 12 000 suspected cases and 170 deaths (141).
On 30 January 2020, the Director-General of WHO declared the novel coronavirus outbreak a public health emergency of international concern (PHEIC), WHO’s highest level of alarm under the International Health Regulations (IHR) (2005) (142). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
By the first quarter of 2019, COVID-19 – caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) – had started spreading aggressively outside China.
It became clear that the pandemic would be a major test of the resilience of health systems, even those considered strong and well resourced.
Unfortunately, the pandemic continued to spread rapidly, with all countries soon affected. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
By the second week of November 2020, the COVID-19 pandemic had resulted in more than 54 million cases and more than 1.3 million deaths (143).
Older patients and those with certain pre-existing morbidities had a higher risk of severe disease and death (144).
Outside of China, several malaria endemic countries in the WHO South-East Asia Region had reported COVID-19 cases by January 2020. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
By April 2020, the virus had spread globally to all malaria endemic countries, and by the third week of November 2020, 24 million cases and about 636 000 deaths had been reported (Fig.
10.1).Brazil and India accounted for more than 64% of all cases reported from malaria endemic countries.
In sub-Saharan Africa, a region that accounts for over 90% of malaria infections, the spread of the disease was much slower and case fatality rates were lower than had first been feared. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Factors that are being considered as possible contributors to the slower spread in this region include early adoption of aggressive control strategies, prior experience in the control of disease outbreaks, a youthful population, a relatively high proportion of rural population with limited mobility and higher ambient temperatures (145, 146).92Isesac91-DVOCforebmuN150 000100 00050 00001/3/20202/3/20203/3/20204/3/20205/3/20206/3/20207/3/20208/3/20209/3/202010/3/202011/3/2020Ishtaed91-DVOCforebmuN7 5005 0002 5000AFR: WHO African Region; AMR: WHO Region of the Americas; EMR: WHO Eastern Mediterranean Region; SEAR: WHO South-East Asia Region; WHO: World Health Organization; WPR: WHO Western Pacific Region.93WORLD MALARIA REPORT 2020WORLD MALARIA REPORT 2020 10Malaria response during the COVID-19 pandemicIndeed, the COVID-19 pandemic and restrictions related to the response have caused major disruptions in essential malaria services. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
Furthermore, early messaging targeted at reducing SARS-CoV2 transmission advised the public to stay at home if they had fever, potentially disrupting treatment seeking for febrile diseases such as malaria.
At the same time, many high malaria burden countries had plans to implement large prevention campaigns before the peak malaria transmission season (which was likely to coincide with peak COVID-19 cases).
These plans needed to be adapted to conform with COVID-19 restrictions (Fig.
10.2).FIG. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
10.2.Malaria seasonality and trends of COVID-19 cases in malaria endemic countries and areas, 2020 (as of 23 November 2020) Source: WHO Coronavirus disease (COVID-19) dashboard (143) and PATH.AfghanistanAngolaBangladeshBelizeBeninBhutanBolivia(Plurinational State of)BotswanaBrazilBurkina FasoBurundiCabo VerdeCambodiaCameroonCentral African RepublicChadColombiaComorosCosta RicaCôte d’IvoireDemocraticRepublic of the CongoDjiboutiDominican RepublicEcuadorEquatorial GuineaEritreaEswatiniEthiopiaFrench GuianaGabonGambiaGhanaGuatemalaGuineaGuinea−BissauGuyanaHaitiHondurasIndiaIndonesiaKenyaLiberiaMadagascarMalawiMaliMauritaniaMexicoMozambiqueMyanmarNamibiaNepalNicaraguaNigerNigeriaPakistanPanamaPapua New GuineaPeruPhilippinesRepublic of KoreaRwandaSao Tome and PrincipeSaudi ArabiaSenegalSierra LeoneSomaliaSouth AfricaSouth SudanSudanSurinameThailandTogoUgandaUnitedRepublic of TanzaniaVenezuela(Bolivarian Republic of)Viet NamYemenZambiaZimbabweMarJun Sep DecMarJun Sep DecMarJun Sep DecMarJun Sep DecMarJun Sep Dec94MarJun Sep DecMarJun Sep DecCOVID-19 cases (scaled)Malaria seasonality10.2 GLOBAL WORKSTREAMS ON SUSTAINING THE MALARIA RESPONSE DURING THE COVID‑19 PANDEMICIn March 2020, as the COVID-19 pandemic spread rapidly around the globe, WHO convened a cross-partner effort to mitigate the negative impact of the coronavirus in malaria-affected countries and contribute to the COVID-19 response. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
The work was carried out in close collaboration with the RBM Partnership to End Malaria, the Global Fund, PMI, several implementation and advocacy partners, and research institutions.This collaborative work was implemented across seven cross-partner workstreams set up to address various thematic areas (Table 10.1).TABLE 10.1.The global workstreams on the malaria response during the COVID-19 pandemicWorkstreamAreas of workClinical trials of COVID-19 treatment with antimalarials and product developmentModelling, surveillance and clinical epidemiologySupplies and commodities ■ Develop a generic protocol to evaluate anti-COVID-19 prophylaxis in malaria endemic settings ■ Coordinate with researchers ■ Disseminate information ■ Establish a network of sites involved in clinical epidemiology in countries with malaria transmission ■ Consider potential scenarios for COVID-19–malaria interactions and feed these into other workstreams ■ Model the impact of service disruptions ■ Track country-level service disruptions using routine health information systems ■ Assess and monitor commodity stocks and supply-chain bottlenecks ■ Estimate potential demand for key malaria commodities ■ Work with international partners to consider how to use global purchasing power to stimulate ongoing production – and potential stockpiling – of key commodities ■ Coordinate and collaborate to optimize global stocks and distribution through careful prioritization ■ Work with international financiers to ensure that the necessary resources for the global COVID-19 response do not divert resources away from malaria or other public health prioritiesMalaria response and guidance ■ Develop integrated guidance to support maintenance of essential malaria services ■ Ensure the continuation of the effective delivery of malaria interventions within a COVID-19 transmission setting ■ Anticipate that the demand for health services may outstrip the ability to deliver CommunicationsCoordinationResource mobilizationroutine care ■ Consider resource requirements (e.g. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
commodities and workforce) for extraordinary measures ■ Communicate to avoid conflicting advice and misinformation ■ Ensure that current advice and public messaging intended to curb coronavirus transmission is appropriate in malaria endemic settings ■ Identify early warning signs of increased costs for implementing malaria programmes or decreased funding for the global malaria response, as both donor and malaria endemic countries respond to COVID-19 ■ Protect and ensure follow-through on existing commitments (e.g. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
to the Global Fund) as resources are allocated to the COVID-19 response ■ Develop proposals and conduct donor outreach during the COVID-19 pandemic, to fill near-term health system gaps, including critical commodities for malaria and other communicable diseasesUnder the leadership of the RBM Partnership to End Malaria, support countries to mobilize resources, through channels such as the Global Fund and others, to: ■ purchase PPE to help protect health workers in the provision of services at clinics and during campaigns ■ provide emergency resources to adapt the response during COVID-19 ■ ensure gains are sustained despite the pandemicWHO: World Health Organization.Global Fund: Global Fund to Fight AIDS, Tuberculosis and Malaria; PPE: personal protective equipment.95WORLD MALARIA REPORT 2020 10Malaria response during the COVID-19 pandemic10.3 GLOBAL HIGHLIGHTS IN THE MALARIA RESPONSE DURING THE COVID‑19 PANDEMIC10.3.1 Partnership alignment and technical guidanceThe cross-partner global response achieved several important milestones, starting with an initial urgent call to countries to maintain core malaria control services while protecting health workers and communities against COVID-19 transmission. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
A WHO statement, shared widely in March 2020, was issued in response to reports that some countries in sub-Saharan Africa had suspended mass ITN campaigns (147). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This statement encouraged countries to move forward with ITN, IRS and SMC campaigns, and to advise the public to avoid delays in seeking treatment for illnesses.To support malaria-affected countries to maintain essential services, in April 2020, WHO issued technical guidance on how to safely maintain malaria control services in the context of the COVID-19 pandemic. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This document was developed in close collaboration with partners, and was consistent with broader guidance on maintaining essential services in COVID-19 settings and on facilitating the role of community-based health care during the pandemic. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
It provided specific malaria guidance on the prevention of infection through vector control and chemoprevention, testing, treatment of cases, clinical services, supply chains and laboratory activities (148).10.3.2 Modelling the potential impact of service disruptions on the burden of malariaTo reinforce the urgent call to maintain essential malaria control services during the pandemic, the WHO GMP, in collaboration with the Malaria Atlas Project (MAP), conducted modelling to quantify the potential impact of service disruptions due to the COVID-19 pandemic (117). | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
This analysis showed that, under the worst-case scenario – in which all ITN campaigns are suspended and there is a 75% reduction in access to effective antimalarial medicines – a staggering 769 000 people in sub-Saharan Africa could die from malaria by the end of 2020.
This figure represents a doubling in the number of malaria deaths compared with 2018 and a return to mortality levels last seen 20 years ago. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |
These dire projections were extensively communicated through the media, and directly to the governments of malaria endemic countries and their partners, catalysing an impressive response, with countries tailoring the delivery of essential malaria services to the COVID-19 response, as described below.10.3.3 Responding to the pressure to shift diagnostic production away from malariaAs early as February or March 2020, during the initial acceleration wave of the pandemic, international demand for the development and large-scale production of SARS-CoV2 antigen-detecting rapid immunoassays increased dramatically, driven by the need to diagnose and track the pandemic. | https://docs-lawep.s3.us-east-2.amazonaws.com/1710417610444.pdf | https://cdn.who.int/media/docs/default-source/malaria/world-malaria-reports/9789240015791-double-page-view.pdf?sfvrsn=2c24349d10 | Zambia |