Liberia African Region

I. Epidemiological profile Population (UN Population Division) 2017 % Parasites and vectors High transmission (>1 case per 1000 population) 4.7M 100 Major plasmodium species: P.falciparum: 100 (%) , P.vivax: 0 (%) Low transmission (0-1 case per 1000 population) 0 - Major anopheles species: An. gambiae Malaria free (0 cases) 0 - Reported confirmed cases (health facility): undefined Estimated cases: 911.3K [422.9K, 1.6M] Total 4.7M Confirmed cases at community level: 23 002 Confirmed cases from private sector: 0 Reported deaths: 758 Estimated deaths: 2.2K [1.9K, 2.5K]

II. Intervention policies and strategies Yes/ Year Intervention Policies/Strategies Medicine Year adopted No adopted Antimalaria treatment policy ITN ITNs/LLINs distributed free of charge Yes 2005 First-line treatment of unconfirmed malaria AS+AQ 2004 ITNs/LLINs distributed to all age groups Yes 2008 First-line treatment of P. falciparum AS+AQ 2004 IRS IRS is recommended Yes 2009 For treatment failure of P. falciparum QN 2004 DDT is used for IRS No - Treatment of severe malaria AS; AM; QN 2004 Larval control Use of Larval Control No Treatment of P. vivax - - IPT IPT used to prevent malaria during pregnancy Yes 2005 Dosage of primaquine for radical treatment of P. vivax Diagnosis Patients of all ages should receive diagnostic test Yes 2005 Type of RDT used P.f only Malaria diagnosis is free of charge in the public sector Yes 2005 Therapeutic efficacy tests (clinical and parasitological failure, %) Treatment ACT is free for all ages in public sector Yes 2005 Medicine Year Min Median Max Follow-up No. of studies Species is The sale of oral artemisinin-based monotherapies (oAMTs) 2011 AS+AQ 2010-2011 0 0 0 28 days 1 P. falciparum banned Single dose of primaquine (0.25 mg base/kg) is used as No - Resistance status by insecticide class (2010-2017) and use of class for malaria vector control (2017) gametocidal medicine for P. falciparum Insecticide class Years (%) sites1 Vectors2 Used3 Primaquine is used for radical treatment of P. vivax No - Carbamates 2010-2016 13.04% (23) An. gambiae s.l. No G6PD test is a requirement before treatment with primaquine No - Organochlorines 2013-2016 100% (16) An. gambiae s.l. No Directly observed treatment with primaquine is undertaken No - Organophosphates 2011-2016 0% (19) - No System for monitoring of adverse reaction to antimalarials exists Yes - Pyrethroids 2010-2017 95% (40) An. gambiae s.l. Yes Surveillance ACD for case investigation (reactive) No - 1Percent of sites for which resistance confirmed and total number of sites that reported data (n) ACD at community level of febrile cases (pro-active) No - 2Principal vectors that exhibited resistance Mass screening is undertaken No - 3Class used for malaria vector control in 2017 Uncomplicated P. falciparum cases routinely admitted No - Uncomplicated P. vivax cases routinely admitted No - Case and foci investigation undertaken No Case reporting from private sector is mandatory Yes -

III. Charts Sources of ﬁnancing Government expenditure by intervention in 2017 40M

30M

20M Contribution($USm) 10M

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Insecticides & spray materials ITNs Diagnostic testing Others WHO/UNICEF USAID/PMI Worldbank (USD) Antimalarial medicines Monitoring and evaluation Global Fund (USD) Government contribution Human resources & technical assistance Management and other costs

IV. Coverage Coverage of ITN and IRS Cases tested and treated in public sector 100 100

75 75

50 50 (%) Population

25 25

0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Suspected cases tested Antimalarials distributed vs reported cases ACTs distributed vs reported P. f. cases % of households >= 1 ITN (Modelled) At risk protected with IRS Primaquine distributed vs reported P. v. cases % of the population who slept under an ITN the previous night (survey) % <5 fever cases who had a ﬁnger/ heel stick (survey) % of the population with access to an ITN (survey) ACTs as % of all antimalarials received by <5 (survey)

Source: DHS 2013, MIS 2009, 2011, 2016 Source: DHS 2007, 2013, MIS 2009, 2011, 2016 V. Impact Cases treated Test positivity 100% 100%

75% 75%

50%

(%) 50% Tests (%)

25% 25%

0% 0%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 % fever cases <5 seeking treatment at public HF (survey) Reporting completeness Slide positivity rate RDT positivity rate

Source: DHS 2007, 2013, MIS 2009, 2011, 2016

V. Impact Conﬁrmed malaria cases per 1000 and ABER Malaria admissions and deaths 500 100 2'500k 2500

400 80 2'000k 2000

300 60 1'500k 1500 Deaths ABER (%)

1'000k 1000 200 40 Admissions Cases per 1000 Cases

500k 500 100 20

0k 0 0 0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Admissions (all species) Admissions (P. vivax)) Deaths (all species) ABER Cases(all species) Cases (P. vivax) Deaths (P. vivax))

World Malaria Report 2018