Central African Republic 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, An. funestus, An. arabiensis Malaria free (0 cases) 0 - Reported confirmed cases (health facility): 383 309 Estimated cases: 1.8M [777.2K, 3.4M] Total 4.7M Confirmed cases at community level: - Confirmed cases from private sector: 28 604 Reported deaths: 3689 Estimated deaths: 4.8K [4K, 5.6K]

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 2006 First-line treatment of unconﬁrmed malaria AL 2005 ITNs/LLINs distributed to all age groups No 2010 First-line treatment of P. falciparum AL - IRS IRS is recommended Yes 2012 For treatment failure of P. falciparum QN - DDT is used for IRS No - Treatment of severe malaria AS, AM; QN 2005 Larval control Use of Larval Control No Treatment of P. vivax - - IPT IPT used to prevent malaria during pregnancy Yes 2004 Dosage of primaquine for radical treatment of P. vivax Diagnosis Patients of all ages should receive diagnostic test Yes 1997 Type of RDT used P.f + all species (Combo) Malaria diagnosis is free of charge in the public sector No - Therapeutic efﬁcacy tests (clinical and parasitological failure, %) Treatment ACT is free for all ages in public sector Yes 2010 Medicine Year Min Median Max Follow-up No. of studies Species is The sale of oral artemisinin-based monotherapies (oAMTs) - AL 2010-2017 0 1.1 2.2 28 days 2 P. falciparum banned AS+AQ 2010-2010 0 0 0 28 days 1 P. falciparum Single dose of primaquine (0.25 mg base/kg) is used as No - gametocidal medicine for P. falciparum Resistance status by insecticide class (2010-2017) and use of class for malaria vector control (2017) Primaquine is used for radical treatment of P. vivax No - Insecticide class Years (%) sites1 Vectors2 Used3 G6PD test is a requirement before treatment with primaquine No - Carbamates 2014-2014 0% (2) - No Directly observed treatment with primaquine is undertaken No - Organochlorines 2014-2014 100% (2) An. funestus s.l., An. gambiae s.l. No System for monitoring of adverse reaction to antimalarials exists No - Organophosphates 2014-2014 50% (2) An. funestus s.l. No Surveillance ACD for case investigation (reactive) - - Pyrethroids 2014-2014 100% (2) An. funestus s.l., An. gambiae s.l. Yes

ACD at community level of febrile cases (pro-active) No - 1Percent of sites for which resistance conﬁrmed and total number of sites that reported data (n) Mass screening is undertaken No - 2Principal vectors that exhibited resistance Uncomplicated P. falciparum cases routinely admitted - - 3Class used for malaria vector control in 2017 Uncomplicated P. vivax cases routinely admitted - - 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 10M

7.5M

5M Contribution($USm) 2.5M

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)

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

V. Impact Conﬁrmed malaria cases per 1000 and ABER Malaria admissions and deaths 250 50 125k 5k

200 40 100k 4k

150 30 75k 3k Deaths ABER (%)

50k 2k 100 20 Admissions Cases per 1000 Cases

25k 1k 50 10

0k 0k 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