1.11. MALARIA Malaria is a disease transmitted by the bites of This is in part due to better detection rather than an increase infected mosquitoes. In the human body, the Plasmodium in the underlying incidence (WHO, 2010a) (Figure 1.11.2). parasites multiply in the liver, and then infect red blood Some key interventions to control malaria include cells. If left untreated, malaria can become life-threatening prompt treatment with artemisinin-based combination by disrupting the blood supply to vital organs. therapies, the use of insecticide-treated nets by people at Malaria is endemic in many countries in the Asia/ risk and indoor residual spraying with insecticide to control Pacific region. It is particularly associated with specific mosquitoes (Figure 1.11.3). ecological zones such as forests in tropical and subtropical Overall mosquito net coverage exceeds 40% in the Solo- Southeast Asia, but it is also found in more temperate areas mon Islands, Malaysia, Sri Lanka and Papua New Guinea. of the region. Among the population living in affected areas, But malaria control efforts are hampered by increased resis- mobile and migrant populations as well as infants, young tance of mosquitoes to insecticides, and uncontrolled popu- children and pregnant women are especially vulnerable. lation movement leading to more frequent epidemics. The Around 85% of those who die from malaria are children. growing problem of multidrug resistance is also more severe The disease especially affects the poor in remote rural in Asia than in any other part of the world. Successful areas who cannot afford treatment or have limited access malaria control depends on long-term, sustained commit- to health care. Malaria causes significant economic losses; ments by national governments. more than 1% of GDP in countries with high levels of trans- mission. In some heavy-burden countries, the disease accounts for up to 40% of public health expenditures, and a significant proportion of hospital admissions and outpa- Definition and comparability tient health clinic visits. Malaria is a tropical disease caused by a parasite Around three-quarters of the total population in Asia/ transmitted by the bites of infected female Anopheles Pacific countries are at risk of malaria. In 2010, there were mosquitoes. After a period spent in the liver, malaria 10 million probable and confirmed cases, but these are a parasites multiply within red blood cells, causing fraction of the suspected number (WHO, 2011f). Most of the symptoms such as fever, headache and vomiting. population at moderate-to-high risk live in Bangladesh, In severe cases, the disease can be fatal. Malaria is Cambodia, India, Indonesia, Myanmar, Papua New Guinea preventable and curable, although no vaccine cur- and Thailand, which together contribute 95% of confirmed rently exists. malaria cases annually (Figure 1.11.1). The vast majority of Microscopy or rapid diagnostic tests are recom- confirmed cases occur in Pakistan and India, whereas mended to confirm malaria infection in suspected death rates are estimated to be highest in Myanmar, Papua patients. In addition to confirmed cases reported to New Guinea and the Solomon Islands. India, Myanmar and health authorities, many probable cases occur annu- Indonesia had high numbers of deaths in 2010. ally. Underreporting of cases and deaths remain a Although a number of countries in the region such as major challenge in countries with inadequate and DPR Korea, Sri Lanka and Thailand have shown a significant limited access to health services and weak surveil- reduction in recorded incidence in recent years, the burden lance systems (WHO, 2008a). appears persistently high in the major endemic centres. 32 HEALTH AT A GLANCE: ASIA/PACIFIC 2012 © OECD/WHO 2012 1.11. MALARIA 1.11.1. Malaria cases and deaths, 2010 Probable and confirmed cases Suspected cases Suspected, probable and confirmed cases Estimated mortality rate Myanmar 53.3 Papua New Guinea 31.6 Solomon Islands 16.4 Cambodia 13.4 Lao PDR 11.6 108 || India 4.9 Indonesia 4.2 Nepal 3.4 Pakistan 3.2 Bangladesh 2.8 Viet Nam 1.4 Philippines 0.4 Thailand 0.4 Malaysia 0.1 Sri Lanka 0.1 China 0.1 Korea, DPR 0.1 Korea, Republic 0.1 10 8 6 4 2 0 0 10 20 30 40 50 60 Million cases Per 1 000 population Source: WHO (2011f); Murray et al. (2012). 1.11.2. Suspected malaria cases, 1.11.3. Estimated coverage of at-risk persons 2000-10 with malaria control interventions, 2010 China India Indonesia Insecticide-treated nets Pakistan Viet Nam Indoor residual spraying Million cases (log scale) % coverage 1 000 60 133 100 50 100 40 30 10 20 10 1 0 s ia ia s h r d n a 2000 2002 2004 2006 2008 2010 d s ka ea s e s n dia n n in e n ma n blic sta la u n Nepal n I u Chin s i La Lao PDRdo gladeea, DPR Thaila Paki n I MalaySr Cambodia In n r Mya Viet Nam Source: WHO (2011f). PhilippiBa Ko ea, Rep a New G r olomo u S Ko Pap Source: WHO (2011f). 1 2 http://dx.doi.org/10.1787/888932723038 HEALTH AT A GLANCE: ASIA/PACIFIC 2012 © OECD/WHO 2012 33 From: Health at a Glance: Asia/Pacific 2012 Access the complete publication at: https://doi.org/10.1787/9789264183902-en Please cite this chapter as: OECD/World Health Organization (2012), “Malaria”, in Health at a Glance: Asia/Pacific 2012, OECD Publishing, Paris. 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