Malaria: Country Profiles Version 1.1 Version 1.1 with updated maps: 31 August 2011 2 Cover photo: RBM/Vergaard Frandsen 3 Contents INTRODUCTION TO THE PROFILES ...................................................................................................5 AFRICA...................................................................................................................................................6 DEMOCRATIC REPUBLIC OF CONGO .......................................................................................................6 ETHIOPIA ............................................................................................................................................13 GHANA ...............................................................................................................................................21 KENYA................................................................................................................................................29 MALAWI ..............................................................................................................................................36 MOZAMBIQUE......................................................................................................................................43 NIGERIA..............................................................................................................................................53 RWANDA.............................................................................................................................................60 SIERRA LEONE....................................................................................................................................66 SOMALIA.............................................................................................................................................73 SOUTH SUDAN ....................................................................................................................................80 SUDAN ...............................................................................................................................................87 TANZANIA (MAINLAND).........................................................................................................................91 UGANDA .............................................................................................................................................99 ZAMBIA.............................................................................................................................................107 ZANZIBAR .........................................................................................................................................114 ASIA....................................................................................................................................................121 AFGHANISTAN ...................................................................................................................................121 BURMA .............................................................................................................................................127 CAMBODIA ........................................................................................................................................134 INDIA ................................................................................................................................................142 PAKISTAN .........................................................................................................................................149 ACRONYMS .......................................................................................................................................155 REFERENCES....................................................................................................................................159 4 Introduction to the profiles DFID commissioned these profiles for health advisers in our country offices. Profiles were prepared for all countries where DFID has an office and where malaria is a public health issue. However, this is not meant to imply that DFID will have a malaria programme in any given country. This is not a policy document and does not represent DFID's policy position. Further information on DFID’s policy commitments on malaria can be found here. Please note that the interpretation of the evidence and the views expressed in these profiles are entirely those of the authors and do not necessarily represent the views of DFID. The profiles were written in October 2010 as rapid reviews from the Malaria Consortium,1 with minor updates and the separation of Sudan and South Sudan profiles in July 2011. First published in July 2011, version 1.1 has some updated maps provided by the Malaria Atlas Project; no other changes have been made.2 The profiles should be read in conjunction with country data available in the World Malaria Reports published and updated by the World Health Organization (WHO).3 The profiles use evidence from multiple sources, much of which is country specific, and so profiles are not necessarily directly cross-comparable. Further, whilst peer reviewed evidence is used where available and appropriate, reported data is not necessarily from peer reviewed sources (for example, many profiles use data from national statistics bureaus or health department strategy documents). For a broader and more detailed overview of evidence related to the burden of malaria and interventions, please see the accompanying DFID evidence paper Malaria: Burden and Interventions. 1 Oliver Williams and Sylvia Meek with Tarekegn Abeku, Ebeneezer Baba, Kate Brownlow, Baltazar Chilundo, Masela Chinyama, Prudence Hamade, Maxwell Kolawole, Caroline Lynch, Stephen Moore, Antonia Pannell, Clare Riches, Richard Ato Selby, David Sintasath, Agonafer Tekalegne. Additional contributions by Mark Rowland and Allan Schapira. 2 The ‘spatial distribution’ maps show the mean probability than an individual will have P. falciparum parasites in their blood. The ‘risk’ maps show where clinical malaria case are found. For further information on the methods used to construct the Malaria Atlas Project maps, go to: http://www.map.ox.ac.uk/data/. 3 www.who.int/malaria/about_us/en/index.html 5 Africa Democratic Republic of Congo Summary table: malaria in Democratic Republic Congo Parasites P. falciparum, P. vivax Vectors A. gambiae, A. funestus, A. nili, A. moucheti, A. brunnipes, A. paludis % of people under ITNs 37% of population covered by ITNs (2008). and variation across the country First-line drug for P. AS+AQ falciparum (unconfirmed) First-line drug for P. AS+AQ falciparum (confirmed) Second-line drug for P. QN(7d) falciparum Evidence of insecticide CQ and SP resistance was first identified in 2000 and &/or drug resistance both were discontinued as malaria treatments in 2001 as policy. IRS use Not widely used, with just 83,000 people covered in 2008. IPTi use Not in use. IPTp use In use due to high ANC coverage (80%), but IPTp utilisation is low (7% IPT2 in 2007). Evidence of diagnostics Microscopy is only mandatory when first-line treatment being used to direct fails, RDTs not available at the community level. Majority antimalarial treatment of malaria cases are clinically diagnosed. July 2011 1. Introduction The Democratic Republic of Congo (DRC) is the third largest country in Africa, and one of the poorest. It has just emerged from two decades of civil war, and sporadic violence continues in places. This has led to a highly fragmented and dilapidated health system, a complex supply management and distribution system, and the presence of a myriad of partners providing a highly variable coverage of basic essential services.1 Health System Strengthening (HSS) is underway, but in the mean time the poor state of the public health system is hindering malaria control. Further constraints include the inaccessibility of many populated areas of DRC, the poor state of transport infrastructure and the lack of financial resources needed to procure malaria control commodities.2 2. The Burden of Disease Malaria is the biggest cause of morbidity and mortality in the DRC, with 5 million cases and 18,928 deaths in 2008. While this represents a pattern of increasing reported cases and mortality rates, it is unclear whether this is due to rising infection rates or more accurate reporting.3 Malaria causes 59% of outpatient consultations and 48% of hospitalisations of 6 children under five. Malaria is also the cause of 37% of deaths in hospital of children under five.4 In the DRC, 97% of the population live in areas experiencing high and stable malaria transmission, and 3% of the population live in more mountainous, epidemic prone areas in the east (Kivu and Katanga). DRC has three different epidemiological zones; the equatorial forest zone with high morbidity in under fives; the tropical zone where transmission increases during the long rainy season which lasts between 5 – 8 months and where morbidity is highest in children under 10; and the mountainous area of the Kivus and Katanga provinces in the east which are fringe areas, and prone to epidemics. 97% of the population live in equatorial forest and tropical zones where malaria transmission is highest. Plasmodium falciparum is the most common parasite species in DRC, causing 95% of infections. P. vivax accounts for the other 5% of cases. The main vectors are Anopheles gambiae