W O R L D M A L A R I A R E P O R T 2 0 0 5: SELECTED COUNTRY PROFILES

ANNEX 1.

Key issues related to programme progress and activities
Reported cases and deaths
Estimated coverage of the key RBM interventions according to the core indicators recommended by the RBM MERG
Drug efficacy rates for relevant antimalarial drugs
Services delivered by the NMCPs
Finances available for malaria control

SELECTED COUNTRY PROFILES

Overview of country profiles

Profiles are presented for 24 selected high-malaria burden countries relative to the region to which they belong—Africa, Asia and the Americas. Profiles for these countries and all other countries reporting malaria are available on the Internet. The profiles are continually updated as part of the global RBM reporting process.

Country profiles are organized in six sections, based on data availability and national policy.

1. Key issues related to programme progress and activities: a brief summary of key strategies and policies used by the NMCP, including: (i) the existence of a national malaria control manual or treatment guidelines and the year of latest publication or update; (ii) the number of sentinel sites currently monitoring antimalarial drug efficacy and insecticide resistance; and (iii) the antimalarial drug policy in 2004.

The antimalarial drug policy as at the end of 2004 is presented separately for treatment of falciparum malaria and vivax malaria. For falciparum malaria, separate policies are defined for: (i) the treatment of uncomplicated (confirmed and unconfirmed) cases; (ii) the treatment of cases that failed firstline treatment (treatment failure); (iii) the treatment of severe malaria; and (iv) the prevention and/or treatment of malaria in pregnant women.

Source of data: WHO annual reporting forms and country presentations, reports and publications.

2. Reported cases and deaths include the number of annual malaria cases and deaths recorded in HIS and reported to WHO—separately for laboratory-confirmed, clinically diagnosed and imported cases as well as by age, gender and subnational division. This section also lists the total number of slides and rapid diagnostic tests taken, a proportion of which would have resulted in a confirmed case, as recorded and reported by countries.

Probable or clinically diagnosed cases: for countries where access to laboratory confirmation of cases is severely limited—such as in most of Africa south of the Sahara—this term denotes patients who are suspected to have malaria based on clinical signs and symptoms and who receive treatment for malaria. For countries where routine laboratory confirmation is widely available and where cases are reported as having been confirmed or not, this term applies to patients clinically diagnosed and treated for malaria but who were not diagnosed by a laboratory test. One exception is Pakistan, where the term refers to all patients with fever. For countries in the Western Pacific and selected countries in eastern Asia, this denotes the number of suspected malaria cases minus the subset of those patients who were laboratory tested and found to be infected with malaria.

Probable or clinically diagnosed severe cases denotes, for areas reporting only clinically diagnosed cases, patients who were clinically diagnosed and required hospitalization for signs and/or symptoms of severe malaria and who received antimalarial treatment.

Probable or clinically diagnosed malaria deaths denotes, for areas reporting only clinically diagnosed malaria cases, deaths among patients diagnosed with probable severe malaria.

Laboratory-confirmed malaria cases denotes, for areas performing laboratory confirmation of malaria diagnoses, all patients with signs and/or symptoms of malaria and laboratory-confirmed diagnosis who received antimalarial treatment. Laboratory diagnosis consists of either slide microscopy or a rapid diagnostic test. Of these:

P. falciparum

Plasmodia

P. vivax

Laboratory-confirmed severe cases denotes, among patients whose malarial illness was confirmed by a laboratory test, the number who required hospitalization for signs and/or symptoms of severe malaria and who received antimalarial treatment.

Laboratory-confirmed malaria deaths denotes deaths among patients with laboratory-confirmed diagnosis of severe malaria.

Imported cases denotes malaria episodes in which the infection was acquired outside the country where it was diagnosed, implying that the origin could be traced to a known malarious area.

Estimated reporting completeness denotes the completeness of HIS data in malaria case reporting, estimated by the country.

Where available, reported cases are also provided by age, gender and subnational area. The percentages of cases in each of these subgroups are based on the number of total annual reported cases in the corresponding year, which is not necessarily the most recent year for which the total number of cases was available. Subnational reported cases are displayed for areas whose reported burden represents at least 2% of the national total, up to a maximum of 15 areas.

The standardized reported malaria rate plotted in the time-trend graph is a standardized rate, per 1000 people per year, calculated against national population sizes in each calendar year estimated by the United Nations Population Division (52). The numerator of the standardized rates was based on the number of reported cases and the proportion of these cases that were laboratory-confirmed. For countries where none of the reported cases were confirmed, as in most of Africa south of the Sahara, the rate was based on probable or clinically diagnosed cases. For countries where all cases are laboratory-confirmed, the rate was based on laboratory-confirmed cases minus imported cases. For the few countries where some cases were laboratory-confirmed (“Some” in column 6 of Table A.21 for Afghanistan, Somalia, Sudan and Yemen), the standardized rate was based on the sum of the reported categories “probable/clinically diagnosed” and “laboratory-confirmed”, which were mutually exclusive for these countries.

All cause under-5 mortality is the number of children who died before the age of exactly 5 years per 1000 live births. This information is from the UNICEF report on the State of the World’s Children 2005 (36) and included for African countries only.

Source of data: WHO annual reporting forms and country presentations, reports and publications.

3. Estimated coverage of the key RBM interventions according to the core indicators recommended by the RBM MERG:

the percentage of households possessing at least one mosquito net and possessing at least one ITN;
the percentage of children under 5 years of age and pregnant women who slept under a net or an ITN during the night before a survey;
for African countries, the percentage of febrile children under 5 years of age who received treatment with any antimalarial, with chloroquine or with sulfadoxine–pyrimethamine.

Each outcome is reported as the national estimate and where applicable and available, disaggregated by the background characteristics urban/rural, male/female and by wealth quintile.

The treatment of febrile children with antimalarials is reported only for African countries; the period-prevalence of fevers in African children under 5 years of age in the 2 weeks preceding a survey is reported as the denominator against which use of antimalarials is evaluated.

Source of data: reports from household surveys, including DHS and MICS (10) or, if no nationally representative surveys were available, cluster-sampled subnational surveys were used. Only surveys with appropriate documentation of dates of field work, sampling design and sample sizes were included. For countries with multiple national surveys available, the most recent survey was used.

4. Drug efficacy rates for relevant antimalarial drugs: each profile includes the number of relevant drug efficacy studies, the range of years in which they were conducted and the minimum, maximum, median and 25th and 75th percentile efficacy rates, where applicable.

Efficacy studies included in this report are those that used one of the protocols recommended by WHO in 1996 or later (9). The WHO protocol recommends the assessment of in vivo efficacy against P. falciparum in patients under 5 years of age presenting with uncomplicated falciparum malaria (9). For countries where such studies have not been conducted, this report included other studies that were judged to be of high quality. Both published and unpublished studies were considered for inclusion.

For countries in Africa, study results are expressed as proportions of clinical failure, which is defined as the proportion of patients who present either with fever in the presence of parasitaemia on day 3 after onset of treatment (early treatment failure) or with recurrent fever 14 days after onset of treatment (late clinical failure). For Asia, the Americas, Southern Africa and moderate-to-low transmission areas in Sudan, the presented results are proportions of total treatment failure, which is the sum of clinical failure and late parasitological failure. Late parasitological failure in these countries is defined as asymptomatic parasitaemia at 28 days after onset of treatment.

All studies are weighted equally irrespective of their differing sample sizes. Percentile calculations are based on N = P/100* (k + 1), where: k = total numbers of values in the dataset; P = percentile (25th or 75th); and N = index number in the dataset that corresponds to the percentile chosen. If N equals an index number, the formula will bring back the failure rate observed in the study with that index number. If N is not equal to an index number, the formula returns the average of the two failure rates associated with the two studies with indexes that N lies between. If N is greater than the highest index number, the failure rate observed in the study with the highest index number (i.e. the maximum failure rate across all studies) is returned.

Source of data: WHO annual reporting forms and country presentations, reports and publications, published studies.

5. Services delivered by the NMCPs, specifically the annual:

number of nets and/or insecticide kits sold or distributed;
number of nets (re-)treated with insecticides;
number of insecticide treatment kits for mosquito nets sold or distributed;
quantities of insecticides used for malaria vector control activities;
number of households or units sprayed during IRS campaigns.

Quantities of insecticides used for malaria vector control activities were based on annual reporting to WHOPES (63). All figures are reported by the NMCPs and do not necessarily include services delivered to countries by other RBM partners. Numbers of households or units sprayed for IRS are not fully standardized between countries, as some countries consider units to be rooms rather than houses, and not all countries specify their definition of unit.

Source of data: WHO annual reporting forms and country presentations, reports and publications.

6. Finances available for malaria control: represents reported national resources—such as annual fiscal year budget allocations from the Ministry of Health (MoH)—and other resources budgeted and allocated for NMCP efforts. Some countries separately report budgeted and allocated malaria resources. For figures reported in currencies other than US$, a standard annual exchange rate conversion based on the World Development Index published by the World Bank was used.

For GFATM financing, data on malaria funds committed for approved proposals and disbursed from rounds 1–4 of proposal submission and review are presented, with specification of the dates when grant agreements were signed and the amounts of disbursements to date.

Source of data: WHO annual reporting forms (malaria and WHOPES), country presentations, reports and publications, and the GFATM.

LIST OF AVAILABLE COUNTRY PROFILES