INTRODUCTION
This report is the first comprehensive effort to compile, analyse and present available information on progress rolling back malaria in all affected countries. It outlines the epidemiological situation of malaria in all regions of the world, and reports on the status of malaria control, including control policies, service delivery and coverage of key interventions. For 24 endemic countries, the situation of malaria and malaria control and the support provided by the international community are reviewed in more detail.
Between 350 and 500 million clinical episodes of malaria occur each year, resulting in over 1 million deaths (1, 2). The disease takes an economic toll as well because of reduced productivity, which is responsible for an estimated average loss of 1.3% of economic growth annually in countries with intense transmission (3). Malaria control is increasingly recognized as playing a key role in poverty reduction in high burden countries.
Recognizing that there are proven and effective interventions against malaria, the Roll Back Malaria (RBM) Partnership was launched in 1998 by the World Health Organization (WHO), the World Bank, the United Nations Children’s Fund (UNICEF) and the United Nations Development Programme (UNDP), with the overall goal of halving the burden of malaria by 2010 (4). The partnership includes malaria-endemic countries, their bilateral and multilateral development partners, the private sector, academia and international organizations. The following core technical strategies for the sustainable control of malaria have been identified:
- improved and prompt access to effective treatment;
- increased use of insecticide-treated nets (ITNs) and other locally appropriate means of vector control;
- early detection of and response to malaria epidemics;
- improved prevention and treatment of malaria in pregnant women in highly endemic areas.
Many partners at country, regional and global levels contribute to global monitoring and evaluation of RBM. This report presents data collected by key RBM partners in 2004 on the malaria situation to the end of 2003. For many countries, the primary information source is the annual reporting to WHO by regional and country offices and national malaria control programmes (NMCPs).
The writers of this report were obliged to rely on data collected in individual regions. One of the greatest challenges in preparing the report was to standardize, insofar as it was feasible, all available data, which were derived from a broad spectrum of sources. Regions currently collect variable types of data for several reasons, including local variations in clinical epidemiology, mosquito biology and intervention approaches. Not all data required for RBM’s basic framework for monitoring and evaluation (5), which is outlined in Table 1, were available for all countries.
The report is an important step forward, but we recognize that better and more standardized data collection is needed. Section IV highlights ways to seek more common monitoring and evaluation methods for the future, and to improve the tracking of progress in control efforts and the consequent changes in the malaria burden. Annexes 1–4 provide additional country and regional information. It is hoped that the recommendations for improving monitoring will facilitate documentation in future reports of progress made towards the achievement of RBM targets, and the prospects for reaching the overall RBM goal by 2010 and the targets of the United Nations Millennium Development Goals (MDGs) by 2015 (Box 1).
Table 1. Basic malaria monitoring and evaluation framework 
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BOX 1. KEY MALARIA CONTROL GOALS AND TARGETS
RBM Partnership
Millennium Development Goals
Indicator 21.Prevalence and death rates associated with malaria (WHO). Abuja coverage targets, from the African Summit on Roll Back Malaria, April 2000 (8), by 2005
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