Academic journal article Bulletin of the World Health Organization

Malaria in China, 2011-2015: An Observational study/Paludisme En Chine, 2011-2015: Etude observationnelle/El Paludismo En China, 2011-2015: Un Estudio De Observacion

Academic journal article Bulletin of the World Health Organization

Malaria in China, 2011-2015: An Observational study/Paludisme En Chine, 2011-2015: Etude observationnelle/El Paludismo En China, 2011-2015: Un Estudio De Observacion

Article excerpt

Introduction

Malaria remains a public health issue, with an estimated 214 million cases and 438000 deaths globally in 2015. (1,2) Historically, malaria has been widespread in China, with 24 malaria-endemic provinces and over 24 million cases being reported in the early 1970s. Plasmodium vivax and P. falciparum are the main parasite species responsible. (3,4) After control efforts were intensified in China in 2007, the incidence of malaria was substantially reduced in the provinces with malaria transmission, with 95% of these counties (2345/2469) having an estimated incidence below 1 per 10 000 persons in 2009. (5) The Chinese government launched a national malaria elimination programme in May 2010, aimed at reducing the number of locally transmitted malaria cases across most of China to zero by 2015 (except in some border areas of Yunnan province where the goal is elimination by 2017), and achieving World Health Organization (WHO) certification of malaria elimination for China by 2020. (3,6) Comprehensive intervention policies and strategies have been adopted, (7,8) and in 2014 indigenous malaria infections were only found in Yunnan and Tibet provinces. (9)

Both international and domestic funds have been used to implement the national malaria elimination programme to achieve the goal of malaria elimination. The Global Fund to Fight AIDS, Tuberculosis and Malaria has supported China, with approximately United States dollars (US$) 113 million, to progress from control to elimination between 2003 and 2012. (9,10) Hence the coverage of Global Fund-supported projects expanded from 47 high malaria-burden counties (within 10 provinces) in 2003 to 762 high and lower malaria-burden counties (within 20 provinces) in 2010. (9) The Global Fund accounted for all documented operational malaria funding in China between 2005 and 2010, (11) and the national strategy application project from the Global Fund has been specific for malaria elimination in China since 2010. However, changes to eligibility criteria in November 2011 meant that China was no longer eligible for grant renewals, due to its categorization as an upper-middle-income country and the malaria burden being sufficiently low. (9,10) The national strategy application was closed ahead of schedule on 30 June 2012, and the Chinese central government has since been committed to covering the investment gaps. (9)

Few comprehensive analyses of the changing epidemiology of malaria in China have been done. The achievement of the national malaria elimination programme by 2015, the challenges for the halfway point goals and the evidence in favour of these actions has been more descriptive than quantitative. (9,12-15) Both donors and policy-makers should ideally have information about the costs and benefits of interventions. (16-18) A robust epidemiological and cost analysis is important to support the design and update of national strategies and future needs for malaria elimination. (17-19) We conducted an observational analysis to determine (i) the epidemiological trends and burden of malaria; (ii) the areas and populations with residual transmission; and (iii) the costs of interventions from different donors for malaria elimination from 2011 to 2015. This work identifies the achievements and challenges and thereby helps to plan resource allocation for the second half (2016-2020) of the elimination plan and the ultimate goals of the national malaria elimination programme in China.

Methods

Data sources

We obtained data on individual malaria cases, including clinically diagnosed and laboratory-confirmed cases reported in all 31 provinces of mainland China during 2011-2015, from the Chinese malaria enhanced surveillance information system. This system was developed as a part of the national malaria elimination programme to actively collect demographic and epidemiological information, using the unified form for case investigation required by the Chinese technical scheme of malaria elimination. …

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