The year 2011 had come and gone. It is in the interest of forging ahead that we should review some achievements, challenges and landmarks as we are ushered into 2012. This article is about Malaria and 2011 which is captured in a detail report by World Health Organization (W.H.O) titled 'World Malaria report 2011'. It summarizes information received from 106 malaria-endemic countries and other sources and updates the analyses presented in the 2010 report. It highlights continued progress made towards meeting the international targets for malaria control set for 2010 and 2015.

Internationally agreed targets and goals for malaria control

The year 2010 was the date set to achieve universal coverage for all populations at risk of malaria using locally appropriate interventions for prevention and case management, and to reduce the malaria burden by at least 50% compared to the levels in the year 2000. In the light of progress made by 2010, the Roll Back Malaria (RBM) targets were updated in June 2011. The targets are now to reduce global malaria deaths to near zero by end-2015; (ii) reduce global malaria cases by 75% from 2000 levels by end-2015; and (iii) eliminate malaria by end-2015 in 10 new countries since 2008, including in the WHO European Region. These targets will be met by: achieving and sustaining universal access to, and utilization of, preventive measures; achieving universal access to case management in the public and private sectors and in the community (including appropriate referral); and accelerating the development of surveillance systems.

Impact of malaria control

A growing number of countries have recorded decreases in the number of confirmed cases of malaria and/ or reported admissions and deaths since 2000. Global control efforts have resulted in a reduction in the incidence of malaria and malaria specific mortality rates.

A total of 8 countries and one area in the WHO African Region showed > 50% reduction in either confirmed malaria cases or malaria admissions and deaths in recent years (Algeria, Botswana, Cape Verde, Namibia, Rwanda, Sao Tome and Principe, South Africa, Swaziland, and Zanzibar, United Republic of Tanzania). Eritrea, Ethiopia, Senegal and Zambia showed reductions of 25%-50%. In all countries, the decreases are associated with intense malaria control interventions. The increases in malaria cases observed in Rwanda and in Sao Tome and Principe in 2009 (two countries that had previously reported reductions) were reversed after intensification of

control measures. This highlights the need to build systems for effective surveillance of malaria and to rigorously maintain control programmes even when cases have been reduced substantially. According to available information, increases in cases and deaths observed in Zambia in 2009 have not yet been reversed.

While substantial decreases in the numbers of malaria cases are observed in countries with well developed surveillance systems, it is much more difficult to detect such changes in countries where surveillance systems are weaker, particularly in the more populous countries of Central and West Africa.

The World Malaria report 2011 provided highlights in malaria incidence and trends and recommended that more detailed investigation of trends in malaria cases and changes in diagnostic practice is needed to obtain a more accurate picture of the real changes in malaria incidence. There were 8 countries in the pre-elimination stage of malaria control in 2011 and 9 countries are implementing elimination programmes nationwide (8 having entered the elimination phase in 2008). A further 8 countries (Bahamas, Egypt, Georgia, Iraq, Jamaica, Oman, Russian Federation, and Syrian Arab Republic) have interrupted transmission and are in the prevention of reintroduction phase. Armenia was certified as free of malaria by the WHO Director-General in 2011.

An estimated 3.3 billion people were at risk of malaria in 2010. Of this total, 2.1 billion were at low risk (< 1 reported case per 1000 population), 94% of whom were living in geographic regions other than the WHO African Region. The 1.2 billion at high risk (> 1 case per 1000 population) were living mostly in the WHO African (47%) and South-East Asia Regions (37%). 43. There were an estimated 216 million episodes of malaria in 2010, with a wide uncertainty interval (5th-95th centiles) from 149 million to 274 million cases. Approximately 81%, or 174 million (113-239 million) cases, were in the African Region, with the South-East Asian Region accounting for another 13%. 44. There were an estimated 655 000 (537 000-907 000) malaria deaths in 2010, of which 91% (596 000, range 468 000-837 000) were in the African Region.

Approximately 86% of malaria deaths globally were of children under 5 years of age. 45. The estimated incidence of malaria has fallen by 17% globally between 2000 and 2010. Larger percentage reductions are seen in the European (99.5%), American (60%) and Western Pacific regions (38%). Malaria specific mortality rates have fallen by 25% between 2000 and 2010 with the largest percentage reductions seen in the European (99%), American (55%), Western Pacific (42%) and African Regions (33%). 46. Estimates of malaria incidence are based, in part, on the numbers of cases reported by National Malaria Control Programme (NMCPs). These case reports are far from complete in most countries. A total of 24 million confirmed malaria cases were reported by NMCPs in 2010, or 11% of the estimated global case incidence.

In the part two of this article, we will comment on the impact of Malaria in Nigeria in 2011.