Sudan Carries Heaviest Burden of Malaria in Eastern Mediterranean

WHO Congratulates Sudan on Adopting the “High Burden to High Impact” Approach

Haffiya Abdalla

WHO welcomes the news from Sudan that it has adopted the “High burden to high impact” (HBHI) approach to accelerate progress against malaria. Through HBHI, countries hardest hit by malaria are reaching populations at greatest risk of malaria with tailored packages of interventions informed by local data and disease settings.

According to WHO’s latest World malaria report, Sudan carried the heaviest burden of malaria in the Eastern Mediterranean Region in 2020, accounting for more than half of all cases (56%) and deaths (61%). Between 2015 and 2020, the country registered an increase of more than 40% in its malaria case incidence. The Ministry of Health attributes the rise in cases to changes in rainfall patterns, frequent flooding, population movement, and the emergence of an invasive malaria vector, Anopheles Stephensi, among other factors.

“The HBHI approach relies on the strong political commitment to prioritizing the malaria fight,” said Dr. Ni’ma Saeed Abid, WHO Representative for Sudan. “On behalf of WHO, I would like to congratulate Sudan’s Federal Ministry of Health for its leadership in adopting this approach.”

He added: “The WHO Sudan country office will continue to provide technical support to the Ministry of Health to maximize the impact of its malaria response. As part of this effort, we will be selecting malaria as a flagship program and positioning it at the top of everyone’s agenda within WHO.”

With today’s announcement, Sudan joins 11 other high burden countries that have embraced the HBHI approach: Burkina Faso, Cameroon, the Democratic Republic of the Congo, Ghana, India, Mali, Mozambique, Niger, Nigeria, Uganda, and the United Republic of Tanzania. Together, they carry more than 70% of the global malaria burden. Progress in tackling malaria in these countries could change the global trajectory of the disease.

A New Approach to Malaria Control:

Since 2017, WHO has warned that global gains against malaria have leveled off, and that progress toward critical targets of the WHO global strategy is off track. The lagging progress prompted countries and global partners to mount renewed efforts to fight malaria. This included, in 2018, the launch of the HBHI approach, catalyzed by WHO and the RBM Partnership to End Malaria.

Country leadership is at the heart of HBHI, and ownership of the malaria challenge lies squarely in the hands of governments most affected by the disease. The approach calls on malaria-endemic countries and global partners to translate their stated political commitment into resources and tangible actions that will save more lives.

The strategic use of data is also a central pillar of this approach. HBHI countries are collecting and analyzing data to better understand the geographical spread of the disease. These analyses will help them maximize impact and use available funds in a more effective, efficient, and equitable way.

On this year’s World Malaria Day, WHO is shining a spotlight on the vital role of innovation in the global response to malaria. Reaching global malaria targets will require the development of new malaria-fighting tools, as well as innovations in the way that currently available tools are deployed.

In recent years, WHO has advocated for a shift in the way that malaria control tools are delivered – from a “one-size-fits-all” strategy to more strategic, customized approaches informed by local data. HBHI embodies this new approach.

A study conducted by Abdalla, Elfatih M Malik, and Kamil M Ali, revealed that estimation of the burden of malaria in Sudan is important for evidence-based planning of malaria control. Estimates of malaria burden in terms of DALYs (Disability Adjusted Life Years) were not developed locally.

The study synthesized information from different sources to calculate malaria incidence, mortality and DALYs lost in Sudan in 2002.

Malaria incidence in Sudan was estimated to be about 9 million episodes in 2002 and the number of deaths due to malaria was about 44,000. 2,877,000 DALYs were lost in Sudan in 2002 due to malaria mortality, episodes, anemia, and neurological sequelae. Children under five years of age had the highest-burden. Males had the highest incidence and mortality, but females lost more DALYs.

No local efforts have previously been made to measure the burden of malaria in terms of DALYs in Sudan, using locally-derived epidemiological data. As part of a project to measure the burden of diseases in Sudan, this study synthesized information about the epidemiology of malaria from different sources to calculate the national incidence rate, mortality rate, and DALYs lost due to malaria.

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