Abstract
ObjectiveTo ascertain the trends and burden of malaria in China and the costs of interventions for 2011–2015.MethodsWe analysed the spatiotemporal and demographic features of locally transmitted and imported malaria cases using disaggregated surveillance data on malaria from 2011 to 2015, covering the range of dominant malaria vectors in China. The total and mean costs for malaria elimination were calculated by funding sources, interventions and population at risk.FindingsA total of 17 745 malaria cases, including 123 deaths (0.7%), were reported in mainland China, with 15 840 (89%) being imported cases, mainly from Africa and south-east Asia. Almost all counties of China (2855/2858) had achieved their elimination goals by 2015, and locally transmitted cases dropped from 1469 cases in 2011 to 43 cases in 2015, mainly occurring in the regions bordering Myanmar where Anopheles minimus and An. dirus are the dominant vector species. A total of United States dollars (US$) 134.6 million was spent in efforts to eliminate malaria during 2011–2015, with US$ 57.2 million (43%) from the Global Fund to Fight AIDS, Tuberculosis and Malaria and US$ 77.3 million (57%) from the Chinese central government. The mean annual investment (US$ 27 million) per person at risk (574 million) was US$ 0.05 (standard deviation: 0.03).ConclusionThe locally transmitted malaria burden in China has decreased. The key challenge is to address the remaining local transmission, as well as to reduce imported cases from Africa and south-east Asia. Continued efforts and appropriate levels of investment are needed in the 2016–2020 period to achieve elimination.
Highlights
Malaria remains a public health issue, with an estimated 214 million cases and 438 000 deaths globally in 2015.1,2 Historically, malaria has been widespread in China, with 24 malariaendemic provinces and over 24 million cases being reported in the early 1970s
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, 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]
2012.9,10 the coverage of Global Fund-supported projects expanded from 47 high malaria-burden counties in 2003 to 762 high and lower malaria-burden counties 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
Summary
Malaria remains a public health issue, with an estimated 214 million cases and 438 000 deaths globally in 2015.1,2 Historically, malaria has been widespread in China, with 24 malariaendemic 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. 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]
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