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Nature. 2015 Oct 8;526(7572):207-211. doi: 10.1038/nature15535. Epub 2015 Sep 16.

The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015.

Author information

Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK.
Institute for Disease Modeling, Intellectual Ventures, 1555 132nd Ave NE, Bellevue, WA 98005, USA.
Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. BOX 4002, Basel, Switzerland.
University of Basel, Petersplatz 1, P.O. BOX 4001, Basel, Switzerland.
Malaria Elimination Initiative, University of California San Francisco, 500 Parnassus Ave, San Francisco, CA 94143, San Francisco, USA.
Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200 New Orleans, LA 70112, USA.
MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK.
Global Malaria Programme, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
Department of Mathematical Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
Clinton Health Access Initiative, Boston, MA, USA.
Institute for Health Metrics and Evaluation, 2301 Fifth Ave., Suite 600, Seattle, WA 98121, USA.
Sanaria Institute for Global Health and Tropical Medicine, Rockville, MD 20850, USA.
Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892-2220, USA.
Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK.
Contributed equally


Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015, and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542-753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies.

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