1. World Health Organization
19 April, 2017
Malaria Medicines & Diagnostics: trends and supply requirements
Dr. Andrea Bosman
Diagnosis, Treatment and Vaccines
WHO Global Malaria Programme
4 November 2010, Geneva

2. World Health Organization
19 April, 2017
Proportion of patients seeking treatment for malaria symptoms
Use of diagnostic tests in formal health sector
53%
Clinical Diagnosis
(355 million/yr)
28%
No action
44%
Formal Health Sector
8% RDT
28%
Informal Private Sector
39% Microscopy
Source: CHAI Analysis, global estimates for patients living at risk of malaria, based on 2008 World Malaria Report & UNICEF Intervention Coverage Reports 2

3. ACT procurement for public sector distribution
World Health Organization
ACT procurement for public sector distribution
19 April, 2017
6-24 months from adoption to implementation
Millions of ACT treatment courses
Cumulative number of countries
WHO policy
on ACTs
GFappeal on ACTs
Forecast

4. Reduction of >50% in cases: 29 countries outside of Africa and …
(Source: World Malaria Report 2009)

5. World Health Organization
Reduction of >50% in cases: …. in 9 African countries
19 April, 2017
Eritrea
Rwanda
Zambia
Sao Tome and Principe
Also: Botswana, Cape Verde, Namibia, South Africa, Swaziland 5

6. World Health Organization
Malaria decrease in Africa due to
effective control
19 April, 2017
Systematic review: 24 studies
conducted between 1989 and in 15 different African countries
including 15’331 patients
Proportion of malaria among fevers highly variable: 2% to 81%: Median parasite rate = 26%
Median PfPR = 37%
Median PfPR = 17%
D'Acrémont et. al. (2009). PLoS Med, 6 (1): e252

7. World Health Organization
Diagnosis of malaria: % reported cases in public sector with parasitological diagnosis
19 April, 2017
Based on cases reported to WHO: African % biased upwards since countries reporting tend to undertake more case confirmation.

8. World Health Organization
19 April, 2017
Deployment of RDTs in Livingstone (Zambia): impact on malaria cases and ACT consumption
ACT
RDTs
From over 25'000 ACTs in 2007 to less than 5'000 in 2008
Source: NMCC, Zambia MoH

9. Reduction of ACT consumption with RDT scale-up in Senegal public health services
Courtesy of Dr S. Thiam, PNLP Senegal
~ 0.5 million less ACT consumed in

10. Rwanda: preliminary analysis (WMR 2010)
Malaria cases & ACT annual orders
% malaria positive %
% malaria outpatients
% malaria inpatients
LLIN
distribution

11. World Health Organization
19 April, 2017
Countries with projects on (integrated)
Community Case Management
PSI/TDR
Malaria Consortium
Save the Children
IRC
IRC: Uganda, Sierra Leone, Ethiopia, Ivory Coast, South Sudan, Rwanda
Save: Malawi, Mozambique, South Sudan
Malaria Consortium: Uganda, South Sudan, Zambia, Mozambique
PSI/TDR: Malawi, Mali, Cameroon, DRC
PMI/MCH: Benin, DRC, Malawi, Mali, Rwanda, Senegal, Uganda, Zambia
Catalytic Initiative/PMNCH: Mali, Ghana, Niger, Burkina Faso, Ethiopia, Malawi, Mozambique
Catalytic Initiative
PMI/MCH
Courtesy of Dr F. Pagnoni, TDR 11

12. Affordable Medicine Facility for malaria: Phase 1
World Health Organization
19 April, 2017
Affordable Medicine Facility for malaria: Phase 1
Ghana
Madagascar
Uganda
Tanzania
Nigeria
Niger
Kenya
Cambodia
As of Sept 2010, 92 first-line buyers
are making 24 co-payment requests
(equivalent to US$ 8.02 million).
AMFm co-paid ACTs are on sale in Ghana and Kenya. 12

13. Conclusions
Malaria reducing in near 40 countries due to high coverage of RDTs, ACTs and LLINs - often in combination
Reduction of ACT consumption in areas with high level of use of malaria diagnostics (e.g. testing >80% of suspected cases)
At global level impact on ACT needs is limited because:
low use of malaria diagnostics in countries with high burden
ongoing expansion of ACT access interventions, i.e community case management and AMFm (Phase I)
variable coverage of vector control (malaria resilience)