Lai, Shengjie, Li, Zhongjie, Wardrop, Nicola A., Sun, Junling, Head, Michael G., Huang, Zhuojie, Zhou, Sheng, Yu, Jianxing, Zhang, Zike, Zhou, Shui-Sen, Xia, Zhigui, Wang, Rubo, Zheng, Bin, Ruan, Yao, Zhang, Li, Zhou, Xiao-Nong, Tatem, Andrew J. and Yu, Hongjie (2017) Malaria in China 2011-2015: an observational study. Bulletin of the World Health Organization, 95 (8), 545-608. (doi:10.2471/BLT.17.191668).
Abstract
Objective To ascertain the trends and burden of malaria in China and the costs of intervention for 2011-2015 while experiencing transitions between funders during a national plan launched to interrupt malaria transmission in most counties by 2015 and ultimately eliminate malaria by 2020.
Methods We analysed the spatiotemporal and demographic features of autochthonous and imported malaria 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.
Findings A total of 17,745 malaria cases, including 123 deaths (0.7%), were reported in mainland China from 2011-2015, with 89% being imported cases, mainly from Africa and Southeast Asia. Most counties (99.9%) have achieved their elimination goals by 2015, and autochthonous cases dropped from 1,469 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 US$134.6 million was spent in efforts to eliminate malaria during 2011-2015, with US$57.2 million (42.5%) from the Global Fund and US$77.3 million (57.5%) from the Chinese Central Government. The average annual investment per person at risk was $0.05 (SD 0.03) with the highest ($0.09) in 2012 and subsequent reductions between 2013 and 2015 after the Global Fund ceased providing investments.
Conclusion The autochthonous malaria burden in China has decreased significantly, and malaria elimination is an achievable prospect in China. The key challenge is to address the remaining autochthonous transmission, as well as simultaneously reducing importation from Africa and Southeast Asia. Continued efforts and appropriate levels of investment are needed in the 2016-2020 period to achieve elimination.
Keywords: Malaria; epidemiology; elimination; cost; importation; China.
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