Areas for improvement to further reduce malaria burden in sub-Saharan Africa?

In 2012, sub-Saharan African countries account for 80% of all malaria cases worldwide. Malaria hampers their development both socially and economically. Global efforts to control malaria in sub-Saharan Africa have been placed in the past. In particular, since 2005, funding for Malaria control has increased dramatically.However, little is known about malaria incidence and mortality rate among sub-Saharan African countries overall. Only few studies investigated, and focused on a few countries in sub-Saharan Africa with limited attributing factors. We expect that national level operational intervention, malaria funding, and economic factors would be associated with reduction of malaria incidence and mortality. Our objectives are to assess progress of malaria control in sub-Saharan Africa overall and associated factors with malaria control. With data between 2005 and 2013 from World Malaria Reports and The World Bank, a dataset was constructed to associate reduction of malaria incidence and mortality rate with national economic factors, malaria funding, and malaria operational interventions. General Liner Model was used for the statistical analyses. Malaria incidence rate was inversely associated with GDP per capita (AME = -0.267, p-value = 0.004), but was positively associated with foreign aid per capita (AME = 0.158, p-value = 0.013)and ACT treatment courses delivered (AME = 0.069, p-value = 0.000). Malaria mortality rate was positively associated with foreign aid per capita (AME = 0.017, p-value = 0.016) and with increased number of ACT treatment courses delivered (AME = 0.073, p-value = 0.004). Increase of ODA per capita was associated with increase of distributed number of ITN/LLIN (AME = 6.601, p-value = 0.006). IRS (AME = 9.421, p-value = 0.001), and ACT (AME = 6.84, p-value = 0.064). In addition, increase of foreign aid per capita was positively associated with distributed number of IRS (AME = 4.070, p-value = 0.00). Economic growth and internal funding increase should be pursued for sustainable malaria control. Careful attention to utilizing operational intervention effectively and adequate education of its utilization is required. As the complicated malaria control can be achieved by multiple efforts, systematic strategies including education, operational management, adequate infrastructure, and cooperation between organizations should be taken into account.