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Malaria in endemic areas: Epidemiology, prevention, and control

Joel G Breman, MD, DTPH
Section Editor
Johanna Daily, MD, MSc
Deputy Editor
Elinor L Baron, MD, DTMH


Malaria is endemic throughout most of the tropics. Ninety-five countries and territories have ongoing transmission [1]. Of the approximately 3.2 billion people living in malarious countries, 1.2 billion are at high risk; the World Health Organization (WHO) states that there were 214 million (range 149 to 303 million) cases of symptomatic malaria in 2015 (table 1).

Between 2000 and 2015, the incidence of malaria decreased by 32 percent, and the number of annual malaria cases estimated by the WHO decreased by 18 percent [1]. The vast majority of these cases and deaths are due to Plasmodium falciparum and occur in Africa, but Plasmodium vivax and Plasmodium knowlesi can also cause severe disease.

Important components for reducing the burden of malaria morbidity and mortality include more sensitive diagnostic tools, effective use of antimalarial drugs, improved personal and community protection, and mosquito control. The approach to elimination or control of malaria includes these basics, along with improvements in tracking of human illness and parasite surveillance, and effective resource delivery.

Issues related to epidemiology of malaria, including definitions and strategies for control, will be reviewed. Other related topics are discussed in detail separately. (See related topics.)


Overview — Malaria is transmitted via the bite of a female Anopheles spp mosquito, which occurs mainly between dusk and dawn. Other comparatively rare mechanisms for transmission include congenitally acquired disease, blood transfusion, sharing of contaminated needles, and organ transplantation [2,3].


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