State of Malaria in the E8

With significant progress having been reported since 2000 in the fight against malaria both globally and within the Southern African region, there is an even greater urgency to reduce the burden of malaria through joint efforts of regional blocs and cross border collaboration.

Snapshot: The Burden of Disease – Globally, and in the E8

The frontline four countries of the E8 are aiming to eliminate local malaria transmission by 2020. These countries – Botswana, Namibia, South Africa, and Swaziland – dramatically reduced malaria incidence between 2000 and 2012, and are now making the strategic move from control efforts (keeping illness low and minimizing the public health burden), to total elimination (no local transmission within their boundaries).

Dramatic Decline in Malaria Cases in the E8’s frontline four



While malaria transmission has declined across E8 countries, malaria transmission intensity varies significantly across the E8 countries. Malaria transmission dynamics across the E8 countries are also highly interconnected. The transmission gradient, along with high population movement across borders results in movement of malaria across borders, undermining individual country elimination efforts.

Source: CHAI

Surge in Number of Cases in 2016/2017 Malaria Season

E8 has experienced a surge in the number of cases reported for the 2016/2017 malaria season, where 2 countries had declared an outbreak (Botswana and Namibia), while another four countries reported more localized increases above the average patterns of the past transmission seasons.

Botswana and Namibia have experienced the sharpest increases in cases, in Okavango district (Botswana) and Kavango regions (Namibia) most notably. In South Africa and Zimbabwe, the increasing trend is more closely associated with population displacement associated with the heavy rains, which has resulted in limited access to services and movement of communities in search of more accessible routes and safer shelter. In Mozambique, provinces of higher transmission to the north have been most affected, while the southern pre-elimination provinces of Maputo and Maputo province have maintained progress towards elimination. Angola has experienced an interruption of funding, which has left the southern parts of the country without resources for a sustained prevention effort. Swaziland has sustained the gains and has not presented an increased trend, while Zambia was acknowledged for impressive progress towards control and elimination, particularly when compared to increasing patterns among all of its neighbours.

While malaria transmission has declined across E8 countries, its distribution remains highly heterogeneous across the region. Transmission boundaries have been established between countries to determine the source of transmission between countries and be better able to develop targeted interventions that address transmission at source.

The E8 annual scorecard reports local vs imported cases, demonstrating the number of cases that are imported annually. This is an important strategic priority for the E8, to investigate the “interconnectedness” of member states and thus address elimination by addressing one of the greatest threats to elimination, being the proximity and connectedness with higher transmission neighbours, and the risk of cross-border transmission.

The map above focuses on most affected areas in the E8, during the malaria season 2016-2017 (outbreaks were also reported in parts of Zimbabwe, Mozambique and South Africa).

The E8 scorecard annually tracks progress towards the common goals – elimination in the frontline four by 2020 (Botswana, Namibia, South Africa, Swaziland) and in the second-line four by 2030.