Thanks to increased disease control, global deaths to malaria have fallen dramatically, and the number of new cases is steadily declining, say the World Health Organization in a new report. Also, an increasing number of countries are moving toward eliminating the mosquito-borne disease altogether. But the UN agency warns these gains are fragile, and no more so than in countries worse-affected by the Ebola crisis.

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A new report from the World Health Organization says the number of lives claimed by malaria worldwide fell by 47% between 2000 and 2013, and by 54% in Africa, where the vast majority of deaths occur.

The 2014 World Health Organization (WHO) report says deaths to malaria worldwide fell by 47% between 2000 and 2013. In the WHO African Region, where 90% of deaths to malaria occur, the reduction is 54%.

WHO say the dramatic progress is thanks to increased malaria control, including better diagnosis and treatment and more access to defense mechanisms such as effective bed-nets.

However, WHO Director-General Dr. Margaret Chan says:

“We can win the fight against malaria. We have the right tools and our defenses are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Malaria is a huge global problem, threatening over 3 billion people in 97 nations. WHO estimates for 2013 suggest 198 million people are living with malaria – 82% of them in Africa. The disease claimed an estimated 584,000 lives in 2013, including 453,000 children under the age of 5.

Humans catch malaria via the bite of a mosquito infected with the Plasmodium parasite. Once it gets into the new host’s bloodstream, the parasite invades and destroys red blood cells.

As the red blood cells succumb to the parasite, the infected individual experiences symptoms of malaria, including headache, chills, muscle aches, tiredness, nausea, vomiting and diarrhea.

Severe malaria is caused by a species of Plasmodium known as P. falciparum and results in coma, severe breathing problems, low blood sugar and severe anemia. If untreated, it can be fatal. Children are particularly susceptible because they have little or no immunity to the parasite.

The new WHO report includes a new analysis of the malaria situation across sub-Saharan Africa, where despite a 43% increase in the population between 2000 and 2013, the number of people infected with malaria fell from 173-128 million.

Improved control of malaria is the reason for this dramatic progress, says the report. For example, access to insecticide-treated bed nets has increased significantly in the last 10 years. In 2004, only 3% of the malaria-threatened population in sub-Saharan Africa could get hold of an effective bed-net. By 2013, this figure was nearly 50%.

Improved access to better diagnosis and treatment is also responsible for the dramatic fall in deaths and cases, says the UN health agency. The number of rapid diagnostic tests purchased for malaria shot up from 46 million in 2008 to 319 million in 2013. There was an even steeper rise in procurement of artemisinin-based combination therapies – a key treatment for malaria – from 11 million courses in 2005 to 392 million in 2013.

The report notes that more countries are moving toward eradication of malaria, and many regions are declaring ambitious targets. For example, at a recent East Asia Summit there was a declaration to eliminate malaria from the Asia-Pacific by 2030.

However, the gains are fragile and significant challenges remain. Among these is the rise in insecticide resistance and treatment resistance, and the fact millions of people still do not have access to accurate diagnosis and effective treatment. Progress is also slow in increasing preventive treatment for pregnant women and the under-5s.

WHO say funding is also a problem – despite it having trebled since 2005, it is still 50% short of the $5.1 billion needed to attain global targets.

Particularly at risk is the progress on malaria in the West African countries affected by the current Ebola crisis. The outbreak has had a devastating effect on the roll-out of malaria treatment and prevention campaigns. In the three countries most severely affected by Ebola – Guinea, Sierra Leone and Liberia – most inpatient facilities are closed, and outpatient facilities are only a small fraction of what they were before the epidemic.

WHO have issued new guidance for malaria control in these three countries, where in 2013, there were 6.6 million cases of malaria and 20,000 lives lost to the disease.

The new malaria control guidance for Guinea, Sierra Leone and Liberia, includes providing malaria treatment to all patients with fever – even if they have been tested for malaria – and to give anti-malaria drugs to all in areas heavily affected by Ebola where malaria transmission is high .

The WHO report also says the need for more anti-malaria bednets in Ebola-affected areas is being met by a boost in international donor funds.

Ray Chambers, the UN Secretary-General’s Special Envoy for Malaria, acknowledges the progress but says we must not lose sight of the goal:

While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable.”