Central African Republic

Malaria facts

The malaria prevalence rate in the Central African Republic is stable, with high transmission during the rainy season. Anopheles gambiae is the main vector, and Plasmodium falciparum is found in 99.6 percent of cases.[1] 

Globally, the Central African Republic accounted for 0.7% of all malaria cases and deaths in 2020, and 0.8% of all malaria deaths.[2] It accounted for 3% of malaria cases in Central Africa in 2020.[2] Between 2017 and 2020, case numbers increased slightly by 2.2% from 329 to 336 per 1000 of the population at risk, and deaths also increased slightly by 0.9% from 1.04 to 1.05 per 1000 of the population at risk.[2]  

For several years, the Central African Republic has been navigating a series of cyclical sociopolitical crises that have caused chronic nationwide instability, making it a “fragile state”. Approximately two-thirds of the country are still controlled by 14 armed groups and the security situation is precarious in several areas of the country.[4] The country’s complex military and political crisis leaves it exposed to epidemics. [1, 3] 

Malaria in pregnancy and children 

The percentage of pregnant women receiving three doses of intermittent preventive treatment (IPTp)3 has been increasing: 14% in 2015; 21% in 2016; 16% in 2017; 30% in 2018.[4] Among cases seen in a consultation in 2018, children aged under 5 years account for 53 percent of confirmed cases, 63 percent of severe cases and 67 percent of malaria-related deaths  recorded by health care facilities. Children aged under 5 years and pregnant women are the most vulnerable target populations. [1] 

Malaria case management and control 

Artemether-lumefantrine is used for the treatment of uncomplicated malaria while injectable artesunate and IM artemether as well as injectable quinine are used for severe malaria.[4] For patients with signs of severe malaria, community health workers administer artesunate rectal capsules (ARC) before referring them to the nearest health facility. About 60% of those at risk were protected by either indoor residual spraying (IRS) or insecticide treated nets (ITN).[4] 

Severe cases of malaria account for approximately 8% of malaria cases per year.[1] 

Health system challenges 

The unstable political situation, and the low volume of funding traditionally allocated to the health sector, significantly limits the Ministry of Health and Population’s capacity to respond to health needs. The Ministry of Health is faced with major structural challenges, including:[4]  

• Deteriorating institutional capacity 
• A shortage of quality human resources due to the exodus of qualified health workers to more secure places 
• Deteriorating preventive services at all levels of the health pyramid and epidemiological surveillance system 
• A resurgence of epidemics and preventable diseases, including malaria 
• Major needs in terms of infrastructure renovation, technical facilities and logistical resources 
• Frequent stock-outs of essential drugs and strategic supplies 
• An unreliable national health information system (NHIS) that threatens the quality of the health care and services offered to the population. 

Health facilities 

According to reports from malaria focal points, there were approximately 989 health care facilities in the Central African Republic in 2015, of which 835 were operational while 154 of these are non-operational.[4] 

The country drew up a national malaria control policy in 2016, in line with the Global Technical Strategy for Malaria 2016-2030. The plan included adopting the World Health Organization’s recommendation on Intermittent preventative treatment of malaria in pregnancy (IPTp).[1] 

As regards health care provision, 95% of health care facilities provide malaria care (diagnosis and treatment). IPTp is available at 77% of healthcare facilities. At the community level, the most accessible preventive and curative care services for children aged under 5 are malaria treatment (86%) and amoxicillin administration for the treatment of pneumonia (73%). [4] 

The involvement of private health care facilities in efforts to control different diseases, including malaria, TB and HIV, is limited to faith-based health care facilities that offer the full package of interventions (LLINs, IPT, diagnosis and treatment, antiretrovirals (ARVs) and anti-TB drugs). The for-profit private sector is underdeveloped in the country. [1].