Democratic Republic of Congo

Malaria situation

The Democratic Republic of Congo (DRC) has the 2nd highest number of malaria cases and deaths globally (12% of cases and 11% of deaths) and 54.6% of cases in Central Africa in 2018.1  Malaria is the main cause of morbidity and mortality in the country. It accounted for more than 40 % of all outpatient visits. Between 2015 and 2018, the malaria case burden fell by about 4% from 320 to 309 per 1000 of the population at risk.20 Deaths fell by nearly 10% from 0.59 to 0.53 per 1000 of the population at risk.2

Malaria in young children

19 % of deaths among children under five years of age in 2016 were as a result of malaria.2 In 2016, about 47% of malaria episodes occurred in children under five years of age.2  

Severe malaria is responsible for 77% of hospitalization for children under five years of age and 55% of hospitalization for patients over five years of age.2 However, research revealed that many alleged cases of malaria are in fact bacterial sepsis cases3 and that mortality due to severe malaria on young children is just over 10%.4

The National Guide for Implementation of Community Care Sites (2016) defines the package of services to include referral of severe malaria cases and treatment of uncomplicated malaria cases in children under five years of age.2

Severe malaria case management

There is a high availability of Injectable quinine; It is available in 80% of primary health centers although it is not the first-line treatment for severe malaria.2 The USAID’s President’s Malaria Initiative is also supporting the implementation of artesunate rectal capsules for pre-referral intervention and will similarly provide future trainings for peripheral health facilities and at the community level.2

There was also a net improvement in the receipt of two doses of sulfadoxine-pyrimethamine, which is for the Intermittent Preventive Treatment of malaria in Pregnancy from 66% to 69% (from 2015 to 2016).1

Health policies

Key updates within DRC’s health policies include the incorporation of World Health Organization’s current antenatal care recommendations into national policies and the Malaria in Pregnancy Strategy. This decision was jointly taken by the National Reproduction Health Program and the National Malaria Control Programme.2

Admissions and death rates

Photo: World Malaria Report 2018 DRC country profile

Severe malaria distribution

Photo: World Malaria Report DRC country profile 2018

Malaria prevalence

  • Equatorial variant (forests and savannahs):  most severe cases occur in under-5s
     
  • Tropical variant (humid areas): more severe cases of malaria are observed up to a greater age
     
  • Mountainous variant (areas at an altitude of over 1,000 m): Severe cases of malaria can occur in all age brackets and as an epidemic or as acute annual outbreaks

Malaria control and elimination stages

Malaria control and elimination stages (PMI DRC Malaria Operational Plan 2019)

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong Injectable artesunate
Alternative Injectable quinine
Recommendation Pre-referral
Strong Rectal artesunate
Recommendation during pregnancy
Intravenous quinine 
"In line with the WHO recommendation, injectable quinine should be replaced with injectable artesunate in the treatment of serious cases by June 2015. The systematic substitution of quinine with injectable artesunate has a significant economic impact on the budget. The transfer plan envisions a transition period of 3 years, initially defined as 2013 to 2015 in line with the NSP, but following the challenges of funding gaps and availability of pre-qualified injectable artesunate on the market, the estimated transition period is now from 2014 to 2016." - The Global Fund DRC malaria Concept Note