Mali

Severe malaria facts

Mali is among the ten countries with the highest number of malaria cases and deaths (3% of the global cases and deaths and 7% of cases in West Africa).  From 2015 to 2018, cases plateaued at between 387 and 391 per 1000 of the population at risk while deaths fell by 30% from 0.89 to 0.62 per 1000 of the population at risk.1

The impact of malaria on children under five years of age in Mali is high. Mali has the 2nd highest level of severe anaemia among children under five years of age.1 Over 40% of children who reported having a fever were not brought for care and less than 30% of the children brought for care were tested for malaria.1 To reduce the burden of malaria in the country, the high burden, high impact approach was introduced in November 2019.1

Malaria prevalence varies across regions, from a minimum of 1% in Bamako to a maximum of 30% in Sikasso region.  The disease prevalence among children under five years of age was 19 % in 2018.  

The country has intentions of reaching universal coverage of bed net distribution by 2022.2 Malaria case management equally continues to be a key priority of the country’s health agenda.

There are three malaria zones in the country.  These are the:

Stable malaria zones: In this zone, the disease is transmitted throughout the year, with some seasonal variations. This transmission type impacts the Guinean and Sudanese zones as well as the dams and inner Niger Delta areas.

Unstable malaria zones: These areas have intermittent transmission of malaria (mainly the Sahelian-Saharan zone) and are impacted by epidemics; local inhabitants are therefore not sufficiently immune to malaria.4

Sporadic malaria zones: This is typical of the Saharan zone and the population has no immunity against malaria with all age groups being exposed to severe and complicated malaria infections.4

Safety nets for vulnerable populations
The country has introduced several policies in support of pregnant women and children.2 These include:  

  • free health care for children under 5 and pregnant women in 2017 
  • heavily subsidized care for the rest of the population

Key populations that may not have access to care include the destitute, internally displaced, refugees, repatriated and populations which have limited geographical access to health centers (over 5km), immigrants and nomads.4

Gaps

Persisting political insecurity and the deteriorated state of health care facilities in a number of areas aggravate the situation.

New malaria strategy

A new malaria control program was developed for the period 2018-2022 with the chief aim of decreasing malaria mortality and morbidity by 50 % versus 2016 levels.5 The use of artesunate rectal capsules prior to the transfer of patients (children) with severe malaria to a higher level healthcare facilities has been recommended by the National Malaria Control Programme since 2009, and has been incorporated into the National Malaria Control Policy in 2011.5

IPTp coverage

IPTp coverage has been on the increase. Between 2015 and 2018, coverage increased by 17 percentage points from 38% in 2015 to 55% of pregnant women attending antenatal care (ANC) receiving at least two doses of SP.2 IPTp3 (third IPTp dose) coverage rose by seven percentage points: 28% of pregnant women in the country received IPTp 3 in 2018 versus 21% in 2017.2

Addressing stock outs

The country also addressed the previous issue of persistent stock outs of sulfadoxine pyrimethamine (SP), the intervention for IPTp, by smoothing the timing for the order of SP and closely monitoring stock-out levels as well as increasing the distribution of SP.2

The SMC programme is being implemented in all but six districts within the country with the support of the NMCP, Global Fund, PMI, World Bank and UNICEF.5 

Inpatient and mortality rates

Distribution of malaria cases

Prevalence of P. falciparum (MIS 2015)

P. falciparum Parasite Prevalence

Severe malaria policy and practice

National Treatment Guidelines
Recommendation Treatment
Strong IV artesunate
Strong IM artesunate
Alternative IM artemether
Alternative IV quinine
Alternative IM quinine
Recommendation Pre-referral
Strong Rectal artesunate
Alternative IM artesunate
Alternative IM artemether
Alternative IM quinine
Treatment during pregnancy
Recommendation Treatment
Strong Inj artesunate
Alternative IM artemether
Alternative Inj quinine