How long is the last mile? Evaluating successful malaria elimination trajectories [Dataset]

Annual malaria case series were sought for 54 successful elimination programmes through an extensive non-systematic review of published and unpublished documents, including searches of PubMed (https://pubmed.ncbi.nlm.nih.gov/), Google Scholar (scholar.google.com), Google Books (books.google.com), WHO’s Institutional Repository for Information Sharing (https://apps.who.int/iris), online surveillance databases, and the authors’ existing collection of malaria-related books and reports. Several of these elimination programmes were implemented in regions that today have disputed jurisdictional claims or countries that no longer exist; their inclusion is to understand the impact of the historical programmes implemented there and no statement on their current geopolitical context is intended.

When annual case totals were classified by origin, the number of locally acquired (i.e., autochthonous) cases was recorded separately from the number of imported cases. If not classified (as is typical until case incidence falls to very low levels), all reported cases were assumed to be locally acquired. Where locally acquired cases were further subclassified, indigenous and cryptic cases were tallied together, while introduced or induced cases were not included in case totals since such cases may arise sporadically in response to importation and are not considered to jeopardize elimination. 

The first year in which zero indigenous or locally acquired cases were recorded was taken as the termination point of the case series, regardless of whether sporadic or resurgent local transmission occurred subsequently. While this definition of elimination is looser than that required for certification by WHO (i.e., three years with no indigenous transmission), it permits us to examine a wider range of elimination experiences, including some where success was not maintained. Secondary re-elimination efforts (where a year with zero local cases was achieved, malaria subsequently resurged, and then elimination was again achieved), as in the case of Mauritius or the former republics of the USSR, were not included. 

Sources for the malaria case data are enumerated in the accompanying Word document. For questions or clarifications, please contact Justin Cohen at jcohen@clintonhealthaccess.org.