title: The changing risk of Plasmodium falciparum malaria infection in Africa: 2000-10: a spatial and temporal analysis of transmission intensity.
abstract: BACKGROUND
  Over a decade ago, the Roll Back Malaria Partnership was launched, and since then there has been unprecedented investment in malaria control. We examined the change in malaria transmission intensity during the period 2000-10 in Africa.
  
  
  METHODS
  We assembled a geocoded and community Plasmodium falciparum parasite rate standardised to the age group 2-10 years (PfPR2-10) database from across 49 endemic countries and territories in Africa from surveys undertaken since 1980. The data were used within a Bayesian space-time geostatistical framework to predict PfPR2-10 in 2000 and 2010 at a 1 × 1 km spatial resolution. Population distribution maps at the same spatial resolution were used to compute populations at risk by endemicity class and estimate population-adjusted PfPR2-10 (PAPfPR2-10) for each of the 44 countries for which predictions were possible for each year.
  
  
  RESULTS
  Between 2000 and 2010, the population in hyperendemic (>50% to 75% PfPR2-10) or holoendemic (>75% PfPR2-10) areas decreased from 218·6 million (34·4%) of 635·7 million to 183·5 million (22·5%) of 815·7 million across 44 malaria-endemic countries. 280·1 million (34·3%) people lived in areas of mesoendemic transmission (>10% to 50% PfPR2-10) in 2010 compared with 178·6 million (28·1%) in 2000. Population in areas of unstable or very low transmission (<5% PfPR2-10) increased from 131·7 million people (20·7%) in 2000 to 219·0 million (26·8%) in 2010. An estimated 217·6 million people, or 26·7% of the 2010 population, lived in areas where transmission had reduced by at least one PfPR2-10 endemicity class. 40 countries showed a reduction in national mean PAPfPR2-10. Only ten countries contributed 87·1% of the population living in areas of hyperendemic or holoendemic transmission in 2010.
  
  
  CONCLUSIONS
  Substantial reductions in malaria transmission have been achieved in endemic countries in Africa over the period 2000-10. However, 57% of the population in 2010 continued to live in areas where transmission remains moderate to intense and global support to sustain and accelerate the reduction of transmission must remain a priority.
  
  
  BACKGROUND
  Wellcome Trust.
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. Electronic address: anoor@kemri-wellcome.org.
authors.forename: Abdisalan M
authors.initials: AM
authors.lastname: Noor
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Damaris K
authors.initials: DK
authors.lastname: Kinyoki
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Clara W
authors.initials: CW
authors.lastname: Mundia
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Caroline W
authors.initials: CW
authors.lastname: Kabaria
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Jonesmus W
authors.initials: JW
authors.lastname: Mutua
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Alegana
authors.affiliation: WHO, Regional Office for Africa, Brazzaville, Republic of Congo.
authors.forename: Ibrahima Socé
authors.initials: IS
authors.lastname: Fall
authors.affiliation: Malaria Public Health Department, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D000349:Africa / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D019353:Endemic Diseases / Q000517:prevention & control / Q000706:statistics & numerical data; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission*; D015233:Models, Statistical; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D062206:Spatial Analysis; D013997:Time Factors