Malaria remains a major public health problem in Sudan. The total population is considered to be at risk of malaria, and 36,325,531 people (86.7%) are at high risk. In 2018, the disease lead to a mid-point estimated 1,954,302 cases (904,000; 3,686,000) and 5,003 deaths (120; 12,300). The disease is considered as a priority in the “National Health Policy, 2017 -2030” and in the National Health Recovery and Reform Policy and Strategic Plan, 2020 -2022 (NHRRP-SP). Both documents considered progress in malaria control as an important landmark for poverty reduction and Sustainable Development Goals (SDGs).
Malaria transmission in Sudan is characterized by a seasonal and unstable pattern. This temporal and spatial distribution is mainly determined by the diverse eco-climatic conditions. The rainfall diversity (ranging between 3 to 237 mm), irrigation pattern and habitation play a major role. The major transmission season is during the period September - December following the main rainy season (July - September) in the North, and (June to November) in the South. A shorter transmission season follows during the January - March season in some parts of the country. Almost all population groups in Sudan are at risk of malaria.
From 2010 to 2018, the “reported confirmed” and the “reported confirmed and presumed” were increasing with notable jump in 2017 and 2018. In 2018, the “reported confirmed and presumed” cases exceeded the mid-point estimates. The reported confirmed malaria cases increased from 14.2/1000 population in 2016 to 17.7/1000 in 2017 and 38.4/1000 in 2018. The increase of the “reported confirmed and presumed” was even sharper: from 22.5 to 38.3 and 85.7 per 1000 over the same years (Fig. 7). During the same period (2010 -2018), reported malaria deaths were far below the estimated figures but the trend was similar with notable increase in 2017 and 2018 (Fig 8). The malaria deaths rate showed steady increase; from 1.8 to 3.8 to 7.5 per 100,000 population in 2016, 2017 and 2018 respectively.
During the period 2005 - 2009 – 2012 – 2016 malaria prevalence dropped from 3.7% to 1.8% and then in 2012 and 2016 increased to 3.3 , 5.9 According to MIS 2016, the overall parasite prevalence was 5.9% (95% CI: 5.7% - 6.2%). Prevalence varies between states. Central Darfur reported the highest prevalence in this survey (21.8%) followed by South Kordofan (14.4%) and Blue Nile (12.1%). Khartoum, River Nile, Northern, White Nile and Red Sea states reported a prevalence of less than 1%. Due to the unstable and seasonal pattern of malaria transmission, malaria was seen in all age groups, but prevalence was significantly higher in children than in adults, in males than in females and in pregnant women compared to non-pregnant. The ratios between the prevalence rates in 2016 vs. 2012 were higher in the higher age-groups than among young children. Thus, there was a (modest) shift of burden towards higher age-groups suggesting lower transmission intensity in recent years compared to around 2012. On the other hand, the prevalence in all age-groups was higher in 2016 than in 2012. The prevalence among camps population tripled that among urban population and double that among rural residence. Higher prevalence was reported among population of lowest, second and middle quintiles.
Since the 2016 survey, the DCD – FMoH/ Sudan has undertaken several measures to increase coverage of interventions and reduce the use of Artemisinin monotherapies (ACT) for uncomplicated malaria, universal coverage by Long-lasting insecticidal nets (LLIN), supported by indoor residual spraying of insecticide (IRS) in agricultural Schemes and Larval Source Management (LSM) in urban setting. The aim of this survey is to monitor use of main Malaria Control interventions and level of Malaria case Management after 2016 to track the progress that has made for achieving situated malaria objectives and to update the baselines for second generation of contributing in Global Technical Strategic Plan (GTS).
The main objective of this consultancy is to lead the designing and implementation of the 5th round of the national malaria indicator survey (MIS)