Malaria is a major public health problem and one of the principal causes of morbidity and mortality in many African countries. Approximately half of all countries with ongoing malaria transmission are on track to meet the World Health Assembly and Roll Back Malaria target: to achieve a 75% reduction in malaria cases by 2015 compared to levels in 2000. Nevertheless, progress in more than a third of countries cannot be assessed due to limitations in their reported data. Unfortunately, surveillance systems are weaker where the malaria burden is higher.
Angola has emerged from three decades of civil war (1975–2002), which interrupted malaria control activities and severely damaged the public health infrastructure. Approximately 3.2 million cases of malaria were reported in 2004, of which two-thirds were in children under five years. Plasmodium falciparum is responsible for more than 90% of malaria infections in Angola and anopheline species most involved in transmission are Anopheles gambiae, Anopheles funestus and Anopheles melas. A national survey performed in 2011 showed malaria prevalence of 13% in children under the age of five. However, prevalence varies depending on the area: malaria is hyperendemic in the north, meso-endemic stable in the centre, and meso-endemic unstable in the south. Apart from this survey, scarce information about malaria epidemiology has been published and where available, it only describes the northern region of Angola. Furthermore, this information shows malaria prevalence to be much lower in under-fives than reported previously.
Cubal is a village of Benguela Province, located in western Angola, with a population of 300,000 inhabitants (Figure 1). The village is on the central highlands of Angola, 900 m above sea level and has a six-month wet season (from November to April). The malaria transmission in Cubal is reported to be meso-endemic stable according the national survey in 2011, however, there are no published data of the transmission in this area. The main health facility in Cubal is the Hospital Nossa Senhora da Paz (HNSP), and it is a referent for infectious pathology in the area. There is another hospital in Cubal (the Municipal Hospital), which also attends to patients with malaria. In 2007, an agreement was established with the Infectious Diseases Department of the Vall d'Hebron University Hospital (Spain), leading to various collaborative projects that focus mainly on malaria, soil-transmitted helminthes, tuberculosis and schistosomiasis. The objective of this study is to describe the epidemiology of malaria at the HNSP and the fatality rate due to malaria (total and in children under five years) in the last five years.
Map of Angola.