Introduction

Despite a 42 percent decrease in global malaria mortality since 2000, the disease was estimated to cause 627,000 estimated deaths worldwide in 2012. Ninety percent of all estimated deaths occurred in sub-Saharan Africa, and 77 percent were in children under age five. Malaria-endemic countries also bear considerable indirect long-term costs associated with physical and cognitive retardation, malnutrition, anemia, and increased disease susceptibility.

Macroeconomic nonhealth costs to the economy result from reduced labor market productivity and loss of tourism and business investment, in addition to lost capital and purchasing power (Mills and Shillcutt, 2004). Annual per-capita GNP growth also suffers; this is particularly costly for malaria-endemic countries, which are among the world's poorest.

In addition to malaria being the focus of MDG 6, in 2007, the World Health Assembly passed a resolution calling for a 75 percent reduction in the global malaria burden by 2015. Between 2000 and 2010, the substantial expansion of malaria interventions has led to a 26 percent decline in malariaspecific mortality rates globally while the estimated global incidence of malaria declined by 17 percent. In the decade since 2000, 1.1 million deaths from malaria were averted and reported malaria cases reduced by more than 50 percent in 43 of the 99 countries with ongoing transmission (WHO, 2012).

The past decade of malaria control has seen significant changes in antimalarial drug policies, mass distribution of insecticide-treated bed nets, and corresponding declines in the incidence of malaria (Fegan et al., 2007). A big push is being contemplated to eliminate malaria in areas of unstable transmission, with the eventual goal of global elimination (Smith et al., 2013). However, despite impressive gains, potential resistance to the first-line drug, artemisinin, looms large; besides declining financial support for malaria control, artemisinin resistance is likely one of the greatest threats to the gains made globally in rolling back malaria, while long-lasting insecticide-treated bed nets (LLITNs) have yet to be fully deployed in some parts of the world where they could be useful.