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Estimating the burden of imported malaria in the Asia Pacific region: a systematic review and meta-analysis
Kinley Penjor1,2, Binay Thapa1, Tsheten Tsheten3,4
1HEAL Global Research Centre, Health Research Institute, University of Canberra, Bruce, Canberra, Australian Capital Territory ACT 2617, Australia.
Introduction:
Imported malaria is a major barrier to achieve and sustain malaria elimination for countries in Asia Pacific. This systematic review and meta-analysis quantified the pooled prevalence of imported malaria in the region.
Methods:
The systematic review and meta-analysis protocol was registered in International Prospective Register of Systematic Reviews (CRD420251008817). Three databases including PubMed, Scopus and Web of Science were used for literature search from 1 January 2010 to 31 December 2024 for imported malaria in 22 Asia Pacific malaria eliminating countries. Pooled prevalence with 95% confidence intervals (CI) was calculated using an inverse variance random-effects meta-analysis. Heterogeneity, sensitivity analysis and publication bias were also assessed.
Results:
Based on 42 studies conducted in nine Asia Pacific countries with a total of 435 454 malaria cases, the pooled prevalence of imported malaria was 89.0% (95% CI: 75.9-95.5, I2-100%, n = 166 412 imported cases). The pooled prevalence of imported malaria in males, Plasmodium falciparum, and origin from Africa was 94% (95% CI: 92.0-96.0, I2-97.5%, n = 70 619), 57.0% (95% CI: 47.2-65.5, I2-99.5%, n = 60 999) and 64.3% (95% CI: 43.1-81.0, I2-99.5%, n = 67 511), respectively. The imported malaria varied by occupation with 53.0% (95% CI: 34.0-71.0, I2-99.7%, n = 7989) in labourer to 40.0% (95% CI: 15.0-72.0, I2-99.7%, n = 9611) in farmers. The subgroup meta-analysis revealed pooled prevalence of 84.6% (95% CI: 68.3-93.3, I2 -100% n = 154 792) in pre-elimination phase, and it ranged between 95.0% in Sri Lanka (95% CI: 13.0-100, n = 761) and China (95% CI:85.8-98.0, n = 156 031) to 3.2% (95% CI: 2.87-3.47, n = 407) in South Korea.
Conclusion:
Imported malaria constitutes a significant proportion of malaria cases in Asia Pacific malaria eliminating countries. The findings highlight the critical need for strengthened cross border coordination for surveillance, and tailored interventions to achieve and sustain malaria elimination efforts in the region.
Insights
Imported malaria is a significant challenge in Asia Pacific malaria elimination efforts, accounting for a high percentage of cases. Strengthening cross-border collaboration and targeted interventions are crucial for sustained elimination.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Imported malaria poses a substantial obstacle to achieving and sustaining malaria elimination in Asia Pacific countries.
- This systematic review and meta-analysis aimed to quantify the prevalence of imported malaria across the region.
Purpose of the Study:
- To systematically review and meta-analyze the pooled prevalence of imported malaria in Asia Pacific malaria-eliminating countries.
- To identify key characteristics associated with imported malaria cases.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, and Web of Science from January 2010 to December 2024.
- Data from 42 studies in nine Asia Pacific countries, encompassing 435,454 malaria cases, were included.
- Pooled prevalence was calculated using random-effects meta-analysis, with heterogeneity, sensitivity, and bias assessed.
Main Results:
- The overall pooled prevalence of imported malaria was 89.0% (95% CI: 75.9-95.5).
- Prevalence was high in males (94.0%), Plasmodium falciparum infections (57.0%), and cases originating from Africa (64.3%).
- Prevalence varied by occupation and country, with Sri Lanka and China reporting high rates, while South Korea reported a low rate.
Conclusions:
- Imported malaria represents a significant proportion of malaria cases in malaria-eliminating countries within the Asia Pacific region.
- Enhanced cross-border coordination for surveillance and tailored interventions are essential for successful malaria elimination.
- Sustained efforts are needed to address the persistent challenge of imported malaria.
