Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015 and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542–753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies.

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Key Points Anemia accounted for 8.8% of the total disability from all conditions in 2010. Children <5 years and women still have the highest burden. Although iron-deficiency anemia is the most common etiology globally, other leading causes of anemia vary widely by geography, age, and sex.

Insecticide-treated nets (ITNs) for malaria control are widespread but coverage remains inadequate. We developed a Bayesian model using data from 102 national surveys, triangulated against delivery data and distribution reports, to generate year-by-year estimates of four ITN coverage indicators. We explored the impact of two potential 'inefficiencies': uneven net distribution among households and rapid rates of net loss from households. We estimated that, in 2013, 21% (17%–26%) of ITNs were over-allocated and this has worsened over time as overall net provision has increased. We estimated that rates of ITN loss from households are more rapid than previously thought, with 50% lost after 23 (20–28) months. We predict that the current estimate of 920 million additional ITNs required to achieve universal coverage would in reality yield a lower level of coverage (77% population access). By improving efficiency, however, the 920 million ITNs could yield population access as high as 95%.DOI: http://dx.doi.org/10.7554/eLife.09672.001

HE BURDEN OF MALARIA IN SUB-Saharan Africa remains intolerable, with more than 20% of all deaths of children younger than 5 years attributed to malaria, 1 resulting in up to 11.9 deaths per 1000 children living in malaria-endemic settings per year. 2 The Roll Back Malaria global partnership, founded by the World Health Organization, the United Nations Development Program, the United Nations Children's Fund, and the World Bank, aims to halve malaria mortality by 2010 through implementation of 4 key technical strategies: insecticide-treated bednets, improved case