There were estimated 247 million malaria case among 3.3 billion people at risk in 2006, causing nearly a million deaths, mostly of children under 5 years. 109 countries were endemic for malaria in 2008, 45 within the WHO African region. An estimated 3.3 billion people were at risk of malaria in 2006. Of this total, 2.1 billion were at low risk (< 1 reported case per 1000 population), 97% of whom were living in regions other than Africa. The 1.2 billion at high risk (more than or equal to 1 case per 1000 population) were living mostly in the WHO African (49%) and South-East Asia regions (37%). There were estiamted 247 million episodes of malaria in 2006, with a wide uncertainty interval (5th-95th centiles) from 189 million to 327 million cases. Eighty-six percent, or 212 million (152-287 million) cases, were in the African region. Eighty percent of the case in Africa were in 13 countries, and over half were in Nigeria, Democratic Republic of the Congo, Ethiopia, United Republic of Tanzania and Kenya. Among the cases that ocurred outside the African Region, 80% were in India, Sudan, Myanmar, Bangladesh, Indonesia, Papua New Guinea and Pakistan. There were an estimated 881,000 (610,000-1,212,000) malaria deaths in 2006, of which 91% (801,000, range 520,000-1,126,000) were in Africa and 85% were of children under 5 years of age. Estimates of malaria are based, in part, on the numbers of cases reported by national malaria control programmes (NMCPs). These case reports are far from complete in most countries. A total of 94 million malaria cases was reported by national malaria control programmes in 2006, or 38% of the estimated global case incidence. The true proportion of malaria episodes detected by NMCPs would have been lower than 38% because, in some countries, reported cases include patients that are diagnosed clinically but do not have malaria. NMCPs reported 301,000 malaria deaths, or 34% of estimated deaths worldwide in 2006. 1.1. Epidemiological profile Population. The total population for each country is taken from the World population prospects, 2006 revision. The population size of children under 5 years of age is also given since this age group is particularly susceptible to malaria infection and disease. Population by malaria endemicity. The country population is subdivided among three levels of malaria endemicity as reported by the national malaria control programme (NMCP): -Areas of high transmission, where the reported malaria case incidence from all species is 1 or more per 1000 population per year in 2006. -Areas of low transmission, where the reported malaria case incidence from all species is less than 1 per 1000 population per year in 2006, but greater than zero. Transmission in these areas is generally highly seasonal with our without epidemic peaks. -Malaria-free areas, where there is no continuing, local mosquito-borne malaria transmission, and all malaria cases are introduced. An area is designated malaria-free when no cases have occurred for several years. Areas may be malaria-free due to environmental factors or as a result of effective control efforts. In practice, malaria-free areas can only be accurately designated by national programmes taking into account the local epidemiological situation and entomological and biomarker investigations. Population at risk. The total population living in areas where malaria is endemic (low and high transmission). The population living in malaria-free areas is excluded. The population at risk is used as the denominator when calculating the operational coverage of ITN and IRS, and hence to assess current and future needs, taking into account the population already covered. Stratification of burden. Epidemiological maps for each country are based on the malaria cases reported in 2006 at the first administrative level (province, region, state, etc.). Four levels of endemicity are depicted: -100 or more cases per 1000 population per year -1 or more cases per 1000 population per year, and less than 100 cases -less than 1 case per 1000 population per year but more than zero -zero recorded cases. The first two categories correspond to the high-transmission category described above. Vector and parasite profile. The species of mosquito responsible for malaria transmission in a country, and the species of Plasmodium involved, are listed according to information provided by WHO regional offices. Estimated burden of malaria. Estimates of the number of malaria cases and deaths for 2006 are given, together with lower and upper limits. The estimates for numbers of cases are for confirmed cases, i.e. fever with parasites. Each estimate was derived by one of two methods: a) by adjusting the malaria cases reported by countries for reporting completeness, health-facility utilization and case-confirmation rates; or b) if the quality of case reporting was not considered sufficiently high, from an empirical relationship between measures of malaria transmission risk and case incidence. 1.2. Malaria High-burden Countries according to 2006 World Malaria Report from the World Health Organization 1.ANGOLA High transmission 16,557,000 Major Anopheles species arabiensis, coustani, flavicosta, funetus, gambiae, melas, nili, paludis, pharoensis Plasmodium species falciparum, vivax Fever suspected being malaria 10,062,000 Malaria cases 3,555,000 Malaria deaths 21,000,000 Malaria case-fatality rate 0.59% 2.BANGLADESH High transmission 17,868,000 Low transmission 95,403,000 Major Anopheles species dirus, minimus, philippinensis, sundaicus Plasmodium species falciparum, vivax Fever suspected being malaria 18,910,000 Malaria cases 2,975,000 Malaria deaths 6,600 Malaria case-fatality rate 0.22% 3.BRAZIL High transmission 23,928,000 Major Anopheles species albitarsis, albimanus, darlingi, nuneztovari Plasmodium species falciparum, vivax Fever suspected being malaria 11,195,000 Malaria cases 1,379,000 Malaria deaths 1,000 Malaria case-fatality rate 0.07% 4.BURKINA FASO High transmission 14,359,000 Major Anopheles species brochieri, arabiensis, coustani, flavicosta, funestus, gambiae, hancocki, nili, paludis, pharoensis Plasmodium species falciparum, vivax Fever suspected being malaria 23,015,000 Malaria cases 6,227,000 Malaria deaths 26,000 Malaria case-fatality rate 0.42% 5.CAMBODIA High transmission 6,232,000 Low transmission 1,334,000 Major Anopheles species dirus, minimus, sundaicus Plasmodium species falciparum, vivax Fever suspected being malaria 820,000 Malaria cases 262,000 Malaria deaths 580 Malaria case-fatality rate 0.22% 6.CAMEROON High transmission 12,889,000 Low transmission 5,286,000 Major Anopheles species arabiensis, brochieri, coustani, flavicosta, funestus, gambiae, hancocki, hargreavesi, melas, mucheti, nili, paludis, pharoensis Plasmodium species falciparum, vivax Fever suspected being malaria 14,705,000 Malaria cases 5,091,000 Malaria deaths 21,000 Malaria case-fatality rate 0.41% 7.CHAD High transmission 4,862,000 Low transmission 5,485,000 Major Anopheles species arabiensis, coustani, funestus, nili, pharoensis Plasmodium species falciparum, vivax Fever suspected being malaria 7,095,000 Malaria cases 4,179,000 Malaria deaths 18,000 Malaria case-fatality rate 0.43% 8.COLOMBIA High transmission 5,772,000 Low transmission 9,675,000 Major Anopheles species albitarsis, albimanus, darlingi, nuneztovari Plasmodium species falciparum, vivax Fever suspected being malaria 1,892,000 Malaria cases 408,000 Malaria deaths 440 Malaria case-fatality rate 0.11% 9.COTE D'VOIRE High transmission 18,914,000 Major Anopheles species brochieri, coustani, funestus, gambiae, hancocki, hargreavesi, melas, moucheti, nili, paludis, pharoensis Plasmodium species falciparum, vivax Fever suspected being malaria 21,572,000 Malaria cases 7,029,000 Malaria deaths 20,000 Malaria case-fatality rate 0.28% 10.DEMOCRATIC REPUBLIC OF CONGO High transmission 60,644,000 Major Anopheles species arabiensis, brochieri, coustani, funestus, gambiae, hancocki, hargreavesi, melas, moucheti, paludis, pharoensis Plasmodium species falciparum, vivax Fever suspected being malaria 75,987,000 Malaria cases 23,620,000 Malaria deaths 96,000 Malaria case-fatality rate 0.41% Source: World Malaria Report 2006 published by World Health Organization.