| Summary: | Malaria transmission is influenced by climate, land use and deliberate intervention. Recent declines have been observed in malaria transmission. Here, we show that the continent has witnessed a long-term recession in the prevalence of Plasmodium falciparum since 1900-29 (40%) to 2010-15 (24%), interrupted at different times by periods of rapidly increasing and decreasing transmission. The cycles and trend over the last 115 years are inconsistent with simplistic explanations in terms of climate or intervention alone. Previous global initiatives had minor impacts on malaria transmission, and a historically unprecedented decline has been observed since 2000. However, there has been little change to the continued high transmission belt covering large parts of West and Central Africa. Previous efforts to model the changing patterns of P. falciparum transmission intensity in Africa have been limited to the last 15 years1,2, or have used maps of historical expert opinion3. We provide quantitative data comprising 50,424 surveys at 36,966 geocoded locations to cover 115 years of malaria history in sub-Saharan Africa.
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