Impact of 1 . 5 o C and 2 o C global warming scenarios on malaria transmission in East Africa [ version 1 ; peer review : 2 approved with reservations ]

Background: Malaria remains a global challenge with approximately 228 million cases and 405,000 malaria-related deaths reported in 2018 alone; 93% of which were in sub-Saharan Africa. Aware of the critical role than environmental factors play in malaria transmission, this study aimed at assessing the relationship between precipitation, temperature, and clinical malaria cases in E. Africa and how the relationship may change under 1.5 oC and 2.0 oC global warming levels (hereinafter GWL1.5 and GWL2.0, respectively). Methods: A correlation analysis was done to establish the current relationship between annual precipitation, mean temperature, and clinical malaria cases. Differences between annual precipitation and mean temperature value projections for periods 2008-2037 and 20232052 (corresponding to GWL1.5 and GWL2.0, respectively), relative to the control period (1977-2005), were computed to determine how malaria transmission may change under the two global warming scenarios. Results: A predominantly positive/negative correlation between clinical malaria cases and temperature/precipitation was observed. Relative to the control period, no major significant changes in precipitation were shown in both warming scenarios. However, an increase in temperature of between 0.5 oC and 1.5 oC and 1.0 oC to 2.0 oC under GWL1.5 and GWL2.0, respectively, was recorded. Hence, more areas in E. Africa are likely to be exposed to temperature thresholds favourable for increased malaria vector abundance and, hence, potentially intensify malaria transmission in the region. Conclusions: GWL1.5 and GWL2.0 scenarios are likely to intensify malaria transmission in E. Africa. Ongoing interventions should, therefore, be intensified to sustain the gains made towards malaria elimination in E. Africa in a warming climate. Open Peer Review