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Wednesday 2 November 2016
Malaria mortality in Africa 1990-2015

The article WAidid suggests this week - Mapping Plasmodium falciparum Mortality in Africa between 1990 and 2015 - combines the data from Malaria Atlas Project and the Global Burden of Disease Study to estimate malaria mortality across sub-Saharan Africa on a grid of 5 km2 from 1990 through 2015.

Measuring the burden of malaria, according to age and geographic area and over time, is important for malaria-control programs and health care providers for planning, implementing, monitoring, and evaluating control and elimination efforts. The Malaria Atlas Project has produced high-spatial-resolution (5-km2) estimates of the prevalence of malaria infection and clinical incidence rates in sub-Saharan Africa from 2000 through 2015. In parallel, the Global Burden of Diseases (GBD), Injuries, and the GBD Study, has produced national-level estimates of morbidity and mortality from malaria on an annual basis since 1990.

The authors integrated the work of the Malaria Atlas Project and the GBD 2015 to produce estimates of age-specific and sex-specific malaria mortality in sub-Saharan Africa for each 5-km2 grid cell and for individual years from 1990 through 2015, considering the following variables: the clinical incidence of malaria, the effectiveness of antimalarial treatments, and the case fatality rate among untreated persons.
From 1990 through 2000 in sub-Saharan Africa, despite declines in mortality from many other causes, the estimated malaria death rate remained largely flat in West Africa and rose in Central Africa, events that were driven primarily by resistance to chloroquine. The number of estimated malaria deaths in Africa rose substantially during the 1990s, and showed a remarkable reduction in the period from 2000 to 2015, with an overall decrease of 57%. The estimates of the number of malaria deaths and death rates in sub-Saharan Africa during 2015 for children 4 years of age or younger, those 5 to 14 years of age, and persons 15 years of age or older displayed enormous heterogeneity across the continent and within individual countries.
A comparison among age groups highlighted the markedly higher vulnerability to death from malaria among children younger than 5 years of age, which expressed with the highest rates and highest numbers of deaths.
Despite illustrating the progress in reducing the burden of malaria, the maps created by the authors also reveal large swaths of Africa, where estimated malaria mortality remains high and the coverage of prevention and treatment remains low.
The authors concluded that the declines in estimated malaria mortality across the continent support the value of the recent global push to control the disease. They highlighted that the residual burden of deaths from malaria remains intolerably and they stressed the importance to manage chloroquine, artemisinin, and pyrethroid resistance. Finally, they stated as their data on the geographic, demographic, and temporal distribution of the risk of death from malaria and its associated factors could help reaching the goal of eradicating malaria.

AUTHORS: Peter W. Gething, Daniel C. Casey, Daniel J. Weiss, Donal Bisanzio, Samir Bhatt, Ewan Cameron, Katherine E. Battle, Ursula Dalrymple, Jennifer Rozier, Puja C. Rao, Michael J. Kutz, Ryan M. Barber, Chantal Huynh, Katya A. Shackelford, Matthew M. Coates, Grant Nguyen, Maya S. Fraser, Rachel Kulikoff, Haidong Wang, Mohsen Naghavi, David L. Smith, Christopher J.L. Murray, Simon I. Hay, Stephen S. Lim.