Malaria Deaths Halved in Africa in 15 Years

Diana Swift

October 10, 2016

Sub-Saharan Africa has seen an estimated drop in malaria deaths of almost 60% during the last 15 years, according to a report published online October 10 in the New England Journal of Medicine.

Peter W. Gething, PhD, a quantitative epidemiologist at the Oxford Big Data Institute, University of Oxford, United Kingdom, and colleagues estimate there was a relative mortality decrease of 57% (95% uncertainty interval [UI], 46% - 65%), from 12.5 deaths (95% UI, 8.3 - 17.0 deaths) per 10,000 population per year in 2000 to 5.4 (95% UI, 3.4 - 7.9) in 2015.

Despite regional population expansion, the decline in mortality rate translated to a net annual reduction in the number of malaria deaths, from 1,007,000 (95% UI, 666,000 - 1,376,000) in 2000 to 631,000 (95% UI, 394,000 - 914,000) in 2015.

In children aged 4 years or younger, death rates declined from 78.7% to 73.5%, whereas the 5-to-14-year-old group saw deaths fall from 6.7% to 4.8%. In contrast, the proportion of deaths increased among those aged 15 years and older, from 14.6% to 21.7%.

However, when analyzed by geographic region, the authors found that the proportion of deaths occurring in the vulnerable under-5-years age group varied widely, from more than 80% (25 per 10,000 population) in areas such as Niger, Burkina Faso, and northern Nigeria, to fewer than 40% (less than one death per 10,000) in Ethiopia and Botswana.

The authors also found that mortality rates of 10 or more deaths per 10,000 population were associated with low regional coverage (less than 50% of at-risk individuals) of insecticide-treated bed nets and antimalarial drugs. This deficit particularly affected countries such as Nigeria, Angola, Cameroon, the Central African Republic, Congo, Guinea, and Equatorial Africa. Nigeria accounted for 31% of all estimated African deaths from malaria in 2015, and the Democratic Republic of the Congo contributed 12%.

"By creating these maps that are both highly local and age-specific, our hope is that on-the-ground efforts to protect vulnerable populations with bed nets and provide them with access to prompt effective treatments can be improved," coauthor Simon I. Hay, DSc, from the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, told Medscape Medical News.

The authors used combined data from Oxford's Malaria Atlas Project and the University of Washington, Seattle–based Global Burden of Disease Study to estimate malaria mortality.

Dr Gething and colleagues note that although the mortality decline reflects the success of concerted global efforts to control Plasmodium falciparum parasites, caution is warranted. "[T]he historical trend in [rising] estimated malaria mortality in the 1990s, which was driven by chloroquine resistance, serves as a stark warning. Existing gains and future effects could be reversed if artemisinin resistance is not managed appropriately." Similarly, resistance to pyrethyroid, used in treated bed nets, must also be addressed.

In 2014, the World Health Organization reported that global malaria deaths had fallen strikingly since 2000, and that malaria cases continued to decline steadily.

Despite notable progress in reducing the malaria morbidity and mortality burden, "a large unfinished agenda remains," the authors write. Risk for death correlates to local environmental, demographic, and intervention programs, and mortality risk data such as those in this study can help refine control strategies and reach eradication goals.

This study was supported by the Bill and Melinda Gates Foundation and other UK and European organizations. Several authors reported receiving research grants from the Medical Council, UK, and/or the Bill and Melinda Gates Foundation.

N Engl J Med. Published online October 10, 2016. Full text

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