Africa: Number of Malaria Deaths Much Higher Than Previously Believed, Study Says

analysis

Researchers from the Institute for Health Metrics and Evaluation have published a study which they say shows that malaria kills twice as many people every year as formerly believed, and that many deaths occur not only among babies but also among older children and adults.

The WHO disputes the findings.

Results show that donors must re-commit to the Global Fund, say the editors of The Lancet.

According to researchers from the Institute for Health Metrics and Evaluation (IHME), which is based in the United States, malaria kills twice as many people every year as formerly believed. In a study published in The Lancet on 3 February 2012, the researchers said that malaria takes 1.2 million lives each year, and that the deaths occur not only among babies but also among older children and adults.

Writing about the findings in The Guardian, Sarah Boseley said that the research "overturns decades of assumptions about one of the world's most lethal diseases." The conventional wisdom had been that almost all malaria deaths occur among babies and children under five. The figure of 1.2 million deaths per year is nearly double the 655,000 estimated by the World Health Organization (WHO) and published in the World Malaria Report 2010.

The IHME researchers said that malaria deaths were on a downward trend as a result of efforts by donors, aid organisations and governments to tackle the disease, but that the decline comes from a much higher peak than had previously been estimated. "That means the interventions such as better treatment and bed nets are working, but there is much further to go than everybody had assumed," Ms Boseley said.

The researchers said that malaria needs a higher priority if the millennium development goal of cutting child mortality by two-thirds between 1990 and 2015 is to be achieved. They also said that there is a need to pay more attention to the risks malaria poses to adults. The researchers said that they support the recently adopted strategy to hand out insecticide-treated bed nets to protect all members of a household against mosquitoes carrying malaria parasites, instead of insisting that the nets are only for babies and pregnant women, as was the norm previously.

More than two-thirds of global funding for efforts to fight malaria comes from the Global Fund. "The announcement by the Fund that Round 11 would be cancelled raises enormous doubts as to whether the gains in malaria mortality reduction can be built on or even sustained," the researchers said.

Professor Rifat Atun, then Director of Strategy, Performance and Evaluation at the Global Fund, told The Guardian more than $2.5 billion had been disbursed for malaria control between 2009 and 2011 and that, by the end of 2011, 235 million bed nets had been distributed. Money that had been pledged was still coming in, Dr Atun said, which means that the Fund will be able to invest substantially in malaria programmes in 2012 and 2013. However, Dr Atun said, recent reductions in the Global Fund's estimates of future revenues mean that the Fund will not be able to maintain the rate of increase in investment that it was able to achieve over the last few years.

As with any research study, the methodology, the findings and the implications of the findings will be debated among researchers and others. Already, the WHO has issued a statement disputing the researchers' claims that the number of malaria deaths are double current estimates. The WHO said that its estimates and those reported in The Lancet study are statistically the same except with respect to children over five and adults in Africa. The WHO said that the IHME researchers and the WHO used different methodologies and different sources of data in arriving at their estimates, and that more scrutiny of the quality of the IHME data was required before reaching any conclusions.

In the same issue of The Lancet that reported on the results of the study, the editors of The Lancet said that the study findings have substantial implications for child survival programmes, and that malaria control and elimination programmes should be paying far greater attention to adults than is currently the case. The editors added that "Although we can be grateful for these new estimates of malaria mortality, one important lesson from the science of estimation is that the urgency to revitalise health information systems has never been greater. We need reliable primary cause of death data to ensure that trends in malaria mortality are readily and reliably monitored - and acted upon."

The editors said that one aspect of the findings that is unlikely to raise objections is the implication that interventions scaled up since 2004 have been phenomenally successful in reducing the number of malaria deaths. "Much of this success can be attributed to the work of the Global Fund. With the recent and untimely resignation of its Executive Director, Michel Kazatchkine, the Global Fund is facing an unprecedented emergency. The results we report today show how essential it is for donors to recommit to the Global Fund, as they did last summer for the Global Alliance for Vaccines and Immunisation."

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