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IJE Advance Access published online on February 28, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl027
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Published by Oxford University Press 2006
Accepted February 1, 2005

Original paper

The burden of malaria mortality among African children in the year 2000

Alexander K. Rowe 1 *, Samantha Y. Rowe 2, Robert W. Snow 3, Eline L. Korenromp 4, Joanna R. M. Armstrong Schellenberg 5, Claudia Stein 6, Bernard L. Nahlen 7, Jennifer Bryce 8, Robert E. Black 9, and Richard W. Steketee 1

1 Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA
2 Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA; Department of Epidemiology, Emory University, Atlanta, USA
3 Public Health Group, Centre for Geographic Medicine, Kenya Medical Research Institute, Nairobi, Kenya; Centre for Tropical Medicine, University of Oxford, Oxford, UK
4 Roll Back Malaria, World Health Organization (WHO), Geneva, Switzerland
5 Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK; Ifakara Health Research and Development Centre, Ifakara, Tanzania
6 Evidence and Information for Policy, WHO, Geneva, Switzerland
7 Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA; Roll Back Malaria, World Health Organization (WHO), Geneva, Switzerland
8 Department of Child and Adolescent Health and Development, WHO, Geneva, Switzerland
9 Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, USA

* To whom correspondence should be addressed.
Alexander K. Rowe, E-mail: axr9{at}cdc.gov


  Abstract

Background Although malaria is a leading cause of child deaths, few well-documented estimates of its direct and indirect burden exist. Our objective was to estimate the number of deaths directly attributable to malaria among children <5 years old in sub-Saharan Africa for the year 2000.

Methods We divided the population into six sub-populations and, using results of studies identified in a literature review, estimated a malaria mortality rate for each sub-population. Malaria deaths were estimated by multiplying each sub-population by its corresponding rate. Sensitivity analyses were performed to assess the impact of varying key assumptions.

Results The literature review identified 31 studies from 14 countries in middle Africa and 17 studies and reports from four countries in southern Africa. In 2000, we estimated that ~100 million children lived in areas where malaria transmission occurs and that 803 620 (precision estimate: 705 821-901 418) children died from the direct effects of malaria. For all of sub-Saharan Africa, including populations not exposed to malaria, malaria accounted for 18.0% (precision estimate: 15.8-20.2%) of child deaths. These estimates were sensitive to extreme assumptions about the causes of deaths with no known cause.

Conclusions These estimates, based on the best available data and methods, clearly demonstrate malaria's enormous mortality burden. We emphasize that these estimates are an approximation with many limitations and that the estimates do not account for malaria's large indirect burden. We describe information needs that, if filled, might improve the validity of future estimates.

Keywords: Malaria; mortality; Africa; epidemiology; child.
A Commentary has been commissioned to accompany this article and will appear with this paper in the printed issue.
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