Global malaria mortality between 1980 and 2010: a systematic analysis

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• 作者：Prof Christopher JL Murray ; MD^a ; ^{cjlm@u.washington.edu} ; Lisa C Rosenfeld ; AB^a ; Stephen S Lim ; PhD^a ; Kathryn G Andrews ; AB^a ; Kyle J Foreman ; MPH^a ; Diana Haring ; BSc^a ; Nancy Fullman ; MPH^a ; Mohsen Naghavi ; MD^a ; Prof Rafael Lozano ; MD^a ; Prof Alan D Lopez ; PhD^b
• 刊名：The Lancet
• 出版年：2012
• 出版时间：4-10 February 2012
• 年：2012
• 卷：379
• 期：9814
• 页码：413-431
• 全文大小：8051 K

文摘

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Summary

Background

During the past decade, renewed global and national efforts to combat malaria have led to ambitious goals. We aimed to provide an accurate assessment of the levels and time trends in malaria mortality to aid assessment of progress towards these goals and the focusing of future efforts.

Methods

We systematically collected all available data for malaria mortality for the period 1980-2010, correcting for misclassification bias. We developed a range of predictive models, including ensemble models, to estimate malaria mortality with uncertainty by age, sex, country, and year. We used key predictors of malaria mortality such as Plasmodium falciparum parasite prevalence, first-line antimalarial drug resistance, and vector control. We used out-of-sample predictive validity to select the final model.

Findings

Global malaria deaths increased from 995?00 (95 % uncertainty interval 711?00-1?12?00) in 1980 to a peak of 1?17?00 (1?30?00-2?66?00) in 2004, decreasing to 1?38?00 (929?00-1?85?00) in 2010. In Africa, malaria deaths increased from 493?00 (290?00-747?00) in 1980 to 1?13?00 (1?43?00-2?45?00) in 2004, decreasing by about 30 % to 1?33?00 (848?00-1?91?00) in 2010. Outside of Africa, malaria deaths have steadily decreased from 502?00 (322?00-833?00) in 1980 to 104?00 (45?00-191?00) in 2010. We estimated more deaths in individuals aged 5 years or older than has been estimated in previous studies: 435?00 (307?00-658?00) deaths in Africa and 89?00 (33?00-177?00) deaths outside of Africa in 2010.

Interpretation

Our findings show that the malaria mortality burden is larger than previously estimated, especially in adults. There has been a rapid decrease in malaria mortality in Africa because of the scaling up of control activities supported by international donors. Donor support, however, needs to be increased if malaria elimination and eradication and broader health and development goals are to be met.

Funding

The Bill & Melinda Gates Foundation.