The burden of malaria mortality among African children in the year 2000.
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 approximately 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.
Rowe
Alexander K
AK
Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. axr9@cdc.gov
Rowe
Samantha Y
SY
Snow
Robert W
RW
Korenromp
Eline L
EL
Schellenberg
Joanna Rm Armstrong
JR
Stein
Claudia
C
Nahlen
Bernard L
BL
Bryce
Jennifer
J
Black
Robert E
RE
Steketee
Richard W
RW
D000349:Africa / Q000453:epidemiology; D002675:Child, Preschool; D017281:Cost of Illness; D006801:Humans; D016778:Malaria, Falciparum / Q000401:mortality* / Q000635:transmission; D015233:Models, Statistical; D012307:Risk Factors; D012423:Rural Health; D014504:Urban Health