Estimates of the burden of malaria morbidity in Africa in children under the age of 5 years.
OBJECTIVE
To estimate the direct burden of malaria among children younger than 5 years in sub-Saharan Africa (SSA) for the year 2000, as part of a wider initiative on burden estimates.


METHODS
A systematic literature review was undertaken in June 2003. Severe malaria outcomes (cerebral malaria, severe malarial anaemia and respiratory distress) and non-severe malaria data were abstracted separately, together with information on the characteristics of each study and its population. Population characteristics were also collated at a national level. A meta-regression model was used to predict the incidence of malaria fevers at a national level. For severe outcomes, results were presented as median rates as data were too sparse for modelling.


RESULTS
For the year 2000, an estimated 545,000 (uncertainty interval: 105,000-1,750,000) children under the age of 5 in SSA experienced an episode of severe malaria for which they were admitted to hospital. A total of 24,000 (interquartile range: 12,000-37,000) suffered from persistent neurological deficits as a result of cerebral malaria. The number of malaria fevers associated with high parasite density in under-5s in SSA in 2000 was estimated as 115,750,000 (uncertainty interval: 91,243,000-257,957,000).


CONCLUSIONS
Our study predicts a lower burden than previous estimates of under-5 malaria morbidity in SSA. As there is a lack of suitable data to enable comprehensive estimates of annual malaria incidence, we describe the information needed to improve the validity of future estimates.
Roca-Feltrer
Arantxa
A
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. arantxa.roca-feltrer@lshtm.ac.uk
Carneiro
Ilona
I
Armstrong Schellenberg
Joanna R M
JR
D017954:Africa South of the Sahara / Q000453:epidemiology; D000740:Anemia / Q000453:epidemiology / Q000469:parasitology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology; D016779:Malaria, Cerebral / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D009017:Morbidity; D012120:Respiration Disorders / Q000453:epidemiology / Q000469:parasitology