title: Malaria's indirect contribution to all-cause mortality in the Andaman Islands during the colonial era.
abstract: Malaria has a substantial secondary effect on other causes of mortality. From the 19th century, malaria epidemics in the Andaman Islands' penal colony were initiated by the brackish swamp-breeding malaria vector Anopheles sundaicus and fuelled by the importation of new prisoners. Malaria was a major determinant of the highly variable all-cause mortality rate (correlation coefficient r(2)=0.60, n=68, p<0.0001) from 1872 to 1939. Directly attributed malaria mortality based on post-mortem examinations rarely exceeded one-fifth of total mortality. Infectious diseases such as pneumonia, tuberculosis, dysentery, and diarrhoea, which combined with malaria made up the majority of all-cause mortality, were positively correlated with malaria incidence over several decades. Deaths secondary to malaria (indirect malaria mortality) were at least as great as mortality directly attributed to malaria infections.
authors.affiliation: Australian Army Malaria Institute, Enoggera, Australia. dennis.shanks@defence.gov.au
authors.forename: G Dennis
authors.initials: GD
authors.lastname: Shanks
authors.forename: Simon I
authors.initials: SI
authors.lastname: Hay
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
mesh_terms: D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007194:India / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology / Q000266:history* / Q000401:mortality*