Global malaria mortality between 1980 and 2010: a systematic analysis.
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.


RESULTS
Global malaria deaths increased from 995,000 (95% uncertainty interval 711,000-1,412,000) in 1980 to a peak of 1,817,000 (1,430,000-2,366,000) in 2004, decreasing to 1,238,000 (929,000-1,685,000) in 2010. In Africa, malaria deaths increased from 493,000 (290,000-747,000) in 1980 to 1,613,000 (1,243,000-2,145,000) in 2004, decreasing by about 30% to 1,133,000 (848,000-1,591,000) in 2010. Outside of Africa, malaria deaths have steadily decreased from 502,000 (322,000-833,000) in 1980 to 104,000 (45,000-191,000) in 2010. We estimated more deaths in individuals aged 5 years or older than has been estimated in previous studies: 435,000 (307,000-658,000) deaths in Africa and 89,000 (33,000-177,000) deaths outside of Africa in 2010.


CONCLUSIONS
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.


BACKGROUND
The Bill & Melinda Gates Foundation.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
Christopher J L
CJ
Murray
Lisa C
LC
Rosenfeld
Stephen S
SS
Lim
Kathryn G
KG
Andrews
Kyle J
KJ
Foreman
Diana
D
Haring
Nancy
N
Fullman
Mohsen
M
Naghavi
Rafael
R
Lozano
Alan D
AD
Lopez
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D014943:Global Health; D006801:Humans; D008288:Malaria / Q000401:mortality* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D055815:Young Adult