title: Estimated under-five deaths associated with poor-quality antimalarials in sub-Saharan Africa.
abstract: Many antimalarials sold in sub-Saharan Africa are poor-quality (falsified, substandard, or degraded), and the burden of disease caused by this problem is inadequately quantified. In this article, we estimate the number of under-five deaths caused by ineffective treatment of malaria associated with consumption of poor-quality antimalarials in 39 sub-Saharan countries. Using Latin hypercube sampling our estimates were calculated as the product of the number of private sector antimalarials consumed by malaria-positive children in 2013; the proportion of private sector antimalarials consumed that were of poor-quality; and the case fatality rate (CFR) of under-five malaria-positive children who did not receive appropriate treatment. An estimated 122,350 (interquartile range [IQR]: 91,577-154,736) under-five malaria deaths were associated with consumption of poor-quality antimalarials, representing 3.75% (IQR: 2.81-4.75%) of all under-five deaths in our sample of 39 countries. There is considerable uncertainty surrounding our results because of gaps in data on case fatality rates and prevalence of poor-quality antimalarials. Our analysis highlights the need for further investigation into the distribution of poor-quality antimalarials and the need for stronger surveillance and regulatory efforts to prevent the sale of poor-quality antimalarials.
authors.forename: John P
authors.initials: JP
authors.lastname: Renschler
authors.forename: Kelsey M
authors.initials: KM
authors.lastname: Walters
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
mesh_terms: D017954:Africa South of the Sahara; D000818:Animals; D000962:Antimalarials / Q000592:standards* / Q000627:therapeutic use*; D002675:Child, Preschool; D058110:Counterfeit Drugs; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000401:mortality*; D009010:Monte Carlo Method
chemical_list: D000962:Antimalarials; D058110:Counterfeit Drugs