title: Mapping Plasmodium falciparum Mortality in Africa between 1990 and 2015.
abstract: Malaria control has not been routinely informed by the assessment of subnational variation in malaria deaths. We combined data from the Malaria Atlas Project and the Global Burden of Disease Study to estimate malaria mortality across sub-Saharan Africa on a grid of 5 km2from 1990 through 2015.
  
  
  
  We estimated malaria mortality using a spatiotemporal modeling framework of geolocated data (i.e., with known latitude and longitude) on the clinical incidence of malaria, coverage of antimalarial drug treatment, case fatality rate, and population distribution according to age.
  
  
  
  Across sub-Saharan Africa during the past 15 years, we estimated that there was an overall decrease of 57% (95% uncertainty interval, 46 to 65) in the rate of malaria deaths, from 12.5 (95% uncertainty interval, 8.3 to 17.0) per 10,000 population in 2000 to 5.4 (95% uncertainty interval, 3.4 to 7.9) in 2015. This led to an overall decrease of 37% (95% uncertainty interval, 36 to 39) in the number of malaria deaths annually, from 1,007,000 (95% uncertainty interval, 666,000 to 1,376,000) to 631,000 (95% uncertainty interval, 394,000 to 914,000). The share of malaria deaths among children younger than 5 years of age ranged from more than 80% at a rate of death of more than 25 per 10,000 to less than 40% at rates below 1 per 10,000. Areas with high malaria mortality (>10 per 10,000) and low coverage (<50%) of insecticide-treated bed nets and antimalarial drugs included much of Nigeria, Angola, and Cameroon and parts of the Central African Republic, Congo, Guinea, and Equatorial Guinea.
  
  
  
  We estimated that there was an overall decrease of 57% in the rate of death from malaria across sub-Saharan Africa over the past 15 years and identified several countries in which high rates of death were associated with low coverage of antimalarial treatment and prevention programs. (Funded by the Bill and Melinda Gates Foundation and others.).
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Peter W
authors.initials: PW
authors.lastname: Gething
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Casey
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weiss
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Donal
authors.initials: D
authors.lastname: Bisanzio
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Samir
authors.initials: S
authors.lastname: Bhatt
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Ewan
authors.initials: E
authors.lastname: Cameron
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Battle
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Ursula
authors.initials: U
authors.lastname: Dalrymple
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rozier
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Puja C
authors.initials: PC
authors.lastname: Rao
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kutz
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Barber
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Chantal
authors.initials: C
authors.lastname: Huynh
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Katya A
authors.initials: KA
authors.lastname: Shackelford
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Coates
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Grant
authors.initials: G
authors.lastname: Nguyen
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Maya S
authors.initials: MS
authors.lastname: Fraser
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Rachel
authors.initials: R
authors.lastname: Kulikoff
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Haidong
authors.initials: H
authors.lastname: Wang
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Simon I
authors.initials: SI
authors.lastname: Hay
authors.affiliation: From the Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford (P.W.G., D.J.W., D.B., E.C., K.E.B., U.D., J.R.), and the Department of Infectious Disease Epidemiology, Imperial College London, London (S.B.) - both in the United Kingdom; and the Institute for Health Metrics and Evaluation, University of Washington, Seattle (D.C.C., P.C.R., M.J.K., R.M.B., C.H., K.A.S., M.M.C., G.N., M.S.F., R.K., H.W., M.N., D.L.S., C.J.L.M., S.I.H., S.S.L.).
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Lim
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000639:trends; D062305:Geographic Mapping; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control; D015233:Models, Statistical; D009026:Mortality / Q000639:trends; D059208:Parasite Load; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D015995:Prevalence; D055815:Young Adult
chemical_list: D000962:Antimalarials