A new international study involving researchers from The University of Queensland (UQ) has found more than 1.2 million people died from malaria worldwide in 2010 – twice the number found in the most recent comprehensive study of the disease.
Head of UQ’s School of Population Health and one of the study’s co-authors, Dr Alan Lopez, said malaria is killing more people worldwide than previously thought, but the number of deaths has fallen rapidly as efforts to combat the disease have ramped up.
The researchers, from UQ and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, say that deaths from malaria have been missed by previous studies because of the assumption that the disease mainly kills children under 5.
“Despite assumptions that mainly young children die from malaria, our study identified that 42 per cent of malaria deaths occur in older children and adults,” Dr Lopez said.
The study found that more than 78,000 children aged 5 to 14, and more than 445,000 people ages 15 and older died from malaria in 2010, meaning that 42 per cent of all malaria deaths were in people aged 5 and older.
While the overall number of malaria deaths is higher than earlier reports, the trend in malaria deaths has followed a similar downward pattern, due to anti-malaria drugs and insecticide-treated bed nets driving mortality down.
“We have seen a huge increase in both funding and in policy attention given to malaria over the past decade, and it’s having a real impact,” Dr Lopez said.
“Reliably demonstrating just how big an impact is important to drive further investments in malaria control programs. This makes it even more critical for us to generate accurate estimates for all deaths, not just in young children and not just in sub-Saharan Africa.”
Starting in 1985, malaria deaths grew every year before peaking in 2004 at 1.8 million deaths worldwide. Since then, the number of deaths has fallen annually and, between 2007 and 2010, the decline in deaths has been more than 7 per cent each year.
The study’s lead author and Director of the IHME, Dr Christopher Murray, said the study’s finding that many more adults are dying from malaria is surprising.
“You learn in medical school that people exposed to malaria as children develop immunity and rarely die from malaria as adults,” said Dr Murray said.
“What we have found in hospital records, death records, surveys and other sources shows that just is not the case.”
The new findings are being published today in The Lancet in ‘Global malaria mortality between 1980 and 2010: a systematic analysis’. The work is part of an ongoing series being generated by the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. Global trends in child mortality, maternal mortality, breast cancer, and cervical cancer were released last year, and more trends will be released in the coming months.
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Background on Malaria
Researchers say the biggest drivers of the decline in malaria deaths have been the scaleup of insecticide-treated bed nets and artemisinin-combination treatments (ACTs). This has been accomplished through the advent of the Global Fund to Fight AIDS, Malaria and Tuberculosis in 2001 and the creation of organisations focused on fighting malaria, such as the World Health Organization’s Roll Back Malaria, Malaria No More and Nothing But Nets.
Overall funding for malaria efforts grew from less than $0.25 billion annually in 2001 to more than $2 billion in 2009, according to IHME’s latest estimates. IHME reported in September 2011 that homes owning at least one bed net were associated with a 23 per cent reduction in child mortality.
One of the most important factors in identifying the new malaria estimates was the use of verbal autopsy data. In a verbal autopsy, researchers interview the relatives of someone who has recently died to identify the cause of death. IHME and collaborators around the world published a series of articles in a special edition of Population Health Metrics in August 2011 focused on advancing the science of verbal autopsy.
Verbal autopsy data were especially important in India, where malaria deaths have been vastly undercounted in both children and adults. IHME found that more than 37,000 people over the age of 15 in India died from malaria in 2010, and the chances of someone dying from malaria in India have fallen rapidly since 1980.
Progress in fighting malaria can be seen everywhere. Countries such as Zambia and Tanzania have seen the malaria deaths fall by more than 30% between 2004 and 2010. In Bangladesh, malaria deaths declined 39 per cent in that period, and in Vietnam they declined 72 per cent. The progress being seen in Africa is especially significant, given that malaria deaths there accounted for a quarter of all deaths in children under 5 in 2010.
But the researchers warn that those gains could be reversed if global economic troubles continue to stifle funding efforts. IHME reported in December that growth in development assistance for health had slowed greatly between 2009 and 2011. The announcement by the Global Fund in November that it would cancel its next round of funding casts a cloud over the future of malaria programs, the researchers say.
“If the Global Fund is weakened, the world could lose 40 per cent of all the funding dedicated to fighting malaria,” Stephen Lim, Associate Professor of Global Health at IHME and a co-author on the study, said.
“That kind of loss of funding poses a definite threat to the health of people in countries with a high malaria burden, which in many cases are some of the poorest countries in the world. We need to think of ways to fill funding deficits in order to insure continued progress on malaria mortality.”
The School of Population Health at The University of Queensland aims to improve the health of populations through leadership and excellence in teaching, scholarship and research. School staff are conducting research and teaching in cancer prevention; alcohol, tobacco and other drugs; burden of disease and cost-effectiveness; international and tropical health; linked health data; and clinical trials and biostatistics. www.sph.uq.edu.au
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health. IHME conducts its research free from the influence of the governments and organisations implementing the programs being studied. For the report and for more information about IHME, please visit http://www.healthmetricsandevaluation.org