BACKGROUND:
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 subSaharan
Africa on a grid of 5 km2
from 1990 through 2015.
METHODS:
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.
RESULTS:
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.
CONCLUSIONS:
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.