finds
Malaria kills 1.2 million people every year, a finding that has
implications for global efforts to eliminate the disease
Sarah Boseley, health editor
Friday February 3 2012
The Guardian
http://www.guardian.co.uk/society/2012/feb/03/malaria-deaths-research
Malaria kills twice as many people every year as formerly believed,
taking 1.2 million lives and causing the deaths not only of babies but
also older children and adults, according to research that overturns
decades of assumptions about one of the world's most lethal diseases.
The findings from the research, published on Friday, which has
reanalysed 30 years of data on the disease using new techniques, will
force a rethink of the huge global effort that has been under way to
eliminate malaria. That ambition now looks highly unlikely by the UN
target date of 2015.
It also raises urgent questions about the future of the troubled
Global Fund to Fight Aids, TB and Malaria [http://
www.theglobalfund.org/en/" title="], which has provided the money for
most of the tools to combat the disease in Africa, such as insecticide-
impregnated bed nets and new drugs. The fund is in financial crisis
and has had to cancel its next grant-making round.
The research comes from the highly respected Institute for Health
Metrics and Evaluation (IHME) [http://
www.healthmetricsandevaluation.org/" title="], based in Seattle, and
is published in the Lancet medical journal [http://www.thelancet.com/
journals/lancet/article/PIIS0140-6736(12)60167-6/abstract" title="].
Dr Christopher Murray and colleagues have systematically collected
data on deaths from all over the world over a 30-year period, from
1980 to 2010, using new methodologies and inventive ways of measuring
mortality in countries where deaths are not conventionally recorded.
The work on malaria is part of a much bigger project which has already
led to new estimates of the death rates of women in childbirth and
pregnancy and from breast and cervical cancer.
Their figure of 1.2 million deaths for 2010 is nearly double the
655,000 estimated in last year's World Malaria Report [http://
www.who.int/malaria/world_malaria_report_2010/en/index.html" title="].
The good news is that they have confirmed the downward trend that the
World Health Organisation's report showed, as a result of efforts by
donors, aid organisations and governments to tackle the disease.
The bad news is that the decline comes from a much higher peak ?
deaths hit 1.8 million in 2004, they say. That means the interventions
such as better treatment and bed nets are working, but there is much
further to go than everybody had assumed.
The study demolishes conventional thinking on malaria ? that almost
all the deaths are in babies and small children under the age of five.
The study found that 42% were in older children and adults.
"You learn in medical school that people exposed to malaria as
children develop immunity and rarely die from malaria as adults," said
Murray, IHME director and the study's lead author. "What we have found
in hospital records, death records, surveys and other sources shows
that just is not the case."
Most deaths are still in children, but a fifth are among those aged 15
to 49, 9% are among 50- to 69-year-olds and 6% are in people over 70,
so a third of all deaths are in adults. In countries outside sub-
Saharan Africa, more than 40% of deaths were in adults.
In Africa, though, the contribution of malaria to children's deaths is
higher than had been thought, causing 24% of their deaths in 2008 and
not 16% as found by a report by Black and colleagues [http://
www.ncbi.nlm.nih.gov/pubmed/20466419" title="], whose methodology was
used in the World Malaria Report.
That means that malaria needs a higher priority if the millennium
development goal of cutting child mortality by two-thirds between 1990
and 2015 is to be achieved, say the authors.
They add: "That malaria is a previously unrecognised driver of adult
mortality also means that the benefits and cost-effectiveness of
malaria control, elimination and eradication are likely to have been
underestimated."
There is a need, they say, to pay attention to the risks malaria poses
to adults and they support the recent strategy to hand out insecticide-
impregnated bed nets to protect all members of the household against
mosquitoes carrying malaria parasites, instead of insisting they are
only for babies and pregnant women, as was originally the case.
Malaria deaths have come down by 32% from 1.8 million in 2004 to 1.2
million in 2010 because of the sustained effort to get bed nets into
homes, indoor spraying and new artemisinin combination drugs ? older
anti-malarials do not work in many areas because the parasite has
developed resistance to them.
More than two-thirds of this has been paid for by the Geneva-based
global fund, which has suffered from donors' unwillingness to invest
more money.
"The announcement by the global fund that round 11 of funding would be
cancelled raises enormous doubts as to whether the gains in malaria
mortality reduction can be built on or even sustained," say the
authors.
"From 2003 to 2008, the global fund provided 40% of development
assistance for health targeted towards malaria. This reduction in
resources for malaria control is a real and imminent threat to
population health in endemic countries."
Professor Rifat Atun, director of strategy, performance and evaluation
at the fund, said more than $2.5bn (?1.6bn) had been disbursed for
malaria control between 2009 and 2011. By the end of 2011, 235m bed
nets had been distributed. Money that had been pledged was still
coming in, he said, which meant it would be able to invest
substantially this year and next. "What we are not able to achieve is
the rate of increase in investment of the last few years. The
trajectory we have been able to establish will not be realised," he
said. "Given the new burden that Christopher Murray has been able to
show, we really need to ramp up investments in malaria and that really
needs more funding. The mortality figures are much, much larger. We
need to double our efforts to address the burden that we have." The
Department for International Development said: "We are committed to
helping halve malaria deaths in at least 10 of the worst affected
countries. We will do this by increasing the number of bednets used by
women and children; improving the diagnosis and treatment of malarial;
and strengthening health information systems to better monitor
progress and target interventions."
guardian.co.uk Copyright (c) Guardian News and Media Limited. 2012
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