Trends in Parasitology
Volume 17, Issue 12, 1 December 2001, Pages 593-597
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The past, present and future of childhood malaria mortality in Africa

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Abstract

During the past few years, there has been a historic series of declarations of renewed commitment to malaria control in Africa. Whether the burden of malaria is increasing in Africa is a moot point. This article attempts to re-construct the evidence for the trends in childhood mortality as a result of Plasmodium falciparum infection over the last century in Africa.

Section snippets

Burden of Malaria in Africa project

The Burden of Malaria in Africa (BOMA) project was established in 1998 to develop a database of all available evidence on morbidity, disability and mortality associated with P. falciparum infection in Africa. The data obtained by the BOMA project have been located using traditional methods of electronic database searches (Medline, Embase and Popline) and manual searches of pre-electronic English and French tropical and regional biomedical journals. In addition, unpublished Ministry of Health

Data limitations

The data presented in Fig. 1 represent a mixture of demographic approaches to mortality assessment. The pre-1960 data derive primarily from intensive civil registration systems organized among defined communities of pre-independence anglophone Africa where malaria was classified as a notifiable disease requiring medical certification. These data were obtained from annual medical reports from the Directors of Medical Services or Colonial Administration reports in Kenya 5, Tanzania 7, Southern

Understanding malaria mortality changes since 1912

During the first half of the 1900s, passionate pleas were made to combat malaria in Africa, viewed then as an impediment to economic and social development in the region 36, 37. There is now a renewed emphasis on malaria as a development issue 38. It has been proposed that US$ one billion of development money is required each year to tackle the burden facing malaria endemic regions of the world such as Africa 39. Through such investment the RBM campaign aims to reduce malaria mortality by a

Perspective

In summary, there are strong reasons to believe that, despite the absence of a targeted campaign, from the 1960s onwards malaria mortality in Africa was declining in parallel with overall changes in childhood mortality. Over the past ten years, this trend seems to have reversed, with malaria-specific mortality apparently rising and accounting for an increasing proportion of overall childhood mortality. The reasons for this are not clear. Whatever the case, it is important to realize that the

Acknowledgements

This work forms part of the Burden of Malaria in Africa (BOMA) project funded by the Wellcome Trust, UK and the Kenya Medical Research Institute (KEMRI). R.W.S and K.M. are supported by the Wellcome Trust as part of their Senior Fellowships program (#033340; #631342) and are affiliated to the Centre for Tropical Medicine, University of Oxford, UK. We are grateful to Brian Greenwood for comments on the manuscript. This paper is published with the permission of the director KEMRI

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