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We thought we were down to 655.000 deaths in 2010, right?

February 3, 2012 - 10:46 -- Bart G.J. Knols

Year after year in December we're seeing the fruits of our collective efforts to combat malaria reflected in the 'World Malaria Report' series produced by the World Health Organisation. And in those reports, year after year, we saw progression in terms of falling numbers of deaths. But today we're confronted with a harsh reality - the figures that were presented to us were off. Way off.

A study that appeared in the renowned medical journal The Lancet [1]today is putting us all back with both feet on the ground. Instead of 655.000 deaths in 2010 reported to us in the World Malaria Report 2011, we are now seeing the disturbing figure of 1,24 million for 2010.   Let me be honest about this: I had already changed my powerpoint presentations to reflect the new situation - we're down to some 300 million cases per annum, and a child is no longer dying every 30 seconds, but every 45 seconds. Some already talk about one death per minute. But now I guess I have to change the figures once more. Early in the millenium we were using the 1 million deaths figure, but to see that in 2010 the figure is 1.24 million raises important issues.   Apparently the methods used so far to estimate the global malaria mortality burden were not adequate and systematically underestimated the true number of casualties. Deaths due to malaria, especially in adults and children over the age of five, is where the largest errors in estimates came from. Thus, without us knowing it, malaria hit its peak in 2004, with an estimated 1.8 million deaths (1.43 - 2.37 million, 95% uncertainty level).   Since 2005, however, malaria has been blown over the head due to massive scaling up of interventions, notably the uptake of preventative measures like  insecticide-treated bednets and indoor residual spraying. Giving us the 2010 figure of 1.24 million. To see how the global picture changed between 1980 and 2010 (the figure below, from IHME), click here [2].       Still, this figure provides a bitter taste for those (including myself) that believed we would soon be heading for the 0.5 million figure. We won't, and we won't for a long time. Zero deaths by 2015 is no longer a dream, it's a shattered dream. Particularly now that large-scale donor funding is stagnating, fuelled by the global economic crisis.   What also disturbes me is the increase in cases observed between the late 1990s and 2004. Given that the Roll Back Malaria initiative was launched in 1998, were they not sorting any effect for a full six years? Or were they, and would the death toll without their work have risen far beyond the 1,8 million in 2004?   Perhaps the best lesson to learn from this is that in spite of increased efforts early on in the new millennium, impact followed only slowly. It's like pushing the breaks when driving on ice.   According to the Lancet's editor, Richard Horton, it remains difficult to get a grip on the true number of deaths due to malaria. I agree. If a child dies of malaria in Eastern DR Congo today, is it likely that it will be recorded as having died of malaria? I wonder. Would it be any better in the jungles of the Central African Republic or Southern Sudan? And what about misdiagnosis: when a child dies of another febrile illness like meningitis, how often will it be recorded as having died of malaria? In places without proper health facilities this may be more common than we think.   One thing for sure: I am looking forward to seeing WHO's World Malaria Report 2012...   Update (5 February): WHO refutes the Lancet study and stands by its own estimate of 655 thousand deaths in 2010 [3]. What do you think? Sign in and fill out the latest poll [4]...   Update (7 February): Read the official response from WHO here [5]. [1] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60034-8/fulltext#article_upsell [2] http://www.healthmetricsandevaluation.org/tools/data-visualization/death... [3] http://www.voanews.com/english/news/health/WHO-Stands-By-Its-Numbers-On-... [4] http://www.malariaworld.org/poll/who-do-you-think-right-when-it-comes-gl... [5] http://www.who.int/features/qa/80/en/index.html

Comments

Submitted by Guest (not verified) on

While the absolute numbers represent lives and are ultimately important, the trend tells us whether interventions are working. I'll go with the same method year after year to measure the trend as a reasonable indicator for whether we're heading in the right direction.

Peter James's picture
Submitted by Peter James on

Considering the controversy surrounding the whole issue, it is pretty much difficult who to believe. I know WHO usually come up with their estimates based on reports received from national malaria control programs and these reports especially from subsaran Africa may not provide the true picture for several reasons.. In most part of Africa, febrile diseases are often misdiagnosed as malaria which of course can be meningitis, typhoid etc. Another is fact that deaths or illness due to malaria are often not recorded especially in remote parts of Africa because of the problem of access and logistics. The most important reason which I have observed is that malaria control programs always try to paint a positive picture in their reports as an indication that their efforts are paying off, which in many times is not the case. Many a time the figures presented are rough estimates that have not been verified by independent research.

On the other hand, the figures provided by the Lancet study can not be totally relied upon as the methodology used for data collection and interpretation is subject to intense scrutiny
WHO should try to independently verify reports from member states and also consider other research that will inform and better guide the outcome of the malaria report that they issue yearly.

P James