Abstract
Estimating the changing burden of malaria disease remains difficult owing to limitations in health reporting systems. Here, we use a transmission model incorporating acquisition and loss of immunity to capture age-specific patterns of disease at different transmission intensities. The model is fitted to age-stratified data from 23 sites in Africa, and we then produce maps and estimates of disease burden. We estimate that in 2010 there were 252 (95% credible interval: 171–353) million cases of malaria in sub-Saharan Africa that active case finding would detect. However, only 34% (12–86%) of these cases would be observed through passive case detection. We estimate that the proportion of all cases of clinical malaria that are in under-fives varies from above 60% at high transmission to below 20% at low transmission. The focus of some interventions towards young children may need to be reconsidered, and should be informed by the current local transmission intensity.
Highlights
Estimating the changing burden of malaria disease remains difficult owing to limitations in health reporting systems
Patterns of clinical disease vary by age and transmission intensity: in highly endemic areas, the disease burden is greatest in infants and young children, while in areas of lower transmission many cases occur in older children and adults[2]
Case-reporting methods capture some of the variation, with higher rates of disease incidence reported via Active case detection (ACD) compared with passive case detection (PCD)
Summary
Estimating the changing burden of malaria disease remains difficult owing to limitations in health reporting systems. We estimate that the proportion of all cases of clinical malaria that are in under-fives varies from above 60% at high transmission to below 20% at low transmission. I n recent years, the burden of disease due to malaria has fallen in many parts of sub-Saharan Africa, often coinciding with the introduction of more effective treatments and the scale-up of long-lasting insecticide-treated net ownership and use[1]. Patterns of clinical disease vary by age and transmission intensity: in highly endemic areas, the disease burden is greatest in infants and young children, while in areas of lower transmission many cases occur in older children and adults[2]. In south-western Senegal, a 30-fold drop in malaria incidence between 1996 and 2010 was accompanied by a shift in the age distribution of cases, with 34% of cases in the under-fives in 1996 falling to B5% in 2010 A rapid fall in the proportion of malaria admissions between 2003 and 2007 was accompanied by an increase in the mean age of paediatric malaria admissions from 3.9 years to 5.6
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