Malaria-anemia comorbidity prevalence as a measure of malaria-related deaths in sub-Saharan Africa

Isidoros Papaioannou,Penelope Vounatsou,Jürg Utzinger

doi:10.1038/s41598-019-47614-6

Isidoros Papaioannou, Penelope Vounatsou + Show 1 more

Open Access

https://doi.org/10.1038/s41598-019-47614-6

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Abstract

Different methods and data sources have been utilized to determine the relationship between malaria and mortality in endemic countries. Most of these efforts have focused on deaths directly attributed to malaria, while they overlooked causes of mortality that might be indirectly related to the disease, for instance anemia. We estimated the association of malaria parasitaemia, anemia, and malaria-anemia comorbidity with all-cause under-five mortality and evaluated the potential of malaria-anemia comorbidity prevalence to quantify malaria-related deaths in sub-Saharan Africa. We analysed data from Demographic and Health Surveys (DHS) and employed Bayesian geostatistical models. Mortality hazard obtained from malaria-anemia comorbidity prevalence was up to 3·5 times higher compared to the hazard related to Plasmodium parasitaemia only. Malaria parasite prevalence alone could not always capture a statistically important association with under-five mortality. Geographical variation of the malaria-anemia comorbidity effect was observed in most, but not all, countries. We concluded that the malaria burden in sub-Saharan Africa is considerably underestimated when anemia in not taken into account and that the malaria-anemia comorbidity prevalence provides a useful measure of the malaria-related deaths.

Highlights

In 2016, malaria caused an estimated 216 million clinical episodes and 445,000 deaths[1]
Severe anemia-malaria maps refine all areas of high risk within a country and demonstrate regions of severe disease, i.e. areas between Lunda Sul and the Moxico border in Angola, Ngozi province in Burundi, Mopti province in Mali, the south-eastern part of Senegal, North Tanzania, and the south-western part of Côte d’Ivoire. This is the first study assessing the association of malaria-anemia comorbidity with child mortality using routinely collected household survey data from Demographic and Health Surveys (DHS) and Malaria Indicator Surveys (MIS)
We included in the analysis survey data with information on mortality, anemia and malaria at the same location to avoid potential bias from surveys misaligned in space and time

Summary

Introduction

In 2016, malaria caused an estimated 216 million clinical episodes and 445,000 deaths[1]. Understanding the relation between malaria transmission and malaria-related mortality provides a useful insight in monitoring and evaluation of malaria control and elimination efforts. It helps in the planning of interventions since regions that are expected to have high malaria deaths could have interventions in place, such as availability of rapid diagnostic tests (RDTs) and Artemisinin-based combination therapy (ACT) in health facilities and information campaigns to prevent progression to severe malaria and death. We estimated the association of malaria parasitaemia, anemia, and malaria-anemia comorbidity with all-cause under-five mortality and evaluated the potential of malaria-anemia comorbidity prevalence to quantify malaria-related deaths in sub-Saharan Africa. Our results are presented at high spatial resolution, including model-based risk maps of malaria, anemia, and malaria-anemia comorbidity

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