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Attempts to quantify the epidemiologic and economic burden of malaria have so far neglected to specifically address the burden of epidemic malaria. Moreover, the data on the effectiveness and cost-effectiveness of interventions in epidemics is extremely limited. Answering such key questions in an epidemic prone context is more challenging than doing so in endemic areas. Using the limited data available, we estimate that in Africa, there are more than 12 million malaria episodes and 155,000–310,000 malaria deaths per year attributable to epidemics if control options are not implemented or well timed, which is equivalent to some 4% of estimated annual malaria cases worldwide and 12–25% of estimated annual worldwide malaria deaths, including up to 50% of the estimated annual worldwide malaria mortality in persons > 15 years of age. The possible economic impact of malaria epidemics is described and the limited evidence on the effectiveness and cost-effectiveness of interventions in areas of low or seasonal transmission is reviewed.
Received August 21, 2003. Accepted for publication February 27, 2004.
Acknowledgments: We thank the participants of the "Intolerable Burden of Malaria" pre-Multilateral Initiative on Malaria meeting, Arusha, Tanzania, 2002, for their useful comments following a presentation of an earlier version of this paper.
Financial support: Eve Worrall is a member of the Health Economics and Financing Program, which is funded by the United Kingdom Department for International Development (DFID). The United Kingdom DFID supports policies, programs, and projects to promote international development. It also provided funds for this study as part of that objective. The Roll Back Malaria Technical Support Network on malaria epidemics, managed by the World Health Organization, provides direction, advice, and financial support to prone/at risk countries to conduct relevant field studies on epidemic prevention and control.
Disclaimer: The views and opinions expressed in this report are those of the author(s) alone.
Authors’ addresses: Eve Worrall, Health Policy Unity, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom, Telephone: 44-20-7927-2142, Fax: 44-20-7637-5391, E-mail: Eve.Worrall{at}lshtm.ac.uk. Aafje Rietveld, Malaria Control Department, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland, Telephone: 41-22-791-3753, Fax: 44-22-791-4824, E-mail: rietvelda{at}who.int. Charles Delacollette, Malaria Control Department, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland, Telephone: 41-22-791-3745, Fax: 44-22-791-4824, E-mail: delacollettec{at}who.ch.
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