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Estimating Trends in the Burden of Malaria at Country Level

National disease burdens are often not estimated at all or are estimated using inaccurate methods, partly because the data sources for assessing disease burden—nationally representative household surveys, demographic surveillance sites, and routine health information systems—each have their limitations. An important step forward would be a more consistent quantification of the population at risk of malaria. This is most likely to be achieved by delimiting the geographical distribution of malaria transmission using routinely collected data on confirmed cases of disease. However, before routinely collected data can be used to assess trends in the incidence of clinical cases and deaths, the incompleteness of reporting and variation in the utilization of the health system must be taken into account. In the future, sentinel surveillance from public and private health facilities, selected according to risk stratification, combined with occasional household surveys and other population-based methods of surveillance, may provide better assessments of malaria trends.

Received December 27, 2006. Accepted for publication July 5, 2007.

Disclosure: The authors are staff members of the WHO. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the WHO.

^* Address correspondence to Richard E. Cibulskis, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. E-mail: cibulskisr{at}who.int

Authors’ addresses: Richard Cibulskis and Maru Aregawi, Global Malaria Program, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Telephone: 41-22-791-2667, Fax: 41-22-791-4824, E-mail: cibulskisr{at}who.int. David Bell and Eva-Maria Christophel, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000 Manila, Philippines. Jeffrey Hii, World Health Organization, P.O. Box 22, Honiara, Solomon Islands. Charles Delacollette, World Health Organization, c/o Ministry of Public Health, Tiwanon Road, Muang, Nonthaburi 11000, Thailand. Nathan Bakyaita, World Health Organization, Regional Office for Africa, Cité du Djoué, P.O. Box 06, Brazzaville, Congo.