Is Malaria an Important Cause of Death among Adults?

Gelband, Hellen; Bogoch, Isaac I.; Rodriguez, Peter S; Ngai, Michelle; Peer, Nazia; Watson, Leah; Jha, Prabhat

doi:10.4269/ajtmh.20-0036

Cited by 8 publications

(12 citation statements)

References 26 publications

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“…These findings are consistent with analyses from the past decade, but which are still controversial, that challenge the long-held view that few malaria deaths occur after childhood in highly endemic areas. 16 , 24 The high malaria death toll among adults accounted for most of the large discrepancy between SL-SRS and WHO estimates. Moreover, WHO estimates do not suggest missing deaths from other acute infections, which has been suggested by commentators in response to previous reports of high levels of adult malaria mortality.…”

Section: Discussionmentioning

confidence: 99%

Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20

Carshon-Marsh

Aimone

Ansumana

et al. 2022

The Lancet Global Health

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Background Sierra Leone's child and maternal mortality rates are among the highest in the world. However, little is known about the causes of premature mortality in the country. To rectify this, the Ministry of Health and Sanitation of Sierra Leone launched the Sierra Leone Sample Registration System (SL-SRS) of births and deaths. Here, we report cause-specific mortality from the first SL-SRS round, representing deaths from 2018 to 2020. Methods The Countrywide Mortality Surveillance for Action platform established the SL-SRS, which involved conducting electronic verbal autopsies in 678 randomly selected villages and urban blocks throughout the country. 61 surveyors, in teams of four or five, enrolled people and ascertained deaths of individuals younger than 70 years in 2019-20, capturing verbal autopsies on deaths from 2018 to 2020. Centrally, two trained physicians independently assigned causes of death according to the International Classification of Diseases (tenth edition). SL-SRS death proportions were applied to 5-year mortality averages from the UN World Population Prospects (2019) to derive causespecific death totals and risks of death nationally and in four Sierra Leone regions, with comparisons made with the Western region where Freetown, the capital, is located. We compared SL-SRS results with the cause-specific mortality estimates for Sierra Leone in the 2019 WHO Global Health Estimates. Findings Between Sept 1, 2019, and Dec 15, 2020, we enrolled 343 000 people and ascertained 8374 deaths of individuals younger than 70 years. Malaria was the leading cause of death in children and adults, nationally and in each region, representing 22% of deaths under age 70 years in 2020. Other infectious diseases accounted for an additional 16% of deaths. Overall maternal mortality ratio was 510 deaths per 100 000 livebirths (95% CI 483-538), and neonatal mortality rate was 31•1 deaths per 1000 livebirths (95% CI 30•4-31•8), both among the highest rates in the world. Haemorrhage was the major cause of maternal mortality and birth asphyxia or trauma was the major cause of neonatal mortality. Excess deaths were not detected in the months of 2020 corresponding to the peak of the COVID-19 pandemic. Half of the deaths occurred in rural areas and at home. If the Northern, Eastern, and Southern regions of Sierra Leone had the lower death rates observed in the Western region, about 20 000 deaths (just over a quarter of national total deaths in people younger than 70 years) would have been avoided. WHO model-based data vastly underestimated malaria deaths and some specific causes of injury deaths, and substantially overestimated maternal mortality. Interpretation Over 60% of individuals in Sierra Leone die prematurely, before age 70 years, most from preventable or treatable causes. Nationally representative mortality surveys such as the SL-SRS are of high value in providing reliable cause-of-death information to set public health priorities and target interventions in low-income countries.

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Section: Discussionmentioning

confidence: 99%

Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20

Carshon-Marsh

Aimone

Ansumana

et al. 2022

The Lancet Global Health

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“…There are both pros and cons of VA methods [ 24 ]. Misclassification of acute febrile deaths by VA among medically unattended adults is not unexpected, and likely results in malaria being over- diagnosed in some cases and under-diagnosed in others [ 1 , 2 ]. Since this study relied only on mortality data, and comparable incidence data were not available, therefore case fatality ratios across space and time could not be compared.…”

Section: Discussionmentioning

confidence: 99%

“…Malaria contributes not only to the global infectious disease burden, but has serious economic consequences borne largely by those in their financially productive ages. Verbal autopsy studies in India report a national estimate of 130,000 malaria deaths before 70 years of age in 2015 [ 1 ], down from about 200,000 deaths at these ages in 2005 [ 2 ]. Malaria, like most other vector-borne diseases, is characterized by spatial and temporal variations due to climatic, ecological, and human factors.…”

Section: Introductionmentioning

confidence: 99%

Spatio-temporal modelling of malaria mortality in India from 2004 to 2013 from the Million Death Study

Jana

Gelband

et al. 2022

Malar J

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Background India has a substantial burden of malaria, concentrated in specific areas and population groups. Spatio-temporal modelling of deaths due to malaria in India is a critical tool for identifying high-risk groups for effective resource allocation and disease control policy-making, and subsequently for the country’s progress towards United Nations 2030 Sustainable Development Goals. Methods In this study, a spatio-temporal model with the objective of understanding the spatial distribution of malaria mortality rates and the rate of temporal decline, across the country, has been constructed. A spatio-temporal “random slope” model was used, with malaria risk depending on a spatial relative risk surface and a linear time effect with a spatially-varying coefficient. The models were adjusted for urban/rural status (residence of the deceased) and Normalized Difference Vegetation Index (NDVI), using 2004–13 data from the Million Death Study (MDS) (the most recent data available), with nationwide geographic coverage. Previous studies based on MDS had focused only on aggregated analyses. Results The rural population had twice the risk of death due to malaria compared to the urban population. Malaria mortality in some of the highest-risk regions, namely the states of Odisha and Jharkhand, are declining faster than other areas; however, the rate of decline was not uniformly correlated with the level of risk. The overall decline was faster after 2010. Conclusion The results suggest a need for increased attention in high-risk rural populations, which already face challenges like inadequate infrastructure, inaccessibility to health care facilities, awareness, and education around malaria mortality and prevalence. It also points to the urgent need to restart the MDS to document changes since 2013, to develop appropriate malaria control measures.

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“…The aim of this present article is therefore to identify some of the obstacles that impede malaria vaccination usage and acceptability in African Nations in combating malaria in the region as it continues to pose a significant global public health problem. In writing this article, we searched relevant articles on malaria and vaccine usage from scientific journals and databases 1–18 …”

Section: Justification and Aim Of This Articlementioning

confidence: 99%

“…2 According to a 2020 article in the American Journal of Tropical Medicine and Hygiene, it was shown that there was a largely unacknowledged malaria burden among adults starting in later middle age in some places with intense transmission. 2,3 A study in Kenya in 2015 showed a prevalence of malaria of 28.1% in the total adult population of 1190 adults. 4 Female respondents had a 50% higher risk of having malaria compared to males (odds ratio of 1.5, p value of 0.005) with an over 6-month period prevalence rates ranging from around 40%-60% in December, January and February to around 10% between March and June.…”

Section: Introductionmentioning

confidence: 99%

Unlocking the potential of novel RTS, S/AS01, and R21/Matrix‐M™ malaria vaccines in African nations

Oduoye,

Haider,

Marsool

et al. 2024

Health Science Reports

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IntroductionMass malaria vaccination, rather than vaccinating only children below age 5, has been proven to have the potential to reduce morbidity and mortality among those vaccinated, both young and old. Addressing vaccine scepticism and misinformation is crucial in African nations to build public trust in malaria prevention. Therefore, including a wider range of demographics in vaccine trials is necessary for equitable representation and achieving herd immunity against malaria.AimThis present article aims to identify some of the obstacles that impede malaria vaccination usage and acceptability in African Nations in combating malaria in the region as it continues to pose a significant global public health problem.MethodologyA literature search was done on the Malaria vaccine between 2000 and 2023. Past and present articles/studies on this topic were consulted on PubMed, Google Scholar, Scopus and Web of Science using the following keywords; “Malaria,” “Vaccines,” “African Nations,” “Obstacles, Strategies,” and “Public Health.”ResultsThe recently approved RTS, S/AS01, and R21/Matrix‐M™ Malaria vaccines have the potential to prevent numerous deaths and cases of Malaria in Africa. These vaccines Malaria vaccines are cost‐effective in African areas with moderate to high plasmodium falciparum and can be delivered through routine immunization.ConclusionTo combat malaria effectively in African Nations, African leaders need to set up a comprehensive approach that involves; prevention, healthcare access, implementation research strategies towards adoption and acceptance of malaria vaccines in Africa as well as community engagement with the religious leaders, the market women, community heads, schools, as well as students’ union towards the willingness and acceptability of the malaria vaccines among the African populations.

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Is Malaria an Important Cause of Death among Adults?

Cited by 8 publications

References 26 publications

Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20

Child, maternal, and adult mortality in Sierra Leone: nationally representative mortality survey 2018–20

Spatio-temporal modelling of malaria mortality in India from 2004 to 2013 from the Million Death Study

Unlocking the potential of novel RTS, S/AS01, and R21/Matrix‐M™ malaria vaccines in African nations

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