AFRO-NETS> The Intolerable Burden of Malaria: A New Look at the Numbers

[Andrea Egan <egana@mail.nih.gov>]

The Intolerable Burden of Malaria: A New Look at the Numbers
------------------------------------------------------------

Scientists find drastic underestimations of malaria morbidity, mor-
tality, and economic burden

Dear Colleagues,

today we sent out the following news release on the Supplement to the 
"The American Journal of Tropical Medicine and Hygiene" titled "The 
Intolerable Burden of Malaria: A New Look at the Numbers." The Sup-
plement derives from a symposium held in December 1999 in Washington 
DC at the annual meeting of the American Society of Tropical Medicine 
and Hygiene. The symposium was organized by Dr Joel Breman, Senior 
Scientific Advisor to the MIM Secretariat, and co-chaired with Dr 
Fred Binka (then at Roll Back Malaria and now at the University of 
Ghana). Once again we would like to thank all the contributing au-
thors to the Supplement, Dr Ebrahim Samba, Director of the WHO Re-
gional Office for Africa, for his Preface to the Supplement, Prof. 
Wen Kilama, Chairperson of the African Malaria Vaccine Testing Net-
work, for his Foreword to the Supplement, and all the MIM partners 
that provided financial support to produce and distribute the Supple-
ment. If you would like a free copy of the Supplement please send an 
e-mail to <mim@nih.gov> or send a fax to +1-301-402-2056.

Andrea Egan

--
The Supplement contains the following papers:

* The ears of the hippopotamus: manifestations, determinants and es-
  timates of the malaria burden; Joel G. Breman
* The public health impact of chloroquine resistance in Africa;
  Jean-Fran?ois Trape
* The impact of Plasmodium falciparum malaria on performance and
  learning: a review of the evidence; P.A. Holding, R.W. Snow
* All-cause mortality among young children in western Kenya, VII: The
  Asembo Bay Cohort Project; Peter D. McElroy, Feiko O. ter Kuile,
  Allen W. Hightower, William A. Hawley, Penelope A. Phillips-Howard,
  Aggrey J. Oloo, Altaf A. Lal, Bernard L. Nahlen
* The epidemiology and burden of Plasmodium falciparum-related anemia
  among pregnant women in sub-Saharan Africa; Helen L. Guyatt, Robert
  W. Snow
* The burden of malaria in pregnancy; Richard W. Steketee, Bernard L.
  Nahlen, Monica E. Parise, Clara Menendez
* Gaps in the childhood malaria burden: adding cerebral malaria,
  neurological sequelae, anemia, respiratory distress, hypoglycemia
  and complications of pregnancy to the calculus; Sean C. Murphy,
  Joel G. Breman
* The cost-effectiveness of antenatal malaria prevention in sub-
  Saharan Africa; C.A. Goodman, P.G. Coleman, A.J. Mills
* The economic burden of malaria; John Luke Gallup, Jeffrey D. Sachs
* The framework and indicators for monitoring Roll Back Malaria
  J.H.F. Remme, F. Binka, D. Nabarro
* The neglected burden of P. vivax malaria; Kamini Mendis, Barbara J.
  Sina, Paola Marchesini, Richard Carter


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SCIENTISTS FIND DRASTIC UNDERESTIMATIONS OF MALARIA MORBIDITY, 
MORTALITY, AND ECONOMIC BURDEN

National Institutes of Health, Bethesda, Md.

Challenging long-standing beliefs about the international burden of 
malaria, scientists have presented new information about the severity 
of malaria morbidity, mortality, and its economic toll in a supple-
ment to "The American Journal of Tropical Medicine and Hygiene". Ti-
tled "The Intolerable Burden of Malaria: A New Look at the Numbers," 
the supplement was published by the Multilateral Initiative on Ma-
laria (MIM) with support from MIM partners, including NIH, The Cen-
ters for Disease Control and Prevention, GlaxoSmithKline, the Rocke-
feller Foundation, The United Kingdom Medical Research Council, The 
United Nations Foundation, the United States Agency for International 
Development (USAID), The Wellcome Trust, and the World Health Organi-
zation.

"With new data and a fresh look, this landmark supplement highlights 
the many burdens caused by malaria. To address the pervasive and in-
tractable problems that malaria represents, it is essential that ma-
laria's full burden on societies and families be measured both epide-
miologically and economically," said Gerald T. Keusch, M.D., Director 
of the Fogarty International Center (FIC) and MIM, and NIH Associate 
Director for International Research. He added, "The enormous burden 
of malaria and the disparity in global malaria research efforts is 
the rationale for the MIM and the reason why U.S., European, and Af-
rican scientists have joined together in the MIM to promote malaria 
research in Africa to develop new and improved control interven-
tions."

For more than 50 years, the mantra of "one million annual deaths due 
to malaria" has been cited by scientists and journalists. Until re-
cently, this estimate had generally gone unexamined in regard to its 
accuracy, clinical components, and economic implications. The supple-
ment reports that, at a minimum, between 700,000 and 2.7 million peo-
ple die annually from malaria, over 75% of them African children. New 
data presented in the supplement show that over 85% of these malaria-
induced childhood deaths are due to anemia, low birth weight, and hy-
poglycemia. The supplement also reports that between 400 and 900 mil-
lion acute febrile episodes occur annually in African children under 
the age of 5 living in malaria-endemic regions, and that this number 
will double by 2020 if effective control interventions are not imple-
mented. This is notable because high fevers and febrile convulsions 
in infants and children can retard brain development, often resulting 
in impairments in high-order cognitive function such as planning, de-
cision-making, self-awareness, and social sensitivity. Of all the 
manifestations of malaria, those impacting cognition and behavior are 
the subtlest, least defined, and have the most profound implications 
for children, families, and societies.

The supplement also presents new information about the cause-effect 
connections between malaria and poverty. For example, growth of in-
come per capita from 1965 to 1990 for countries with severe malaria 
transmission was only 0.4% per year, whereas economic growth for 
countries with fewer malaria infections was 2.3% per year, more than 
5 times higher.

Launched in 1997 by an international alliance of research and public 
health agencies and African scientists, MIM stimulates collaborative 
research to answer the needs of public health programs in malaria-
endemic countries, to modernize communication systems used by the Af-
rican research community, and to strengthen research capacity and hu-
man resources where malaria takes its greatest toll -- sub-Saharan 
Africa. FIC currently serves as MIM Secretariat, and the 14-article 
supplement was edited by MIM Senior Scientific Advisor Joel Breman, 
M.D., D.T.P.H.

Detailed information about MIM, its partners, and activities is 
available on the MIM website at <http://mim.nih.gov>. To request a 
copy of "The Intolerable Burden of Malaria: A New Look at the Num-
bers," e-mail:

MIM Secretariat Coordinator
Andrea Egan, Ph.D.
mailto:mim@nih.gov

FIC is the international component of the NIH. FIC promotes and sup-
ports scientific research internationally to reduce disparities in 
global health and currently serves as the MIM Secretariat. NIH is an 
agency of the U.S. Department of Health and Human Services. Fact 
sheets, press releases, and other FIC-related materials are available 
on the FIC website at 
http://www.nih.gov/fic

Andrea Egan, PhD
Coordinator
Multilateral Initiative on Malaria
Fogarty International Center
National Institutes of Health
31 Center Drive MSC 2220
Building 31, Room B2C39
Bethesda, MD 20892, USA
Tel: +1-301-402-6680
Fax: +1-301-402-2056
mailto:egana@mail.nih.gov
http://mim.nih.gov


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