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Malaria in Tropical Africa - Estimated Incidence and Mortality (WHO-DOCS 7)

In Africa south of the Sahara, between 13 and 23 million cases per year have been reported during 1985-1989. Based on the population exposed to malaria risk and on the number of fever episodes (less than 1 up to more than 6, depending on the age group) from which a person will be suffering every year and of which about half are typically due to malaria, it has been estimated that between 270 and 480 million clinical malaria cases may occur every year. About 140 to 280 million of these clinical malaria attacks will occur in children less than 5 years old.

Africa has the highest levels of endemicity in the world; in very large areas transmission is intense and perennial (in forest or savannah at altitudes up to 1,000 m with an average rain- fall over 2,000 mm/year). At altitudes over 1,500 m and rainfall below 1,000 mm/year, endemicity decreases and the potential for epidemic outbreaks increases. Ecological, demographical and meteorological factors including quasi-cyclic occurrence of heavy rains have led to epidemics or serious exacerbations of endemicity (Botswana, Burundi, Ethiopia, Kenya, Madagascar, Rwanda, Sudan, Swaziland, Zaire and Zambia).

In highly endemic areas, malaria mortality is concentrated in the younger age groups. In 1969, it was estimated that malaria might be responsible for the death of 1 million infants and children per year in tropical Africa. From data collected in 1970-75, it was concluded that in Kenya (Kisumu) and Nigeria (Garki), malaria was responsible for about 20 to 30% of the infant mortality. A more recent study in the Gambia (1987) concluded that malaria mortality may be as high as 6.3 per 1,000 per year in infants (4% of all infant deaths) and 10.7 per 1,000 per year in children 1 - 4 years old (one-quarter of deaths in that age group). Among children referred to hospitals with severe malaria, case- fatality rates of 10-30% have been noted, and in rural areas with little access to adequate treatment these rates might be even higher. Taking into account the above morbidity estimates one could expect malaria mortality to be in the order of 1.4 to 2.6 million annually, of which approximately 1 million deaths will occur in children below the age of 5 years; for some of the deaths malaria may not be the only cause.

Please address requests for further information or suggestions concerning the contents to:
Mr. J. Hempel, World Health Organization, 20 Avenue Appia,CH-1211 Geneva 27, Switzerland, Telephone: (+41 22) 791.37.53, Fax: (+41 22) 791.07.46, Email: hempel@who.ch

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Last updated January 21, 1999