Rowe Alexander K, Rowe Samantha Y, Snow Robert W, Korenromp Eline L, Schellenberg Joanna Rm Armstrong, Stein Claudia, Nahlen Bernard L, Bryce Jennifer, Black Robert E, Steketee Richard W
Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
Int J Epidemiol. 2006 Jun;35(3):691-704. doi: 10.1093/ije/dyl027. Epub 2006 Feb 28.
Although malaria is a leading cause of child deaths, few well-documented estimates of its direct and indirect burden exist. Our objective was to estimate the number of deaths directly attributable to malaria among children <5 years old in sub-Saharan Africa for the year 2000.
We divided the population into six sub-populations and, using results of studies identified in a literature review, estimated a malaria mortality rate for each sub-population. Malaria deaths were estimated by multiplying each sub-population by its corresponding rate. Sensitivity analyses were performed to assess the impact of varying key assumptions.
The literature review identified 31 studies from 14 countries in middle Africa and 17 studies and reports from four countries in southern Africa. In 2000, we estimated that approximately 100 million children lived in areas where malaria transmission occurs and that 803 620 (precision estimate: 705 821-901 418) children died from the direct effects of malaria. For all of sub-Saharan Africa, including populations not exposed to malaria, malaria accounted for 18.0% (precision estimate: 15.8-20.2%) of child deaths. These estimates were sensitive to extreme assumptions about the causes of deaths with no known cause.
These estimates, based on the best available data and methods, clearly demonstrate malaria's enormous mortality burden. We emphasize that these estimates are an approximation with many limitations and that the estimates do not account for malaria's large indirect burden. We describe information needs that, if filled, might improve the validity of future estimates.
尽管疟疾是儿童死亡的主要原因之一，但关于其直接和间接负担的详细记录估计却很少。我们的目标是估计2000年撒哈拉以南非洲5岁以下儿童中直接归因于疟疾的死亡人数。
我们将人群分为六个亚人群，并利用文献综述中确定的研究结果，估计每个亚人群的疟疾死亡率。通过将每个亚人群乘以其相应的死亡率来估计疟疾死亡人数。进行敏感性分析以评估关键假设变化的影响。
文献综述确定了来自中非14个国家的31项研究以及来自南部非洲4个国家的17项研究和报告。2000年，我们估计约有1亿儿童生活在疟疾传播地区，803620名（精确估计：705821 - 901418名）儿童死于疟疾的直接影响。对于整个撒哈拉以南非洲，包括未接触疟疾的人群，疟疾占儿童死亡人数的18.0%（精确估计：15.8 - 20.2%）。这些估计对关于死因不明的死亡原因的极端假设很敏感。
这些基于现有最佳数据和方法的估计清楚地表明了疟疾巨大的死亡负担。我们强调这些估计是一种有许多局限性的近似值，并且这些估计没有考虑疟疾的巨大间接负担。我们描述了如果得到满足可能会提高未来估计有效性的信息需求。
