Letters to Nature

Nature 434, 214-217 (10 March 2005) | doi:10.1038/nature03342; Received 10 November 2004; Accepted 30 December 2004

There is a Brief Communications Arising (8 September 2005) associated with this document.

There is a Brief Communications Arising (8 September 2005) associated with this document.

The global distribution of clinical episodes of Plasmodium falciparum malaria

Robert W. Snow1,2, Carlos A. Guerra3, Abdisalan M. Noor1, Hla Y. Myint4 & Simon I. Hay1,3

  1. Public Health Group, KEMRI/Wellcome Trust Research Laboratories PO Box 43640, 00100 Nairobi, Kenya
  2. Centre for Tropical Medicine, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DS, UK
  3. TALA Research Group, Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK
  4. Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand

Correspondence to: Robert W. Snow1,2 Correspondence and requests for materials should be addressed to R.W.S. (Email: rsnow@wtnairobi.mimcom.net).

Interest in mapping the global distribution of malaria is motivated by a need to define populations at risk for appropriate resource allocation1, 2 and to provide a robust framework for evaluating its global economic impact3, 4. Comparison of older5, 6, 7 and more recent1, 4 malaria maps shows how the disease has been geographically restricted, but it remains entrenched in poor areas of the world with climates suitable for transmission. Here we provide an empirical approach to estimating the number of clinical events caused by Plasmodium falciparum worldwide, by using a combination of epidemiological, geographical and demographic data. We estimate that there were 515 (range 300–660) million episodes of clinical P. falciparum malaria in 2002. These global estimates are up to 50% higher than those reported by the World Health Organization (WHO) and 200% higher for areas outside Africa, reflecting the WHO's reliance upon passive national reporting for these countries. Without an informed understanding of the cartography of malaria risk, the global extent of clinical disease caused by P. falciparum will continue to be underestimated.


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