The global distribution of clinical episodes of Plasmodium falciparum malaria

Abstract

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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Figure 1: Annual clinical incidence of P. falciparum per 1,000 population according to hypoendemic (n = 39), mesoendemic (n = 25) and combined hyperendemic and holoendemic (n = 8) conditions.
Figure 2: P. falciparum endemicity distribution within the global limits of risk.

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Acknowledgements

This research was funded by the Wellcome Trust, UK. Part of the work on mapping population risk distributions was funded by the World Health Organization Roll Back Malaria Department. The World Health Organization/RBM Department Monitoring and Evaluation Team and staff from WHO regional offices provided passive case detection data, the WHO Evidence for Information and Policy Department provided SALB data and the WHO Public Health Mapping Group provided other geographical boundary files. We thank K. Marsh, D. Forster, C. Macintosh, K. Maitland and D. Rogers for comments on earlier drafts of the manuscript, D. Balk and G. Yetman for supplying alpha versions of GPW 3.0, and A. Tatem for the urban extractions. R.W.S. is a Wellcome Trust Senior Research Fellow and acknowledges the support of the Kenyan Medical Research Institute (KEMRI). S.I.H. is funded by a Research Career Development Fellowship from the Wellcome Trust. C.A.G. is partially funded by the Fundación para la Ciencia y Tecnología (FUNDACYT).

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Correspondence to Robert W. Snow.

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Since completing this research S.I.H., C.A.G. and R.W.S. have undertaken an agreement to perform work for which remuneration was received, with RBM/WHO to estimate global, regional, national, and sub-national population at risk of various levels of malaria endemicity, by age group and parasite type in countries outside Africa (see Supplementary Information B).

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This file contains information on malaria morbidity (part A) and populations at risk (part B). (DOC 114 kb)

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Snow, R., Guerra, C., Noor, A. et al. The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature 434, 214–217 (2005). https://doi.org/10.1038/nature03342

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