Malaria mortality in Africa and Asia: Evidence from INDEPTH health and demographic surveillance system sites

P. Kim Streatfield, Wasif A. Khan, Abbas Bhuiya, Syed M.A. Hanifi, Nurul Alam, Eric Diboulo, Ali Sié, Maurice Yé, Yacouba Compaoré, Abdramane B. Soura, Bassirou Bonfoh, Fabienne Jaeger, Eliezer K. Ngoran, Juerg Utzinger, Yohannes A. Melaku, Afework Mulugeta, Berhe Weldearegawi, Pierre Gomez, Momodou Jasseh, Abraham HodgsonAbraham Oduro, Paul Welaga, John Williams, Elizabeth Awini, Fred N. Binka, Margaret Gyapong, Shashi Kant, Puneet Misra, Rahul Srivastava, Bharat Chaudhary, Sanjay Juvekar, Abdul Wahab, Siswanto Wilopo, Evasius Bauni, George Mochamah, Carolyne Ndila, Thomas N. Williams, Mary J. Hamel, Kim A. Lindblade, Frank O. Odhiambo, Laurence Slutsker, Alex Ezeh, Catherine Kyobutungi, Marylene Wamukoya, Valérie Delaunay, Aldiouma Diallo, Laetitia Douillot, Cheikh Sokhna, F. Xavier Gómez-Olivé, Chodziwadziwa W. Kabudula, Paul Mee, Kobus Herbst, Joël Mossong, Nguyen T.K. Chuc, Samuelina S. Arthur, Osman A. Sankoh, Marcel Tanner, Peter Byass

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Background: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. Objective: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. Design: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. Results: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. Conclusions: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology.

Original languageEnglish
Article number25369
Number of pages14
JournalGlobal Health Action
Issue number1
Publication statusPublished - 29 Oct 2014
Externally publishedYes

Bibliographical note

© 2014 INDEPTH Network. This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 License (, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.


  • Africa
  • Asia
  • Indepth network
  • Inter VA
  • Malaria
  • Mortality
  • Verbal autopsy


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