posts: 3000

This table contains the full text for all our old WORDPRESS content in html form. The format is a bit odd as it represents a direct copy from wordpress content that includes a lot of wordpress specific comments that carry some meaning in terms of layout instructions etc.. The html in the content column can thus be rendered as is but will not look identical to the way it looks on our website as several post processing steps are not applied yet. The content should work though as a readable approximation for every post. For easy searching etc, a markdown copy of the content is available in the markdown column. If you want to query all posts (both wordpress and gdocs), use the posts_unified table or the posts_unified_with_content view.

Data license: CC-BY

This data as json

id	title	slug	type	status	content	archieml	archieml_update_statistics	published_at	updated_at	gdocSuccessorId	authors	excerpt	created_at_in_wordpress	updated_at_in_wordpress	featured_image	formattingOptions	markdown	wpApiSnapshot
3000	Malaria	malaria	page	publish	<!-- wp:html --> <div class="blog-info">This article was first published in November 2015; last revised in Februrary 2022.</div> <!-- /wp:html --> <!-- wp:paragraph --> <p>Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim’s blood system and travels into the person’s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Most victims are children. It is one of the leading causes of <a href="https://ourworldindata.org/child-mortality/">child mortality</a>. Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME's Global Burden of Disease study <a href="https://vizhub.healthdata.org/gbd-compare/">here</a>. In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:heading --> <h2>Malaria deaths</h2> <!-- /wp:heading --> <!-- wp:paragraph --> <p>In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher.</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":4} --> <h4>Malaria death estimates from WHO</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the <a href="http://ourworldindata.org/coronavirus">Coronavirus pandemic</a>.{ref}<a href="https://www.who.int/publications/i/item/9789240040496">World malaria report 2021</a>. Geneva: World Health Organization; 2021.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":4} --> <h4>Malaria death estimates from IHME</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. </p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-deaths-by-region" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":4} --> <h4>Malaria deaths by age group</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart.</p> <!-- /wp:paragraph --> <!-- wp-block-tombstone 27105 --> <!-- wp:paragraph --> <p>At a global level, the most vulnerable age group to malaria deaths are children under five years old — in 2019 they accounted for 55 percent of total deaths.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-deaths-by-age" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Malaria Death Rates</h2> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-death-rates" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading {"level":4} --> <h4>Malaria death rates by age</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. </p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-death-rates-by-age" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Malaria Incidence</h2> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/incidence-of-malaria" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>The history of malaria</h2> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Humanity’s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) – Sickle-cell trait in human biological and cultural evolution. Science. 157:1134–40. Joy DA, Feng XR, Mu JB, et al. (2003) – Early origin and recent expansion of Plasmodium falciparum. Science. 300:318–21.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>For most of that time humanity was exposed to the disease without any defense.</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":4} --> <h4>Malaria’s mark on the human body</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: <a href="https://vizhub.healthdata.org/gbd-compare/">https://vizhub.healthdata.org/gbd-compare/</a>{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species’ history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) – Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":4} --> <h4>Malaria’s mark on history</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) – Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) – The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online <a href="https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC">here</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) – Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: <a href="https://economics.mit.edu/files/4127">ttps://economics.mit.edu/files/4127</a> John Luke Gallup and Jeffrey D. Sachs (2001) – The Economic Burden of Malaria <a href="https://www.ncbi.nlm.nih.gov/books/NBK2624/">https://www.ncbi.nlm.nih.gov/books/NBK2624/</a>{/ref}</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":4} --> <h4>Malaria’s mark on our drinks</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy – A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.<a href="#_ftnref1" name="_ftn1"></a></p> <!-- /wp:paragraph --> <!-- wp:heading {"level":3} --> <h3>Malaria was common across half the world – since then it has been eliminated in many regions</h3> <!-- /wp:heading --> <!-- wp-block-tombstone 25173 --> <!-- wp:paragraph --> <p>Malaria <a href="https://ourworldindata.org/malaria#the-history-of-malaria">left its mark</a> on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20<sup>th</sup> century the disease was eliminated in many populous regions of the world, saving the lives of millions.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America – poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell’s death see <a href="http://www.olivercromwell.org/faqs8.htm">the FAQs at OliverCromwell.org</a>, on Friedrich Schiller see <a href="https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html">Bayerischer Rundfunk here</a>, on Abraham Lincoln see <a href="http://www.physical-lincoln.com/books.html">‘The Physical Lincoln</a>’. Other famous victims – although it is not always possible to diagnose the disease of historical figures – were German painter Albrecht Dürer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The researchers estimate that historically – and up to around 1900 – our ancestors were at risk from malaria across about half of the world’s land surface (53%).  Since then the area where humans are at risk of malaria contracted to a quarter (27%).</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See "Box 4.1 Malaria-related mortality in the 20th century" in the World Health Organization's <a href="https://www.who.int/whr/1999/en/whr99_en.pdf">World Health Report (1999)</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":5} --> <h5>Why are these parts not malarious anymore?</h5> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) – Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) – World Development Report (2009) - Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online <a href="http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf">here</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p> First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for <a href="https://ourworldindata.org/yields-and-land-use-in-agriculture">expanding</a><a href="https://ourworldindata.org/yields-and-land-use-in-agriculture"> agricultural land</a> had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>All three factors – insecticides, land use change, and economic development – were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.<a href="#_ftnref3" name="_ftn3"></a></p> <!-- /wp:paragraph --> <!-- wp:heading {"level":6} --> <h6>Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) – The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327–336. DOI: 10.1016/S1473-3099(04)01043-6. <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly">https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext</a> I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) – A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25–146. Lysenko AJ, Beljaev AE (1969) – An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383–94.{/ref}</h6> <!-- /wp:heading --> <!-- wp:image {"align":"center","id":49975,"sizeSlug":"full","linkDestination":"custom"} --> <div class="wp-block-image"><figure class="aligncenter size-full"><img src="https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map.png" alt="" class="wp-image-49975"/></figure></div> <!-- /wp:image --> <!-- wp:heading {"level":3} --> <h3>Malaria in the US</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans.</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":6} --> <h6>Proportion of deaths from malaria to deaths of all causes – US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography <a href="http://www.radicalcartography.net/index.html?9thcensus">here</a>. This map shown here is available in high-resolution <a href="http://www.radicalcartography.net/9thcensus/9th44.jpg">here</a>.{/ref}</h6> <!-- /wp:heading --> <!-- wp:image {"align":"center","id":4054,"linkDestination":"custom"} --> <div class="wp-block-image"><figure class="aligncenter"><a href="http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-–-US-Census-18700.png"><img src="http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-–-US-Census-18700-774x1024.png" alt="Proportion of deaths from malaria to deaths of all causes – US Census 1870" class="wp-image-4054"/></a></figure></div> <!-- /wp:image --> <!-- wp:heading --> <h2>How can the world continue to make progress against malaria?</h2> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The world has already been very successful against this disease which is one of the most deadliest diseases in humanity's history. How was this possible and what can we do to continue this progress?</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":3} --> <h3>Insecticide-treated bednets</h3> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>The world is making progress against malaria thanks to insecticide-treated bednets</h4> <!-- /wp:heading --> <!-- wp-block-tombstone 25159 --> <!-- wp:columns {"className":"is-style-sticky-right"} --> <div class="wp-block-columns is-style-sticky-right"><!-- wp:column --> <div class="wp-block-column"><!-- wp:paragraph --> <p>Even after <a href="https://owid.cloud/malaria-past-prevalence">a century of progress</a> against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: <a href="http://www.who.int/malaria/en/">http://www.who.int/malaria/en/</a>{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME’s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: <a href="https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative">https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative</a>{/ref}</p> <!-- /wp:paragraph --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:columns {"className":"is-style-sticky-right"} --> <div class="wp-block-columns is-style-sticky-right"><!-- wp:column --> <div class="wp-block-column"><!-- wp:heading {"level":4} --> <h4>The world is making progress against malaria</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity’s most ingenious and successful way of transmission interruption – immunization through vaccines – is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has <a href="https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark">rolled out</a> a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine <a href="https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss"><em>RTS,S</em></a>, the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract">here</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>But we have other weapons in our arsenal.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>One line of humanity’s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>From 2000 to 2015 the number of malaria deaths fell by <a href="https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region">almost 40%</a>, from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria <a href="https://ourworldindata.org/malaria">https://ourworldindata.org/malaria</a>{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>A recent publication in <em>Nature</em>{ref}Bhatt et al. (2015) – The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207–211 (08 October 2015) doi:10.1038/nature15535. Online <a href="https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html">here</a>.{/ref} studied what made this success possible. The focus of the study was Africa, where – as the chart shows – most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The authors of the <em>Nature </em>study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study's authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases.</p> <!-- /wp:paragraph --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"><!-- wp:image {"id":54610,"sizeSlug":"large","linkDestination":"none"} --> <figure class="wp-block-image size-large"><img src="https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-800x462.png" alt="" class="wp-image-54610"/><figcaption>Malaria mortality rate of children in 2000 and 2019{ref}Citation: Institute for Health Metrics and Evaluation (IHME), Malaria Atlas Project. Global Malaria Incidence, Prevalence, and Mortality Geospatial Estimates 2000-2019. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME), 2020. <a href="https://doi.org/10.6069/CG0J-2R97">https://doi.org/10.6069/CG0J-2R97</a> <br>Shown is the mortality rate due to plasmodium falciparum – direct link to the interactive maps as published by the IHME <a href="http://ihmeuw.org/5dhp">http://ihmeuw.org/5dhp</a> <br>For the background see: Weiss, D. J., Lucas, T. C. D., Nguyen, M., Nandi, A. K., Bisanzio, D., Battle, K. E., Cameron, E., Twohig, K. A., Pfeffer, D. A., Rozier, J. A., Gibson, H. S., Rao, P. C., Casey, D., Bertozzi-Villa, A., Collins, E. L., Dalrymple, U., Gray, N., Harris, J. R., Howes, R. E., … Gething, P. W. (2019) – <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31097-9/fulltext">Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum, 2000–17: A spatial and temporal modelling study</a>. In The Lancet, 394(10195), 322–331. <a href="https://doi.org/10.1016/S0140-6736(19)31097-9">https://doi.org/10.1016/S0140-6736(19)31097-9</a>{/ref}</figcaption></figure> <!-- /wp:image --> <!-- wp:paragraph --> <p></p> <!-- /wp:paragraph --></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:columns {"className":"is-style-sticky-right"} --> <div class="wp-block-columns is-style-sticky-right"><!-- wp:column --> <div class="wp-block-column"><!-- wp:heading {"level":4} --> <h4>We can do more</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It’s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is ‘GiveWell’ and on the very top of their <a href="https://www.givewell.org/charities/top-charities">recommended charities</a> are two organizations that are fighting malaria – the <em>Against Malaria Foundation</em> and the <em>Malaria Consortium</em>.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The diseases many children die from are preventable – we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) – where more than 90% of all malaria deaths occur – shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: <a href="https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart">https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart</a>{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world.</p> <!-- /wp:paragraph --> <!-- wp:separator --> <hr class="wp-block-separator"/> <!-- /wp:separator --> <!-- wp:list --> <ul><li>If you want to know more before you donate, GiveWell’s information on malaria can be found <a href="https://www.givewell.org/international/health/malaria">here</a>.</li><li>And if you want to donate right away to help the successful fight against malaria you can do so via the page of <a href="https://www.givewell.org/charities/top-charities">GiveWell’s recommended charities</a>.</li></ul> <!-- /wp:list --></div> <!-- /wp:column --> <!-- wp:column --> <div class="wp-block-column"><!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria"></iframe> <!-- /wp:html --> <!-- wp:paragraph --> <p></p> <!-- /wp:paragraph --></div> <!-- /wp:column --></div> <!-- /wp:columns --> <!-- wp:separator --> <hr class="wp-block-separator"/> <!-- /wp:separator --> <!-- wp:heading {"level":3} --> <h3>A vaccine against malaria</h3> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) – History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>This has changed with the malaria vaccine <a href="https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss"><em>RTS,S</em></a>, the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract">here</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:heading {"level":3} --> <h3>Malaria and economic prosperity</h3> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>There are high economic costs of malaria</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>Malaria <a href="https://owid.cloud/malaria-past-prevalence">was once prevalent</a> in many of today's richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) – Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the "malaria penalty" to GDP is as high as 9% in Nigeria and Chad respectively.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>Azemar and Desbordes (2009){ref}Céline Azémar and Rodolphe Desbordes (2009) – Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: <a href="http://jae.oxfordjournals.org/content/18/4/667">http://jae.oxfordjournals.org/content/18/4/667</a>.{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of <a href="https://ourworldindata.org/malaria/">malaria</a> and <a href="https://ourworldindata.org/hiv-aids/">HIV</a>. Slightly more than one-half of this is attributed to malaria.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Data Quality & Definitions</h2> <!-- /wp:heading --> <!-- wp:paragraph --> <p>The United Nations give the following definitions:{ref}See <a href="https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx">the UN's definitions here</a>.{/ref}</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p><em>Ii = (Cases / Pop) * 100,000</em></p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p><em>Id = (Deaths / Pop) * 100,000</em></p> <!-- /wp:paragraph --> <!-- wp:heading {"level":4} --> <h4>Comparison of WHO and IHME malaria deaths</h4> <!-- /wp:heading --> <!-- wp:paragraph --> <p>In our section on <a href="https://ourworldindata.org/malaria/#deaths-due-to-malaria">Deaths Due to Malaria</a>, we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO.</p> <!-- /wp:paragraph --> <!-- wp:paragraph --> <p>For many countries — although not all — IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released — hopefully this data will begin to converge with time.</p> <!-- /wp:paragraph --> <!-- wp:html --> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-deaths-comparisons" width="300" height="150"></iframe> <!-- /wp:html --> <!-- wp:heading --> <h2>Data Sources</h2> <!-- /wp:heading --> <!-- wp:heading {"level":4} --> <h4>World Health Organization (WHO)</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong>Data: </strong>Data on cases, deaths (reported and estimates) and prevention and treatment<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global – by country and WHO region<strong><br></strong></li><li><strong>Time span: </strong>Since 2000 (for reported deaths); shorter for other measures.<strong><br></strong></li><li><strong>Available at:</strong> Online <a href="http://apps.who.int/gho/data/node.main.A1362?lang=en">here</a>.</li><li class="no-bullet"><em>WHO data on malaria deaths and cases (1990-2006) is also available through <a href=" http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=">Gapminder</a> where it can be plotted against a second indicator.</em></li></ul> <!-- /wp:list --> <!-- wp:heading {"level":4} --> <h4>Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong>Data:</strong> Death rates & absolute number of deaths from malaria</li><li><strong>Geographical coverage:</strong>Global, across all regions and countries</li><li><strong>Time span:</strong>Available from 1990 onwards</li><li><strong>Available at: </strong>Online <a href="http://ghdx.healthdata.org/gbd-results-tool">here</a></li></ul> <!-- /wp:list --> <!-- wp:heading {"level":4} --> <h4>World Development Indicators (WDI) – published by the World Bank</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong>Data:</strong> Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population)</li><li><strong>Geographical coverage:</strong> Global – by country & world region</li><li><strong>Time span:</strong> Annual data – since 2000.</li><li><strong>Available at:</strong> Online <a href="http://data.worldbank.org/indicator/SH.MLR.TRET.ZS">here</a>.</li></ul> <!-- /wp:list --> <!-- wp:heading {"level":4} --> <h4>United Nations – Millennium Development Goals Database</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong>Data: </strong>Notified cases of malaria (per 100,000 people) and malaria death rate (all ages & ages 0-4)<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global – by country and region.<strong><br></strong></li><li><strong>Time span: </strong>Only very recent data.<strong><br></strong></li><li><strong>Available: </strong>Notified cases of malaria (per 100,000 people) <a href="http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A644">here</a>.<br>Malaria death rate (all ages) <a href="http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A663">here</a>.<br>Malaria death rate (ages 0-4) <a href="http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A664#MDG">here</a>.</li></ul> <!-- /wp:list --> <!-- wp:heading {"level":4} --> <h4>DHS Malaria Indicator Survey (MIS)</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong><strong>Data: </strong></strong>Detailed survey data from African countries</li><li><strong>Geographical coverage: </strong>Some African countries.<strong><br></strong></li><li><strong>Time span: </strong>late 2000s<strong><br></strong></li><li><strong>Available at: </strong>Online <a href="http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis">here</a>.<strong><br></strong></li></ul> <!-- /wp:list --> <!-- wp:heading {"level":4} --> <h4>The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong>Data:</strong> MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk.</li><li><strong>Geographical coverage:  </strong>Entire Africa – low level</li><li><strong>Time span:</strong> Mostly recent data</li><li><strong>Available at:</strong> Online at <a href="http://www.mara-database.org//login.html">http://www.mara-database.org//login.html</a>.</li><li class="no-bullet"><em>Often it is possible to download the data and to view the data visualized on maps.<br></em></li></ul> <!-- /wp:list --> <!-- wp:heading {"level":4} --> <h4>Conley, McCord and Sachs (2007) Malaria Dataset</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong>Data:</strong> % of population at risk of malaria.</li><li><strong>Geographical coverage:</strong> Global – by country.</li><li><strong>Time span:</strong> 1960 - 2000 (observations every 5 years – including interpolations)</li><li><strong>Available at:</strong> Online <a href="https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0">here</a>.</li></ul> <!-- /wp:list --> <!-- wp:heading {"level":4} --> <h4>WHO data on incidence of malaria cases</h4> <!-- /wp:heading --> <!-- wp:list --> <ul><li><strong>Data:</strong> Incidence of malaria cases</li><li><strong>Geographical coverage:</strong> Global – by country.</li><li><strong>Time span:</strong> 1962-1997 – annual data.</li><li><strong>Available at:</strong> Online available at the <a href="http://84.89.132.1/~reynal/data_web.htm">website of Marta Reynal-Querol</a>.</li></ul> <!-- /wp:list --> <!-- wp:paragraph --> <p>Other sources: Up-to-date information on the current state of malaria is published by the <a href="http://www.rollbackmalaria.org">Roll Back Malaria Partnership</a> – a partnership between WHO, UNICEF, UNDP and the World Bank.</p> <!-- /wp:paragraph -->	{ "id": "wp-3000", "slug": "malaria", "content": { "toc": [], "body": [ { "type": "text", "value": [ { "text": "This article was first published in November 2015; last revised in Februrary 2022.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim\u2019s blood system and travels into the person\u2019s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Most victims are children. It is one of the leading causes of ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/child-mortality/", "children": [ { "text": "child mortality", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME's Global Burden of Disease study ", "spanType": "span-simple-text" }, { "url": "https://vizhub.healthdata.org/gbd-compare/", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "url": "#all-charts", "children": [ { "text": "See all interactive charts on malaria \u2193", "spanType": "span-simple-text" } ], "spanType": "span-link" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Malaria deaths", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. ", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Malaria death estimates from WHO", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the ", "spanType": "span-simple-text" }, { "url": "http://ourworldindata.org/coronavirus", "children": [ { "text": "Coronavirus pandemic", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{ref}", "spanType": "span-simple-text" }, { "url": "https://www.who.int/publications/i/item/9789240040496", "children": [ { "text": "World malaria report 2021", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". Geneva: World Health Organization; 2021.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "Malaria death estimates from IHME", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. ", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/malaria-deaths-by-region", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "Malaria deaths by age group", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "At a global level, the most vulnerable age group to malaria deaths are children under five years old \u2014 in 2019 they accounted for 55 percent of total deaths.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/malaria-deaths-by-age", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Malaria Death Rates", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "type": "text", "value": [ { "text": "The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/malaria-death-rates", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "Malaria death rates by age", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. ", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/malaria-death-rates-by-age", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Malaria Incidence", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "type": "text", "value": [ { "text": "The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/incidence-of-malaria", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "The history of malaria", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "type": "text", "value": [ { "text": "Humanity\u2019s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) \u2013 Sickle-cell trait in human biological and cultural evolution. Science. 157:1134\u201340. Joy DA, Feng XR, Mu JB, et al. (2003) \u2013 Early origin and recent expansion of Plasmodium falciparum. Science. 300:318\u201321.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "For most of that time humanity was exposed to the disease without any defense.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Malaria\u2019s mark on the human body", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: ", "spanType": "span-simple-text" }, { "url": "https://vizhub.healthdata.org/gbd-compare/", "children": [ { "text": "https://vizhub.healthdata.org/gbd-compare/", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species\u2019 history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) \u2013 Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Malaria\u2019s mark on history", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) \u2013 Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) \u2013 The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online ", "spanType": "span-simple-text" }, { "url": "https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) \u2013 Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: ", "spanType": "span-simple-text" }, { "url": "https://economics.mit.edu/files/4127", "children": [ { "text": "ttps://economics.mit.edu/files/4127", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " John Luke Gallup and Jeffrey D. Sachs (2001) \u2013 The Economic Burden of Malaria ", "spanType": "span-simple-text" }, { "url": "https://www.ncbi.nlm.nih.gov/books/NBK2624/", "children": [ { "text": "https://www.ncbi.nlm.nih.gov/books/NBK2624/", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Malaria\u2019s mark on our drinks", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy \u2013 A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.", "spanType": "span-simple-text" }, { "url": "#_ftnref1", "children": [], "spanType": "span-link" } ], "parseErrors": [] }, { "text": [ { "text": "Malaria was common across half the world \u2013 since then it has been eliminated in many regions", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Malaria ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/malaria#the-history-of-malaria", "children": [ { "text": "left its mark", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20", "spanType": "span-simple-text" }, { "children": [ { "text": "th", "spanType": "span-simple-text" } ], "spanType": "span-superscript" }, { "text": " century the disease was eliminated in many populous regions of the world, saving the lives of millions.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America \u2013 poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell\u2019s death see ", "spanType": "span-simple-text" }, { "url": "http://www.olivercromwell.org/faqs8.htm", "children": [ { "text": "the FAQs at OliverCromwell.org", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ", on Friedrich Schiller see ", "spanType": "span-simple-text" }, { "url": "https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html", "children": [ { "text": "Bayerischer Rundfunk here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ", on Abraham Lincoln see ", "spanType": "span-simple-text" }, { "url": "http://www.physical-lincoln.com/books.html", "children": [ { "text": "\u2018The Physical Lincoln", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "\u2019. Other famous victims \u2013 although it is not always possible to diagnose the disease of historical figures \u2013 were German painter Albrecht D\u00fcrer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The researchers estimate that historically \u2013 and up to around 1900 \u2013 our ancestors were at risk from malaria across about half of the world\u2019s land surface (53%).\u00a0 Since then the area where humans are at risk of malaria contracted to a quarter (27%).", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See \"Box 4.1 Malaria-related mortality in the 20th century\" in the World Health Organization's ", "spanType": "span-simple-text" }, { "url": "https://www.who.int/whr/1999/en/whr99_en.pdf", "children": [ { "text": "World Health Report (1999)", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Why are these parts not malarious anymore?", "spanType": "span-simple-text" } ], "type": "heading", "level": 4, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) \u2013 Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) \u2013 World Development Report (2009) - Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online ", "spanType": "span-simple-text" }, { "url": "http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": " First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/yields-and-land-use-in-agriculture", "children": [ { "text": "expanding", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "url": "https://ourworldindata.org/yields-and-land-use-in-agriculture", "children": [ { "text": " agricultural land", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "All three factors \u2013 insecticides, land use change, and economic development \u2013 were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.", "spanType": "span-simple-text" }, { "url": "#_ftnref3", "children": [], "spanType": "span-link" } ], "parseErrors": [] }, { "text": [ { "text": "Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) \u2013 The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327\u2013336. DOI: 10.1016/S1473-3099(04)01043-6. ", "spanType": "span-simple-text" }, { "url": "https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly", "children": [ { "text": "https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) \u2013 A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25\u2013146. Lysenko AJ, Beljaev AE (1969) \u2013 An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383\u201394.{/ref}", "spanType": "span-simple-text" } ], "type": "heading", "level": 5, "parseErrors": [] }, { "alt": "", "size": "wide", "type": "image", "filename": "Previous-prevalence-of-malaria-world-map.png", "parseErrors": [] }, { "text": [ { "text": "Malaria in the US", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography ", "spanType": "span-simple-text" }, { "url": "http://www.radicalcartography.net/index.html?9thcensus", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". This map shown here is available in high-resolution ", "spanType": "span-simple-text" }, { "url": "http://www.radicalcartography.net/9thcensus/9th44.jpg", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "type": "heading", "level": 5, "parseErrors": [] }, { "alt": "Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870", "size": "wide", "type": "image", "filename": "The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700.png", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "How can the world continue to make progress against malaria?", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "type": "text", "value": [ { "text": "The world has already been very successful against this disease which is one of the most deadliest diseases in humanity's history. How was this possible and what can we do to continue this progress?", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Insecticide-treated bednets", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "text": [ { "text": "The world is making progress against malaria thanks to insecticide-treated bednets", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Even after ", "spanType": "span-simple-text" }, { "url": "https://owid.cloud/malaria-past-prevalence", "children": [ { "text": "a century of progress", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: ", "spanType": "span-simple-text" }, { "url": "http://www.who.int/malaria/en/", "children": [ { "text": "http://www.who.int/malaria/en/", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME\u2019s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative", "children": [ { "text": "https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "The world is making progress against malaria", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity\u2019s most ingenious and successful way of transmission interruption \u2013 immunization through vaccines \u2013 is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has ", "spanType": "span-simple-text" }, { "url": "https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark", "children": [ { "text": "rolled out", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine ", "spanType": "span-simple-text" }, { "url": "https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss", "children": [ { "children": [ { "text": "RTS,S", "spanType": "span-simple-text" } ], "spanType": "span-italic" } ], "spanType": "span-link" }, { "text": ", the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online ", "spanType": "span-simple-text" }, { "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "But we have other weapons in our arsenal.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "One line of humanity\u2019s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "From 2000 to 2015 the number of malaria deaths fell by ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region", "children": [ { "text": "almost 40%", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ", from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/malaria", "children": [ { "text": "https://ourworldindata.org/malaria", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "A recent publication in ", "spanType": "span-simple-text" }, { "children": [ { "text": "Nature", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": "{ref}Bhatt et al. (2015) \u2013 The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207\u2013211 (08 October 2015) doi:10.1038/nature15535. Online ", "spanType": "span-simple-text" }, { "url": "https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref} studied what made this success possible. The focus of the study was Africa, where \u2013 as the chart shows \u2013 most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The authors of the ", "spanType": "span-simple-text" }, { "children": [ { "text": "Nature ", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": "study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study's authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "alt": "", "size": "wide", "type": "image", "filename": "Malaria-mortality-of-children-in-Africa.png", "parseErrors": [] }, { "text": [ { "text": "We can do more", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It\u2019s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is \u2018GiveWell\u2019 and on the very top of their ", "spanType": "span-simple-text" }, { "url": "https://www.givewell.org/charities/top-charities", "children": [ { "text": "recommended charities", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " are two organizations that are fighting malaria \u2013 the ", "spanType": "span-simple-text" }, { "children": [ { "text": "Against Malaria Foundation", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": " and the ", "spanType": "span-simple-text" }, { "children": [ { "text": "Malaria Consortium", "spanType": "span-simple-text" } ], "spanType": "span-italic" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The diseases many children die from are preventable \u2013 we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) \u2013 where more than 90% of all malaria deaths occur \u2013 shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart", "children": [ { "text": "https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": "{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "text": "If you want to know more before you donate, GiveWell\u2019s information on malaria can be found ", "spanType": "span-simple-text" }, { "url": "https://www.givewell.org/international/health/malaria", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "And if you want to donate right away to help the successful fight against malaria you can do so via the page of ", "spanType": "span-simple-text" }, { "url": "https://www.givewell.org/charities/top-charities", "children": [ { "text": "GiveWell\u2019s recommended charities", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria", "type": "chart", "parseErrors": [] }, { "text": [ { "text": "A vaccine against malaria", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) \u2013 History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as\u00a0SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In\u00a0Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814.\u00a0doi: 10.1098/rstb.2011.0091.{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "This has changed with the malaria vaccine ", "spanType": "span-simple-text" }, { "url": "https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss", "children": [ { "children": [ { "text": "RTS,S", "spanType": "span-simple-text" } ], "spanType": "span-italic" } ], "spanType": "span-link" }, { "text": ",\u00a0the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online ", "spanType": "span-simple-text" }, { "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "text": [ { "text": "Malaria and economic prosperity", "spanType": "span-simple-text" } ], "type": "heading", "level": 2, "parseErrors": [] }, { "text": [ { "text": "There are high economic costs of malaria", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "Malaria ", "spanType": "span-simple-text" }, { "url": "https://owid.cloud/malaria-past-prevalence", "children": [ { "text": "was once prevalent", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " in many of today's richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) \u2013 Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the \"malaria penalty\" to GDP is as high as 9% in Nigeria and Chad respectively.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Azemar and Desbordes (2009){ref}C\u00e9line Az\u00e9mar and Rodolphe Desbordes (2009) \u2013 Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: ", "spanType": "span-simple-text" }, { "url": "http://jae.oxfordjournals.org/content/18/4/667", "children": [ { "text": "http://jae.oxfordjournals.org/content/18/4/667", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/malaria/", "children": [ { "text": "malaria", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " and ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/hiv-aids/", "children": [ { "text": "HIV", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ". Slightly more than one-half of this is attributed to malaria.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Data Quality & Definitions", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "type": "text", "value": [ { "text": "The United Nations give the following definitions:{ref}See ", "spanType": "span-simple-text" }, { "url": "https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx", "children": [ { "text": "the UN's definitions here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".{/ref}", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Ii = (Cases / Pop) * 100,000", "spanType": "span-simple-text" } ], "spanType": "span-italic" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Id = (Deaths / Pop) * 100,000", "spanType": "span-simple-text" } ], "spanType": "span-italic" } ], "parseErrors": [] }, { "text": [ { "text": "Comparison of WHO and IHME malaria deaths", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "text", "value": [ { "text": "In our section on ", "spanType": "span-simple-text" }, { "url": "https://ourworldindata.org/malaria/#deaths-due-to-malaria", "children": [ { "text": "Deaths Due to Malaria", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ", we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "For many countries\u00a0\u2014 although not all\u00a0\u2014 IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released\u00a0\u2014 hopefully this data will begin to converge with time.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "url": "https://ourworldindata.org/grapher/malaria-deaths-comparisons", "type": "chart", "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "Data Sources", "spanType": "span-simple-text" } ], "type": "heading", "level": 1, "parseErrors": [] }, { "type": "horizontal-rule", "parseErrors": [] }, { "text": [ { "text": "World Health Organization (WHO)", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "text": "Data: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Data on cases, deaths (reported and estimates) and prevention and treatment", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Global \u2013 by country and WHO region", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Since 2000 (for reported deaths); shorter for other measures.", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available at:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Online ", "spanType": "span-simple-text" }, { "url": "http://apps.who.int/gho/data/node.main.A1362?lang=en", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "WHO data on malaria deaths and cases (1990-2006) is also available through ", "spanType": "span-simple-text" }, { "url": " http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=", "children": [ { "text": "Gapminder", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " where it can be plotted against a second indicator.", "spanType": "span-simple-text" } ], "spanType": "span-italic" } ], "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "text": "Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "text": "Data:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Death rates & absolute number of deaths from malaria", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Global, across all regions and countries", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Available from 1990 onwards", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available at:\u00a0", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Online ", "spanType": "span-simple-text" }, { "url": "http://ghdx.healthdata.org/gbd-results-tool", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" } ], "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "text": "World Development Indicators (WDI) \u2013 published by the World Bank", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "text": "Data:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population)", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Global \u2013 by country & world region", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "\u00a0Annual data \u2013 since 2000.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available at:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Online ", "spanType": "span-simple-text" }, { "url": "http://data.worldbank.org/indicator/SH.MLR.TRET.ZS", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "text": "United Nations \u2013 Millennium Development Goals Database", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "text": "Data: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Notified cases of malaria (per 100,000 people) and malaria death rate (all ages & ages 0-4)", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Global \u2013 by country and region.", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Only very recent data.", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Notified cases of malaria (per 100,000 people) ", "spanType": "span-simple-text" }, { "url": "http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A644", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" }, { "spanType": "span-newline" }, { "text": "Malaria death rate (all ages) ", "spanType": "span-simple-text" }, { "url": "http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A663", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" }, { "spanType": "span-newline" }, { "text": "Malaria death rate (ages 0-4) ", "spanType": "span-simple-text" }, { "url": "http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A664#MDG", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "text": "DHS Malaria Indicator Survey (MIS)", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "children": [ { "text": "Data: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" } ], "spanType": "span-bold" }, { "text": "Detailed survey data from African countries", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Some African countries.", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "late 2000s", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available at: ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Online ", "spanType": "span-simple-text" }, { "url": "http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" }, { "children": [ { "spanType": "span-newline" } ], "spanType": "span-bold" } ], "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "text": "The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "text": "Data:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "\u00a0MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage:\u00a0 ", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": "Entire Africa \u2013 low level", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Mostly recent data", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available at:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Online at ", "spanType": "span-simple-text" }, { "url": "http://www.mara-database.org//login.html", "children": [ { "text": "http://www.mara-database.org//login.html", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Often it is possible to download the data and to view the data visualized on maps.", "spanType": "span-simple-text" }, { "spanType": "span-newline" } ], "spanType": "span-italic" } ], "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "text": "Conley, McCord and Sachs (2007) Malaria Dataset", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "text": "Data:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " % of population at risk of malaria.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Global \u2013 by country.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " 1960 - 2000 (observations every 5 years \u2013 including interpolations)", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available at:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Online ", "spanType": "span-simple-text" }, { "url": "https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0", "children": [ { "text": "here", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "parseErrors": [] }, { "text": [ { "text": "WHO data on incidence of malaria cases", "spanType": "span-simple-text" } ], "type": "heading", "level": 3, "parseErrors": [] }, { "type": "list", "items": [ { "type": "text", "value": [ { "children": [ { "text": "Data:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Incidence of malaria cases", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Geographical coverage:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Global \u2013 by country.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Time span:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " 1962-1997 \u2013 annual data.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "type": "text", "value": [ { "children": [ { "text": "Available at:", "spanType": "span-simple-text" } ], "spanType": "span-bold" }, { "text": " Online available at the ", "spanType": "span-simple-text" }, { "url": "http://84.89.132.1/~reynal/data_web.htm", "children": [ { "text": "website of Marta Reynal-Querol", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": ".", "spanType": "span-simple-text" } ], "parseErrors": [] } ], "parseErrors": [] }, { "type": "text", "value": [ { "text": "Other sources: Up-to-date information on the current state of malaria is published by the ", "spanType": "span-simple-text" }, { "url": "http://www.rollbackmalaria.org", "children": [ { "text": "Roll Back Malaria Partnership", "spanType": "span-simple-text" } ], "spanType": "span-link" }, { "text": " \u2013 a partnership between WHO, UNICEF, UNDP and the World Bank.", "spanType": "span-simple-text" } ], "parseErrors": [] }, { "top": [], "type": "all-charts", "heading": "Interactive charts on malaria", "parseErrors": [] } ], "type": "linear-topic-page", "title": "Malaria", "authors": [ "Max Roser", "Hannah Ritchie" ], "excerpt": "The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?", "dateline": "November 12, 2019", "subtitle": "The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?", "sticky-nav": [], "sidebar-toc": true, "featured-image": "Screen-Shot-2021-02-11-at-10.54.25.png" }, "createdAt": "2019-10-03T14:03:36.000Z", "published": false, "updatedAt": "2023-08-18T10:02:30.000Z", "revisionId": null, "publishedAt": "2019-11-12T23:56:00.000Z", "relatedCharts": [ { "slug": "child-deaths-from-malaria-ihme", "title": "Child deaths from malaria", "variantName": null, "keyChartLevel": 0 }, { "slug": "deaths-conflict-terrorism-per-100000", "title": "Death rate from conflict and terrorism", "variantName": "IHME, crude", "keyChartLevel": 0 }, { "slug": "death-rates-from-conflict-and-terrorism-gbd", "title": "Death rate from conflict and terrorism", "variantName": "IHME, age-standardized", "keyChartLevel": 0 }, { "slug": "malaria-death-rates", "title": "Death rate from malaria", "variantName": null, "keyChartLevel": 2 }, { "slug": "death-rate-from-malaria-ghe", "title": "Death rate from malaria", "variantName": "WHO, Global Health Estimates", "keyChartLevel": 2 }, { "slug": "death-rate-from-malaria-ihme", "title": "Death rate from malaria", "variantName": "IHME data", "keyChartLevel": 2 }, { "slug": "death-rate-from-malaria", "title": "Death rate from malaria", "variantName": "WHO, GHO data", "keyChartLevel": 2 }, { "slug": "deaths-from-conflict-and-terrorism", "title": "Deaths from conflict and terrorism", "variantName": "IHME, GBD", "keyChartLevel": 0 }, { "slug": "incidence-of-malaria", "title": "Incidence of malaria", "variantName": "WHO", "keyChartLevel": 2 }, { "slug": "malaria-deaths-by-age", "title": "Malaria deaths by age", "variantName": "IHME", "keyChartLevel": 2 }, { "slug": "global-malaria-deaths-by-world-region", "title": "Malaria deaths by world region", "variantName": "WHO", "keyChartLevel": 2 }, { "slug": "malaria-deaths-by-region", "title": "Malaria deaths by world region", "variantName": "IHME", "keyChartLevel": 2 }, { "slug": "malaria-deaths-comparisons", "title": "Malaria deaths: IHME vs. WHO estimates", "variantName": null, "keyChartLevel": 2 }, { "slug": "child-deaths-from-malaria", "title": "Malaria mortality in children", "variantName": null, "keyChartLevel": 2 }, { "slug": "malaria-prevalence-vs-gdp-per-capita", "title": "Malaria prevalence vs. GDP per capita", "variantName": null, "keyChartLevel": 2 }, { "slug": "child-deaths-from-malaria-number", "title": "Number of child deaths from malaria", "variantName": null, "keyChartLevel": 2 }, { "slug": "malaria-deaths-ihme", "title": "Number of deaths from malaria", "variantName": "IHME", "keyChartLevel": 2 }, { "slug": "number-of-deaths-from-malaria-who", "title": "Number of deaths from malaria", "variantName": "WHO GHO", "keyChartLevel": 2 }, { "slug": "number-of-deaths-from-malaria-ghe", "title": "Number of deaths from malaria", "variantName": "WHO GHE", "keyChartLevel": 2 }, { "slug": "children-sleeping-under-treated-bednet", "title": "Share of children sleeping under insecticide-treated nets", "variantName": null, "keyChartLevel": 2 }, { "slug": "share-of-children-with-a-fever-receiving-antimalarial-drugs", "title": "Share of children with a fever receiving antimalarial drugs", "variantName": null, "keyChartLevel": 2 }, { "slug": "share-of-the-population-with-malaria", "title": "Share of the population with malaria", "variantName": null, "keyChartLevel": 2 } ], "publicationContext": "listed" }	{ "errors": [ { "name": "iframe with src that is not a grapher", "details": "Found iframe with src that is not a grapher" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag image" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag image" }, { "name": "too many figcaption elements after archieml transform", "details": "Found 11 elements after transforming to archieml" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag image" }, { "name": "unhandled html tag found", "details": "Encountered the unhandled tag hr" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag separator" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unhandled html tag found", "details": "Encountered the unhandled tag hr" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag separator" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" }, { "name": "unexpected wp component tag", "details": "Found unhandled wp:comment tag list" } ], "numBlocks": 138, "numErrors": 18, "wpTagCounts": { "html": 10, "list": 9, "image": 3, "column": 6, "columns": 3, "heading": 35, "paragraph": 67, "separator": 2 }, "htmlTagCounts": { "p": 67, "h2": 7, "h3": 5, "h4": 20, "h5": 1, "h6": 2, "hr": 2, "ul": 9, "div": 12, "figure": 3, "iframe": 9, "figcaption": 1 } }	2019-11-12 23:56:00	2024-02-27 00:30:12		[ "Max Roser", "Hannah Ritchie" ]	The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?	2019-10-03 14:03:36	2023-08-18 10:02:30	https://ourworldindata.org/wp-content/uploads/2021/02/Screen-Shot-2021-02-11-at-10.54.25.png	{}	This article was first published in November 2015; last revised in Februrary 2022. Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim’s blood system and travels into the person’s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death. The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths. The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000. Most victims are children. It is one of the leading causes of [child mortality](https://ourworldindata.org/child-mortality/). Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME's Global Burden of Disease study [here](https://vizhub.healthdata.org/gbd-compare/). In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref} [See all interactive charts on malaria ↓](#all-charts) --- # Malaria deaths --- In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher. ### Malaria death estimates from WHO Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the [Coronavirus pandemic](http://ourworldindata.org/coronavirus).{ref}[World malaria report 2021](https://www.who.int/publications/i/item/9789240040496). Geneva: World Health Organization; 2021.{/ref} Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly. <Chart url="http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region"/> ### Malaria death estimates from IHME The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019. These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region. <Chart url="https://ourworldindata.org/grapher/malaria-deaths-by-region"/> ### Malaria deaths by age group The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart. At a global level, the most vulnerable age group to malaria deaths are children under five years old — in 2019 they accounted for 55 percent of total deaths. <Chart url="https://ourworldindata.org/grapher/malaria-deaths-by-age"/> --- # Malaria Death Rates --- The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals. <Chart url="https://ourworldindata.org/grapher/malaria-death-rates"/> ### Malaria death rates by age The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. <Chart url="https://ourworldindata.org/grapher/malaria-death-rates-by-age"/> --- # Malaria Incidence --- The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator. <Chart url="https://ourworldindata.org/grapher/incidence-of-malaria"/> --- # The history of malaria --- Humanity’s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) – Sickle-cell trait in human biological and cultural evolution. Science. 157:1134–40. Joy DA, Feng XR, Mu JB, et al. (2003) – Early origin and recent expansion of Plasmodium falciparum. Science. 300:318–21.{/ref} For most of that time humanity was exposed to the disease without any defense. ### Malaria’s mark on the human body The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: [https://vizhub.healthdata.org/gbd-compare/](https://vizhub.healthdata.org/gbd-compare/){/ref} Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species’ history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) – Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref} ### Malaria’s mark on history Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) – Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) – The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online [here](https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC).{/ref} A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) – Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: [ttps://economics.mit.edu/files/4127](https://economics.mit.edu/files/4127) John Luke Gallup and Jeffrey D. Sachs (2001) – The Economic Burden of Malaria [https://www.ncbi.nlm.nih.gov/books/NBK2624/](https://www.ncbi.nlm.nih.gov/books/NBK2624/){/ref} ### Malaria’s mark on our drinks One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy – A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.[](#_ftnref1) ## Malaria was common across half the world – since then it has been eliminated in many regions Malaria [left its mark](https://ourworldindata.org/malaria#the-history-of-malaria) on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world. But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20th century the disease was eliminated in many populous regions of the world, saving the lives of millions. What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America – poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell’s death see [the FAQs at OliverCromwell.org](http://www.olivercromwell.org/faqs8.htm), on Friedrich Schiller see [Bayerischer Rundfunk here](https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html), on Abraham Lincoln see [‘The Physical Lincoln](http://www.physical-lincoln.com/books.html)’. Other famous victims – although it is not always possible to diagnose the disease of historical figures – were German painter Albrecht Dürer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref} Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa. The researchers estimate that historically – and up to around 1900 – our ancestors were at risk from malaria across about half of the world’s land surface (53%). Since then the area where humans are at risk of malaria contracted to a quarter (27%). The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See "Box 4.1 Malaria-related mortality in the 20th century" in the World Health Organization's [World Health Report (1999)](https://www.who.int/whr/1999/en/whr99_en.pdf).{/ref} #### Why are these parts not malarious anymore? Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) – Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) – World Development Report (2009) - Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online [here](http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf).{/ref} First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for [expanding](https://ourworldindata.org/yields-and-land-use-in-agriculture)[ agricultural land](https://ourworldindata.org/yields-and-land-use-in-agriculture) had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place. All three factors – insecticides, land use change, and economic development – were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.[](#_ftnref3) ##### Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) – The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327–336. DOI: 10.1016/S1473-3099(04)01043-6. [https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext](https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly) I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) – A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25–146. Lysenko AJ, Beljaev AE (1969) – An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383–94.{/ref} <Image filename="Previous-prevalence-of-malaria-world-map.png" alt=""/> ## Malaria in the US The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time. Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans. ##### Proportion of deaths from malaria to deaths of all causes – US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography [here](http://www.radicalcartography.net/index.html?9thcensus). This map shown here is available in high-resolution [here](http://www.radicalcartography.net/9thcensus/9th44.jpg).{/ref} <Image filename="The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-–-US-Census-18700.png" alt="Proportion of deaths from malaria to deaths of all causes – US Census 1870"/> --- # How can the world continue to make progress against malaria? --- The world has already been very successful against this disease which is one of the most deadliest diseases in humanity's history. How was this possible and what can we do to continue this progress? ## Insecticide-treated bednets ### The world is making progress against malaria thanks to insecticide-treated bednets Even after [a century of progress](https://owid.cloud/malaria-past-prevalence) against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: [http://www.who.int/malaria/en/](http://www.who.int/malaria/en/){/ref} Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME’s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: [https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative](https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative){/ref} ### The world is making progress against malaria In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity’s most ingenious and successful way of transmission interruption – immunization through vaccines – is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has [rolled out](https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark) a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine [_RTS,S_](https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss), the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online [here](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract).{/ref} But we have other weapons in our arsenal. One line of humanity’s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone. The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll. From 2000 to 2015 the number of malaria deaths fell by [almost 40%](https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region), from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria [https://ourworldindata.org/malaria](https://ourworldindata.org/malaria){/ref} A recent publication in _Nature_{ref}Bhatt et al. (2015) – The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207–211 (08 October 2015) doi:10.1038/nature15535. Online [here](https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html).{/ref} studied what made this success possible. The focus of the study was Africa, where – as the chart shows – most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them. The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities. The authors of the _Nature _study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study's authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases. <Image filename="Malaria-mortality-of-children-in-Africa.png" alt=""/> ### We can do more Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations. Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further. To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It’s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is ‘GiveWell’ and on the very top of their [recommended charities](https://www.givewell.org/charities/top-charities) are two organizations that are fighting malaria – the _Against Malaria Foundation_ and the _Malaria Consortium_. The diseases many children die from are preventable – we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them. The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) – where more than 90% of all malaria deaths occur – shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: [https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart](https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart){/ref} It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world. * If you want to know more before you donate, GiveWell’s information on malaria can be found [here](https://www.givewell.org/international/health/malaria). * And if you want to donate right away to help the successful fight against malaria you can do so via the page of [GiveWell’s recommended charities](https://www.givewell.org/charities/top-charities). <Chart url="https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria"/> ## A vaccine against malaria Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) – History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091.{/ref} This has changed with the malaria vaccine [_RTS,S_](https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss), the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online [here](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract).{/ref} ## Malaria and economic prosperity ### There are high economic costs of malaria Malaria [was once prevalent](https://owid.cloud/malaria-past-prevalence) in many of today's richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy. Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) – Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the "malaria penalty" to GDP is as high as 9% in Nigeria and Chad respectively. Azemar and Desbordes (2009){ref}Céline Azémar and Rodolphe Desbordes (2009) – Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: [http://jae.oxfordjournals.org/content/18/4/667](http://jae.oxfordjournals.org/content/18/4/667).{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of [malaria](https://ourworldindata.org/malaria/) and [HIV](https://ourworldindata.org/hiv-aids/). Slightly more than one-half of this is attributed to malaria. <Chart url="https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita"/> --- # Data Quality & Definitions --- The United Nations give the following definitions:{ref}See [the UN's definitions here](https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx).{/ref} The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000. _Ii = (Cases / Pop) * 100,000_ The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000. _Id = (Deaths / Pop) * 100,000_ ### Comparison of WHO and IHME malaria deaths In our section on [Deaths Due to Malaria](https://ourworldindata.org/malaria/#deaths-due-to-malaria), we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably. In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO. For many countries — although not all — IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released — hopefully this data will begin to converge with time. <Chart url="https://ourworldindata.org/grapher/malaria-deaths-comparisons"/> --- # Data Sources --- ### World Health Organization (WHO) * Data: Data on cases, deaths (reported and estimates) and prevention and treatment * Geographical coverage: Global – by country and WHO region * Time span: Since 2000 (for reported deaths); shorter for other measures. * Available at: Online [here](http://apps.who.int/gho/data/node.main.A1362?lang=en). * _WHO data on malaria deaths and cases (1990-2006) is also available through [Gapminder]( http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=) where it can be plotted against a second indicator._ ### Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) * Data: Death rates & absolute number of deaths from malaria * Geographical coverage:Global, across all regions and countries * Time span:Available from 1990 onwards * Available at: Online [here](http://ghdx.healthdata.org/gbd-results-tool) ### World Development Indicators (WDI) – published by the World Bank * Data: Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population) * Geographical coverage: Global – by country & world region * Time span: Annual data – since 2000. * Available at: Online [here](http://data.worldbank.org/indicator/SH.MLR.TRET.ZS). ### United Nations – Millennium Development Goals Database * Data: Notified cases of malaria (per 100,000 people) and malaria death rate (all ages & ages 0-4) * Geographical coverage: Global – by country and region. * Time span: Only very recent data. * Available: Notified cases of malaria (per 100,000 people) [here](http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A644). Malaria death rate (all ages) [here](http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A663). Malaria death rate (ages 0-4) [here](http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A664#MDG). ### DHS Malaria Indicator Survey (MIS) * **Data: *Detailed survey data from African countries Geographical coverage: Some African countries. * Time span: late 2000s * Available at: Online [here](http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis). ### The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project * Data: MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk. * Geographical coverage: Entire Africa – low level * Time span: Mostly recent data * Available at: Online at [http://www.mara-database.org//login.html](http://www.mara-database.org//login.html). * _Often it is possible to download the data and to view the data visualized on maps. _ ### Conley, McCord and Sachs (2007) Malaria Dataset * Data: % of population at risk of malaria. * Geographical coverage: Global – by country. * Time span: 1960 - 2000 (observations every 5 years – including interpolations) * Available at: Online [here](https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0). ### WHO data on incidence of malaria cases * Data: Incidence of malaria cases * Geographical coverage: Global – by country. * Time span: 1962-1997 – annual data. * Available at: Online available at the [website of Marta Reynal-Querol](http://84.89.132.1/~reynal/data_web.htm). Other sources: Up-to-date information on the current state of malaria is published by the [Roll Back Malaria Partnership](http://www.rollbackmalaria.org) – a partnership between WHO, UNICEF, UNDP and the World Bank. <AllCharts heading="Interactive charts on malaria"/>	{ "id": 3000, "date": "2019-11-12T23:56:00", "guid": { "rendered": "http://ourworldindata.org/?page_id=3000" }, "link": "https://owid.cloud/malaria", "meta": { "owid_publication_context_meta_field": [], "owid_key_performance_indicators_meta_field": { "raw": "630,000 people die from malaria every year.\n\n55% are children younger than 5 years old.", "rendered": "<p><strong>630,000</strong> people die from malaria every year.</p>\n<p>55% are children younger than 5 years old.</p>\n" } }, "slug": "malaria", "tags": [], "type": "page", "title": { "rendered": "Malaria" }, "_links": { "self": [ { "href": "https://owid.cloud/wp-json/wp/v2/pages/3000" } ], "about": [ { "href": "https://owid.cloud/wp-json/wp/v2/types/page" } ], "author": [ { "href": "https://owid.cloud/wp-json/wp/v2/users/2", "embeddable": true } ], "curies": [ { "href": "https://api.w.org/{rel}", "name": "wp", "templated": true } ], "replies": [ { "href": "https://owid.cloud/wp-json/wp/v2/comments?post=3000", "embeddable": true } ], "wp:term": [ { "href": "https://owid.cloud/wp-json/wp/v2/categories?post=3000", "taxonomy": "category", "embeddable": true }, { "href": "https://owid.cloud/wp-json/wp/v2/tags?post=3000", "taxonomy": "post_tag", "embeddable": true } ], "collection": [ { "href": "https://owid.cloud/wp-json/wp/v2/pages" } ], "wp:attachment": [ { "href": "https://owid.cloud/wp-json/wp/v2/media?parent=3000" } ], "version-history": [ { "href": "https://owid.cloud/wp-json/wp/v2/pages/3000/revisions", "count": 30 } ], "wp:featuredmedia": [ { "href": "https://owid.cloud/wp-json/wp/v2/media/40625", "embeddable": true } ], "predecessor-version": [ { "id": 58019, "href": "https://owid.cloud/wp-json/wp/v2/pages/3000/revisions/58019" } ] }, "author": 2, "parent": 0, "status": "publish", "content": { "rendered": "\n<div class=\"blog-info\">This article was first published in November 2015; last revised in Februrary 2022.</div>\n\n\n\n<p>Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim\u2019s blood system and travels into the person\u2019s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death.</p>\n\n\n\n<p>The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths.</p>\n\n\n\n<p>The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000.</p>\n\n\n\n<p>Most victims are children. It is one of the leading causes of <a href=\"https://ourworldindata.org/child-mortality/\">child mortality</a>. Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME’s Global Burden of Disease study <a href=\"https://vizhub.healthdata.org/gbd-compare/\">here</a>. In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref}</p>\n\n\n\n<h2>Malaria deaths</h2>\n\n\n\n<p>In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. </p>\n\n\n\n<p>These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher.</p>\n\n\n\n<h4>Malaria death estimates from WHO</h4>\n\n\n\n<p>Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the <a href=\"http://ourworldindata.org/coronavirus\">Coronavirus pandemic</a>.{ref}<a href=\"https://www.who.int/publications/i/item/9789240040496\">World malaria report 2021</a>. Geneva: World Health Organization; 2021.{/ref}</p>\n\n\n\n<p>Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h4>Malaria death estimates from IHME</h4>\n\n\n\n<p>The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. </p>\n\n\n\n<p>Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019.</p>\n\n\n\n<p>These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-deaths-by-region\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h4>Malaria deaths by age group</h4>\n\n\n\n<p>The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart.</p>\n\n\n\n<p>At a global level, the most vulnerable age group to malaria deaths are children under five years old \u2014 in 2019 they accounted for 55 percent of total deaths.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-deaths-by-age\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Malaria Death Rates</h2>\n\n\n\n<p>The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-death-rates\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h4>Malaria death rates by age</h4>\n\n\n\n<p>The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. </p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-death-rates-by-age\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Malaria Incidence</h2>\n\n\n\n<p>The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/incidence-of-malaria\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>The history of malaria</h2>\n\n\n\n<p>Humanity\u2019s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) \u2013 Sickle-cell trait in human biological and cultural evolution. Science. 157:1134\u201340. Joy DA, Feng XR, Mu JB, et al. (2003) \u2013 Early origin and recent expansion of Plasmodium falciparum. Science. 300:318\u201321.{/ref}</p>\n\n\n\n<p>For most of that time humanity was exposed to the disease without any defense.</p>\n\n\n\n<h4>Malaria\u2019s mark on the human body</h4>\n\n\n\n<p>The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: <a href=\"https://vizhub.healthdata.org/gbd-compare/\">https://vizhub.healthdata.org/gbd-compare/</a>{/ref}</p>\n\n\n\n<p>Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species\u2019 history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) \u2013 Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref}</p>\n\n\n\n<h4>Malaria\u2019s mark on history</h4>\n\n\n\n<p>Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) \u2013 Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) \u2013 The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online <a href=\"https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC\">here</a>.{/ref}</p>\n\n\n\n<p>A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) \u2013 Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: <a href=\"https://economics.mit.edu/files/4127\">ttps://economics.mit.edu/files/4127</a> John Luke Gallup and Jeffrey D. Sachs (2001) \u2013 The Economic Burden of Malaria <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK2624/\">https://www.ncbi.nlm.nih.gov/books/NBK2624/</a>{/ref}</p>\n\n\n\n<h4>Malaria\u2019s mark on our drinks</h4>\n\n\n\n<p>One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy \u2013 A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.<a href=\"#_ftnref1\" name=\"_ftn1\"></a></p>\n\n\n\n<h3>Malaria was common across half the world \u2013 since then it has been eliminated in many regions</h3>\n\n\n\n<p>Malaria <a href=\"https://ourworldindata.org/malaria#the-history-of-malaria\">left its mark</a> on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world.</p>\n\n\n\n<p>But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20<sup>th</sup> century the disease was eliminated in many populous regions of the world, saving the lives of millions.</p>\n\n\n\n<p>What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America \u2013 poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell\u2019s death see <a href=\"http://www.olivercromwell.org/faqs8.htm\">the FAQs at OliverCromwell.org</a>, on Friedrich Schiller see <a href=\"https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html\">Bayerischer Rundfunk here</a>, on Abraham Lincoln see <a href=\"http://www.physical-lincoln.com/books.html\">\u2018The Physical Lincoln</a>\u2019. Other famous victims \u2013 although it is not always possible to diagnose the disease of historical figures \u2013 were German painter Albrecht D\u00fcrer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref}</p>\n\n\n\n<p>Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa.</p>\n\n\n\n<p>The researchers estimate that historically \u2013 and up to around 1900 \u2013 our ancestors were at risk from malaria across about half of the world\u2019s land surface (53%).  Since then the area where humans are at risk of malaria contracted to a quarter (27%).</p>\n\n\n\n<p>The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See “Box 4.1 Malaria-related mortality in the 20th century” in the World Health Organization’s <a href=\"https://www.who.int/whr/1999/en/whr99_en.pdf\">World Health Report (1999)</a>.{/ref}</p>\n\n\n\n<h5>Why are these parts not malarious anymore?</h5>\n\n\n\n<p>Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) \u2013 Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) \u2013 World Development Report (2009) – Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online <a href=\"http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf\">here</a>.{/ref}</p>\n\n\n\n<p> First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for <a href=\"https://ourworldindata.org/yields-and-land-use-in-agriculture\">expanding</a><a href=\"https://ourworldindata.org/yields-and-land-use-in-agriculture\"> agricultural land</a> had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place.</p>\n\n\n\n<p>All three factors \u2013 insecticides, land use change, and economic development \u2013 were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.<a href=\"#_ftnref3\" name=\"_ftn3\"></a></p>\n\n\n\n<h6>Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) \u2013 The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327\u2013336. DOI: 10.1016/S1473-3099(04)01043-6. <a href=\"https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly\">https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext</a> I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) \u2013 A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25\u2013146. Lysenko AJ, Beljaev AE (1969) \u2013 An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383\u201394.{/ref}</h6>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full\"><img loading=\"lazy\" width=\"3105\" height=\"1433\" src=\"https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map.png\" alt=\"\" class=\"wp-image-49975\" srcset=\"https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map.png 3105w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-400x185.png 400w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-800x369.png 800w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-150x69.png 150w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-768x354.png 768w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-1536x709.png 1536w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-2048x945.png 2048w\" sizes=\"(max-width: 3105px) 100vw, 3105px\" /></figure></div>\n\n\n\n<h3>Malaria in the US</h3>\n\n\n\n<p>The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time.</p>\n\n\n\n<p>Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans.</p>\n\n\n\n<h6>Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography <a href=\"http://www.radicalcartography.net/index.html?9thcensus\">here</a>. This map shown here is available in high-resolution <a href=\"http://www.radicalcartography.net/9thcensus/9th44.jpg\">here</a>.{/ref}</h6>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><a href=\"http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700.png\"><img loading=\"lazy\" width=\"774\" height=\"1024\" src=\"http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-774x1024.png\" alt=\"Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870\" class=\"wp-image-4054\" srcset=\"https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-774x1024.png 774w, https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-113x150.png 113w, https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-416x550.png 416w, https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700.png 1486w\" sizes=\"(max-width: 774px) 100vw, 774px\" /></a></figure></div>\n\n\n\n<h2>How can the world continue to make progress against malaria?</h2>\n\n\n\n<p>The world has already been very successful against this disease which is one of the most deadliest diseases in humanity’s history. How was this possible and what can we do to continue this progress?</p>\n\n\n\n<h3>Insecticide-treated bednets</h3>\n\n\n\n<h4>The world is making progress against malaria thanks to insecticide-treated bednets</h4>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>Even after <a href=\"https://owid.cloud/malaria-past-prevalence\">a century of progress</a> against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: <a href=\"http://www.who.int/malaria/en/\">http://www.who.int/malaria/en/</a>{/ref}</p>\n\n\n\n<p>Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME\u2019s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: <a href=\"https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative\">https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative</a>{/ref}</p>\n</div>\n\n\n\n<div class=\"wp-block-column\"></div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<h4>The world is making progress against malaria</h4>\n\n\n\n<p>In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity\u2019s most ingenious and successful way of transmission interruption \u2013 immunization through vaccines \u2013 is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has <a href=\"https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark\">rolled out</a> a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine <a href=\"https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss\"><em>RTS,S</em></a>, the world’s first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract\">here</a>.{/ref}</p>\n\n\n\n<p>But we have other weapons in our arsenal.</p>\n\n\n\n<p>One line of humanity\u2019s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone.</p>\n\n\n\n<p>The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll.</p>\n\n\n\n<p>From 2000 to 2015 the number of malaria deaths fell by <a href=\"https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region\">almost 40%</a>, from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria <a href=\"https://ourworldindata.org/malaria\">https://ourworldindata.org/malaria</a>{/ref}</p>\n\n\n\n<p>A recent publication in <em>Nature</em>{ref}Bhatt et al. (2015) \u2013 The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207\u2013211 (08 October 2015) doi:10.1038/nature15535. Online <a href=\"https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html\">here</a>.{/ref} studied what made this success possible. The focus of the study was Africa, where \u2013 as the chart shows \u2013 most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them.</p>\n\n\n\n<p>The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities.</p>\n\n\n\n<p>The authors of the <em>Nature </em>study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study’s authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"800\" height=\"462\" src=\"https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-800x462.png\" alt=\"\" class=\"wp-image-54610\" srcset=\"https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-800x462.png 800w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-400x231.png 400w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-150x87.png 150w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-768x444.png 768w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-1536x888.png 1536w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-2048x1184.png 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\" /><figcaption>Malaria mortality rate of children in 2000 and 2019{ref}Citation: Institute for Health Metrics and Evaluation (IHME), Malaria Atlas Project. Global Malaria Incidence, Prevalence, and Mortality Geospatial Estimates 2000-2019. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME), 2020. <a href=\"https://doi.org/10.6069/CG0J-2R97\">https://doi.org/10.6069/CG0J-2R97</a> <br>Shown is the mortality rate due to plasmodium falciparum \u2013 direct link to the interactive maps as published by the IHME <a href=\"http://ihmeuw.org/5dhp\">http://ihmeuw.org/5dhp</a> <br>For the background see: Weiss, D. J., Lucas, T. C. D., Nguyen, M., Nandi, A. K., Bisanzio, D., Battle, K. E., Cameron, E., Twohig, K. A., Pfeffer, D. A., Rozier, J. A., Gibson, H. S., Rao, P. C., Casey, D., Bertozzi-Villa, A., Collins, E. L., Dalrymple, U., Gray, N., Harris, J. R., Howes, R. E., \u2026 Gething, P. W. (2019) \u2013 <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31097-9/fulltext\">Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum, 2000\u201317: A spatial and temporal modelling study</a>. In The Lancet, 394(10195), 322\u2013331. <a href=\"https://doi.org/10.1016/S0140-6736(19)31097-9\">https://doi.org/10.1016/S0140-6736(19)31097-9</a>{/ref}</figcaption></figure>\n\n\n\n<p></p>\n</div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<h4>We can do more</h4>\n\n\n\n<p>Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations.</p>\n\n\n\n<p>Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further.</p>\n\n\n\n<p>To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It\u2019s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is \u2018GiveWell\u2019 and on the very top of their <a href=\"https://www.givewell.org/charities/top-charities\">recommended charities</a> are two organizations that are fighting malaria \u2013 the <em>Against Malaria Foundation</em> and the <em>Malaria Consortium</em>.</p>\n\n\n\n<p>The diseases many children die from are preventable \u2013 we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them.</p>\n\n\n\n<p>The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) \u2013 where more than 90% of all malaria deaths occur \u2013 shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: <a href=\"https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart\">https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart</a>{/ref}</p>\n\n\n\n<p>It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world.</p>\n\n\n\n<hr class=\"wp-block-separator\"/>\n\n\n\n<ul><li>If you want to know more before you donate, GiveWell\u2019s information on malaria can be found <a href=\"https://www.givewell.org/international/health/malaria\">here</a>.</li><li>And if you want to donate right away to help the successful fight against malaria you can do so via the page of <a href=\"https://www.givewell.org/charities/top-charities\">GiveWell\u2019s recommended charities</a>.</li></ul>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria\"></iframe>\n\n\n\n<p></p>\n</div>\n</div>\n\n\n\n<hr class=\"wp-block-separator\"/>\n\n\n\n<h3>A vaccine against malaria</h3>\n\n\n\n<p>Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) \u2013 History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814. doi: 10.1098/rstb.2011.0091.{/ref}</p>\n\n\n\n<p>This has changed with the malaria vaccine <a href=\"https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss\"><em>RTS,S</em></a>, the world’s first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract\">here</a>.{/ref}</p>\n\n\n\n<h3>Malaria and economic prosperity</h3>\n\n\n\n<h4>There are high economic costs of malaria</h4>\n\n\n\n<p>Malaria <a href=\"https://owid.cloud/malaria-past-prevalence\">was once prevalent</a> in many of today’s richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy.</p>\n\n\n\n<p>Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) \u2013 Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the “malaria penalty” to GDP is as high as 9% in Nigeria and Chad respectively.</p>\n\n\n\n<p>Azemar and Desbordes (2009){ref}C\u00e9line Az\u00e9mar and Rodolphe Desbordes (2009) \u2013 Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: <a href=\"http://jae.oxfordjournals.org/content/18/4/667\">http://jae.oxfordjournals.org/content/18/4/667</a>.{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of <a href=\"https://ourworldindata.org/malaria/\">malaria</a> and <a href=\"https://ourworldindata.org/hiv-aids/\">HIV</a>. Slightly more than one-half of this is attributed to malaria.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Data Quality & Definitions</h2>\n\n\n\n<p>The United Nations give the following definitions:{ref}See <a href=\"https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx\">the UN’s definitions here</a>.{/ref}</p>\n\n\n\n<p>The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000.</p>\n\n\n\n<p><em>Ii = (Cases / Pop) * 100,000</em></p>\n\n\n\n<p>The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000.</p>\n\n\n\n<p><em>Id = (Deaths / Pop) * 100,000</em></p>\n\n\n\n<h4>Comparison of WHO and IHME malaria deaths</h4>\n\n\n\n<p>In our section on <a href=\"https://ourworldindata.org/malaria/#deaths-due-to-malaria\">Deaths Due to Malaria</a>, we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably.</p>\n\n\n\n<p>In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO.</p>\n\n\n\n<p>For many countries \u2014 although not all \u2014 IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released \u2014 hopefully this data will begin to converge with time.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-deaths-comparisons\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Data Sources</h2>\n\n\n\n<h4>World Health Organization (WHO)</h4>\n\n\n\n<ul><li><strong>Data: </strong>Data on cases, deaths (reported and estimates) and prevention and treatment<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global \u2013 by country and WHO region<strong><br></strong></li><li><strong>Time span: </strong>Since 2000 (for reported deaths); shorter for other measures.<strong><br></strong></li><li><strong>Available at:</strong> Online <a href=\"http://apps.who.int/gho/data/node.main.A1362?lang=en\">here</a>.</li><li class=\"no-bullet\"><em>WHO data on malaria deaths and cases (1990-2006) is also available through <a href=\" http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=\">Gapminder</a> where it can be plotted against a second indicator.</em></li></ul>\n\n\n\n<h4>Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)</h4>\n\n\n\n<ul><li><strong>Data:</strong> Death rates & absolute number of deaths from malaria</li><li><strong>Geographical coverage:</strong>Global, across all regions and countries</li><li><strong>Time span:</strong>Available from 1990 onwards</li><li><strong>Available at: </strong>Online <a href=\"http://ghdx.healthdata.org/gbd-results-tool\">here</a></li></ul>\n\n\n\n<h4>World Development Indicators (WDI) \u2013 published by the World Bank</h4>\n\n\n\n<ul><li><strong>Data:</strong> Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population)</li><li><strong>Geographical coverage:</strong> Global \u2013 by country & world region</li><li><strong>Time span:</strong> Annual data \u2013 since 2000.</li><li><strong>Available at:</strong> Online <a href=\"http://data.worldbank.org/indicator/SH.MLR.TRET.ZS\">here</a>.</li></ul>\n\n\n\n<h4>United Nations \u2013 Millennium Development Goals Database</h4>\n\n\n\n<ul><li><strong>Data: </strong>Notified cases of malaria (per 100,000 people) and malaria death rate (all ages & ages 0-4)<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global \u2013 by country and region.<strong><br></strong></li><li><strong>Time span: </strong>Only very recent data.<strong><br></strong></li><li><strong>Available: </strong>Notified cases of malaria (per 100,000 people) <a href=\"http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A644\">here</a>.<br>Malaria death rate (all ages) <a href=\"http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A663\">here</a>.<br>Malaria death rate (ages 0-4) <a href=\"http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A664#MDG\">here</a>.</li></ul>\n\n\n\n<h4>DHS Malaria Indicator Survey (MIS)</h4>\n\n\n\n<ul><li><strong><strong>Data: </strong></strong>Detailed survey data from African countries</li><li><strong>Geographical coverage: </strong>Some African countries.<strong><br></strong></li><li><strong>Time span: </strong>late 2000s<strong><br></strong></li><li><strong>Available at: </strong>Online <a href=\"http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis\">here</a>.<strong><br></strong></li></ul>\n\n\n\n<h4>The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project</h4>\n\n\n\n<ul><li><strong>Data:</strong> MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk.</li><li><strong>Geographical coverage:  </strong>Entire Africa \u2013 low level</li><li><strong>Time span:</strong> Mostly recent data</li><li><strong>Available at:</strong> Online at <a href=\"http://www.mara-database.org//login.html\">http://www.mara-database.org//login.html</a>.</li><li class=\"no-bullet\"><em>Often it is possible to download the data and to view the data visualized on maps.<br></em></li></ul>\n\n\n\n<h4>Conley, McCord and Sachs (2007) Malaria Dataset</h4>\n\n\n\n<ul><li><strong>Data:</strong> % of population at risk of malaria.</li><li><strong>Geographical coverage:</strong> Global \u2013 by country.</li><li><strong>Time span:</strong> 1960 – 2000 (observations every 5 years \u2013 including interpolations)</li><li><strong>Available at:</strong> Online <a href=\"https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0\">here</a>.</li></ul>\n\n\n\n<h4>WHO data on incidence of malaria cases</h4>\n\n\n\n<ul><li><strong>Data:</strong> Incidence of malaria cases</li><li><strong>Geographical coverage:</strong> Global \u2013 by country.</li><li><strong>Time span:</strong> 1962-1997 \u2013 annual data.</li><li><strong>Available at:</strong> Online available at the <a href=\"http://84.89.132.1/~reynal/data_web.htm\">website of Marta Reynal-Querol</a>.</li></ul>\n\n\n\n<p>Other sources: Up-to-date information on the current state of malaria is published by the <a href=\"http://www.rollbackmalaria.org\">Roll Back Malaria Partnership</a> \u2013 a partnership between WHO, UNICEF, UNDP and the World Bank.</p>\n", "protected": false }, "excerpt": { "rendered": "The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?", "protected": false }, "date_gmt": "2019-11-12T23:56:00", "modified": "2023-08-18T11:02:30", "template": "", "categories": [ 44, 46, 171 ], "menu_order": 177, "ping_status": "closed", "authors_name": [ "Max Roser", "Hannah Ritchie" ], "modified_gmt": "2023-08-18T10:02:30", "comment_status": "open", "featured_media": 40625, "featured_media_paths": { "thumbnail": "/app/uploads/2021/02/Screen-Shot-2021-02-11-at-10.54.25-150x84.png", "medium_large": "/app/uploads/2021/02/Screen-Shot-2021-02-11-at-10.54.25-768x428.png" } }

title

slug

type

status

content

archieml

archieml_update_statistics

published_at

updated_at

gdocSuccessorId

authors

excerpt

created_at_in_wordpress

updated_at_in_wordpress

featured_image

formattingOptions

markdown

wpApiSnapshot

3000

Malaria

malaria

page

publish

<div class="blog-info">This article was first published in November 2015; last revised in Februrary 2022.</div>   <p>Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim’s blood system and travels into the person’s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death.</p>   <p>The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths.</p>   <p>The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000.</p>   <p>Most victims are children. It is one of the leading causes of <a href="https://ourworldindata.org/child-mortality/">child mortality</a>. Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME's Global Burden of Disease study <a href="https://vizhub.healthdata.org/gbd-compare/">here</a>. In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref}</p>   <h2>Malaria deaths</h2>   <p>In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. </p>   <p>These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher.</p>   <h4>Malaria death estimates from WHO</h4>   <p>Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the <a href="http://ourworldindata.org/coronavirus">Coronavirus pandemic</a>.{ref}<a href="https://www.who.int/publications/i/item/9789240040496">World malaria report 2021</a>. Geneva: World Health Organization; 2021.{/ref}</p>   <p>Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region" width="300" height="150"></iframe>   <h4>Malaria death estimates from IHME</h4>   <p>The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. </p>   <p>Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019.</p>   <p>These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-deaths-by-region" width="300" height="150"></iframe>   <h4>Malaria deaths by age group</h4>   <p>The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart.</p>    <p>At a global level, the most vulnerable age group to malaria deaths are children under five years old — in 2019 they accounted for 55 percent of total deaths.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-deaths-by-age" width="300" height="150"></iframe>   <h2>Malaria Death Rates</h2>   <p>The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-death-rates" width="300" height="150"></iframe>   <h4>Malaria death rates by age</h4>   <p>The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. </p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-death-rates-by-age" width="300" height="150"></iframe>   <h2>Malaria Incidence</h2>   <p>The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/incidence-of-malaria" width="300" height="150"></iframe>   <h2>The history of malaria</h2>   <p>Humanity’s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) – Sickle-cell trait in human biological and cultural evolution. Science. 157:1134–40. Joy DA, Feng XR, Mu JB, et al. (2003) – Early origin and recent expansion of Plasmodium falciparum. Science. 300:318–21.{/ref}</p>   <p>For most of that time humanity was exposed to the disease without any defense.</p>   <h4>Malaria’s mark on the human body</h4>   <p>The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: <a href="https://vizhub.healthdata.org/gbd-compare/">https://vizhub.healthdata.org/gbd-compare/</a>{/ref}</p>   <p>Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species’ history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) – Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref}</p>   <h4>Malaria’s mark on history</h4>   <p>Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) – Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) – The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online <a href="https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC">here</a>.{/ref}</p>   <p>A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) – Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: <a href="https://economics.mit.edu/files/4127">ttps://economics.mit.edu/files/4127</a> John Luke Gallup and Jeffrey D. Sachs (2001) – The Economic Burden of Malaria <a href="https://www.ncbi.nlm.nih.gov/books/NBK2624/">https://www.ncbi.nlm.nih.gov/books/NBK2624/</a>{/ref}</p>   <h4>Malaria’s mark on our drinks</h4>   <p>One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy – A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.<a href="#_ftnref1" name="_ftn1"></a></p>   <h3>Malaria was common across half the world – since then it has been eliminated in many regions</h3>    <p>Malaria <a href="https://ourworldindata.org/malaria#the-history-of-malaria">left its mark</a> on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world.</p>   <p>But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20<sup>th</sup> century the disease was eliminated in many populous regions of the world, saving the lives of millions.</p>   <p>What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America – poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell’s death see <a href="http://www.olivercromwell.org/faqs8.htm">the FAQs at OliverCromwell.org</a>, on Friedrich Schiller see <a href="https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html">Bayerischer Rundfunk here</a>, on Abraham Lincoln see <a href="http://www.physical-lincoln.com/books.html">‘The Physical Lincoln</a>’. Other famous victims – although it is not always possible to diagnose the disease of historical figures – were German painter Albrecht Dürer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref}</p>   <p>Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa.</p>   <p>The researchers estimate that historically – and up to around 1900 – our ancestors were at risk from malaria across about half of the world’s land surface (53%).  Since then the area where humans are at risk of malaria contracted to a quarter (27%).</p>   <p>The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See "Box 4.1 Malaria-related mortality in the 20th century" in the World Health Organization's <a href="https://www.who.int/whr/1999/en/whr99_en.pdf">World Health Report (1999)</a>.{/ref}</p>   <h5>Why are these parts not malarious anymore?</h5>   <p>Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) – Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) – World Development Report (2009) - Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online <a href="http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf">here</a>.{/ref}</p>   <p> First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for <a href="https://ourworldindata.org/yields-and-land-use-in-agriculture">expanding</a><a href="https://ourworldindata.org/yields-and-land-use-in-agriculture"> agricultural land</a> had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place.</p>   <p>All three factors – insecticides, land use change, and economic development – were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.<a href="#_ftnref3" name="_ftn3"></a></p>   <h6>Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) – The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327–336. DOI: 10.1016/S1473-3099(04)01043-6. <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly">https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext</a> I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) – A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25–146. Lysenko AJ, Beljaev AE (1969) – An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383–94.{/ref}</h6>   <div class="wp-block-image"><figure class="aligncenter size-full"><img src="https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map.png" alt="" class="wp-image-49975"/></figure></div>   <h3>Malaria in the US</h3>   <p>The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time.</p>   <p>Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans.</p>   <h6>Proportion of deaths from malaria to deaths of all causes – US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography <a href="http://www.radicalcartography.net/index.html?9thcensus">here</a>. This map shown here is available in high-resolution <a href="http://www.radicalcartography.net/9thcensus/9th44.jpg">here</a>.{/ref}</h6>   <div class="wp-block-image"><figure class="aligncenter"><a href="http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-–-US-Census-18700.png"><img src="http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-–-US-Census-18700-774x1024.png" alt="Proportion of deaths from malaria to deaths of all causes – US Census 1870" class="wp-image-4054"/></a></figure></div>   <h2>How can the world continue to make progress against malaria?</h2>   <p>The world has already been very successful against this disease which is one of the most deadliest diseases in humanity's history. How was this possible and what can we do to continue this progress?</p>   <h3>Insecticide-treated bednets</h3>   <h4>The world is making progress against malaria thanks to insecticide-treated bednets</h4>    <div class="wp-block-columns is-style-sticky-right"> <div class="wp-block-column"> <p>Even after <a href="https://owid.cloud/malaria-past-prevalence">a century of progress</a> against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: <a href="http://www.who.int/malaria/en/">http://www.who.int/malaria/en/</a>{/ref}</p>   <p>Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME’s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: <a href="https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative">https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative</a>{/ref}</p> </div>   <div class="wp-block-column"></div> </div>   <div class="wp-block-columns is-style-sticky-right"> <div class="wp-block-column"> <h4>The world is making progress against malaria</h4>   <p>In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity’s most ingenious and successful way of transmission interruption – immunization through vaccines – is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has <a href="https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark">rolled out</a> a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine <a href="https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss"><em>RTS,S</em></a>, the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract">here</a>.{/ref}</p>   <p>But we have other weapons in our arsenal.</p>   <p>One line of humanity’s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone.</p>   <p>The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll.</p>   <p>From 2000 to 2015 the number of malaria deaths fell by <a href="https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region">almost 40%</a>, from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria <a href="https://ourworldindata.org/malaria">https://ourworldindata.org/malaria</a>{/ref}</p>   <p>A recent publication in <em>Nature</em>{ref}Bhatt et al. (2015) – The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207–211 (08 October 2015) doi:10.1038/nature15535. Online <a href="https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html">here</a>.{/ref} studied what made this success possible. The focus of the study was Africa, where – as the chart shows – most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them.</p>   <p>The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities.</p>   <p>The authors of the <em>Nature </em>study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study's authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases.</p> </div>   <div class="wp-block-column"> <figure class="wp-block-image size-large"><img src="https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-800x462.png" alt="" class="wp-image-54610"/><figcaption>Malaria mortality rate of children in 2000 and 2019{ref}Citation: Institute for Health Metrics and Evaluation (IHME), Malaria Atlas Project. Global Malaria Incidence, Prevalence, and Mortality Geospatial Estimates 2000-2019. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME), 2020. <a href="https://doi.org/10.6069/CG0J-2R97">https://doi.org/10.6069/CG0J-2R97</a> <br>Shown is the mortality rate due to plasmodium falciparum – direct link to the interactive maps as published by the IHME <a href="http://ihmeuw.org/5dhp">http://ihmeuw.org/5dhp</a> <br>For the background see: Weiss, D. J., Lucas, T. C. D., Nguyen, M., Nandi, A. K., Bisanzio, D., Battle, K. E., Cameron, E., Twohig, K. A., Pfeffer, D. A., Rozier, J. A., Gibson, H. S., Rao, P. C., Casey, D., Bertozzi-Villa, A., Collins, E. L., Dalrymple, U., Gray, N., Harris, J. R., Howes, R. E., … Gething, P. W. (2019) – <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31097-9/fulltext">Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum, 2000–17: A spatial and temporal modelling study</a>. In The Lancet, 394(10195), 322–331. <a href="https://doi.org/10.1016/S0140-6736(19)31097-9">https://doi.org/10.1016/S0140-6736(19)31097-9</a>{/ref}</figcaption></figure>   <p></p> </div> </div>   <div class="wp-block-columns is-style-sticky-right"> <div class="wp-block-column"> <h4>We can do more</h4>   <p>Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations.</p>   <p>Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further.</p>   <p>To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It’s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is ‘GiveWell’ and on the very top of their <a href="https://www.givewell.org/charities/top-charities">recommended charities</a> are two organizations that are fighting malaria – the <em>Against Malaria Foundation</em> and the <em>Malaria Consortium</em>.</p>   <p>The diseases many children die from are preventable – we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them.</p>   <p>The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) – where more than 90% of all malaria deaths occur – shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: <a href="https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart">https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart</a>{/ref}</p>   <p>It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world.</p>   <hr class="wp-block-separator"/>   <ul><li>If you want to know more before you donate, GiveWell’s information on malaria can be found <a href="https://www.givewell.org/international/health/malaria">here</a>.</li><li>And if you want to donate right away to help the successful fight against malaria you can do so via the page of <a href="https://www.givewell.org/charities/top-charities">GiveWell’s recommended charities</a>.</li></ul> </div>   <div class="wp-block-column"> <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria"></iframe>   <p></p> </div> </div>   <hr class="wp-block-separator"/>   <h3>A vaccine against malaria</h3>   <p>Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) – History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091.{/ref}</p>   <p>This has changed with the malaria vaccine <a href="https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss"><em>RTS,S</em></a>, the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract">here</a>.{/ref}</p>   <h3>Malaria and economic prosperity</h3>   <h4>There are high economic costs of malaria</h4>   <p>Malaria <a href="https://owid.cloud/malaria-past-prevalence">was once prevalent</a> in many of today's richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy.</p>   <p>Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) – Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the "malaria penalty" to GDP is as high as 9% in Nigeria and Chad respectively.</p>   <p>Azemar and Desbordes (2009){ref}Céline Azémar and Rodolphe Desbordes (2009) – Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: <a href="http://jae.oxfordjournals.org/content/18/4/667">http://jae.oxfordjournals.org/content/18/4/667</a>.{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of <a href="https://ourworldindata.org/malaria/">malaria</a> and <a href="https://ourworldindata.org/hiv-aids/">HIV</a>. Slightly more than one-half of this is attributed to malaria.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita" width="300" height="150"></iframe>   <h2>Data Quality & Definitions</h2>   <p>The United Nations give the following definitions:{ref}See <a href="https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx">the UN's definitions here</a>.{/ref}</p>   <p>The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000.</p>   <p><em>Ii = (Cases / Pop) * 100,000</em></p>   <p>The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000.</p>   <p><em>Id = (Deaths / Pop) * 100,000</em></p>   <h4>Comparison of WHO and IHME malaria deaths</h4>   <p>In our section on <a href="https://ourworldindata.org/malaria/#deaths-due-to-malaria">Deaths Due to Malaria</a>, we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably.</p>   <p>In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO.</p>   <p>For many countries — although not all — IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released — hopefully this data will begin to converge with time.</p>   <iframe style="width: 100%; height: 600px; border: 0px none;" src="https://ourworldindata.org/grapher/malaria-deaths-comparisons" width="300" height="150"></iframe>   <h2>Data Sources</h2>   <h4>World Health Organization (WHO)</h4>   <ul><li><strong>Data: </strong>Data on cases, deaths (reported and estimates) and prevention and treatment<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global – by country and WHO region<strong><br></strong></li><li><strong>Time span: </strong>Since 2000 (for reported deaths); shorter for other measures.<strong><br></strong></li><li><strong>Available at:</strong> Online <a href="http://apps.who.int/gho/data/node.main.A1362?lang=en">here</a>.</li><li class="no-bullet"><em>WHO data on malaria deaths and cases (1990-2006) is also available through <a href=" http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=">Gapminder</a> where it can be plotted against a second indicator.</em></li></ul>   <h4>Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)</h4>   <ul><li><strong>Data:</strong> Death rates & absolute number of deaths from malaria</li><li><strong>Geographical coverage:</strong>Global, across all regions and countries</li><li><strong>Time span:</strong>Available from 1990 onwards</li><li><strong>Available at: </strong>Online <a href="http://ghdx.healthdata.org/gbd-results-tool">here</a></li></ul>   <h4>World Development Indicators (WDI) – published by the World Bank</h4>   <ul><li><strong>Data:</strong> Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population)</li><li><strong>Geographical coverage:</strong> Global – by country & world region</li><li><strong>Time span:</strong> Annual data – since 2000.</li><li><strong>Available at:</strong> Online <a href="http://data.worldbank.org/indicator/SH.MLR.TRET.ZS">here</a>.</li></ul>   <h4>United Nations – Millennium Development Goals Database</h4>   <ul><li><strong>Data: </strong>Notified cases of malaria (per 100,000 people) and malaria death rate (all ages & ages 0-4)<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global – by country and region.<strong><br></strong></li><li><strong>Time span: </strong>Only very recent data.<strong><br></strong></li><li><strong>Available: </strong>Notified cases of malaria (per 100,000 people) <a href="http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A644">here</a>.<br>Malaria death rate (all ages) <a href="http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A663">here</a>.<br>Malaria death rate (ages 0-4) <a href="http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A664#MDG">here</a>.</li></ul>   <h4>DHS Malaria Indicator Survey (MIS)</h4>   <ul><li><strong><strong>Data: </strong></strong>Detailed survey data from African countries</li><li><strong>Geographical coverage: </strong>Some African countries.<strong><br></strong></li><li><strong>Time span: </strong>late 2000s<strong><br></strong></li><li><strong>Available at: </strong>Online <a href="http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis">here</a>.<strong><br></strong></li></ul>   <h4>The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project</h4>   <ul><li><strong>Data:</strong> MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk.</li><li><strong>Geographical coverage:  </strong>Entire Africa – low level</li><li><strong>Time span:</strong> Mostly recent data</li><li><strong>Available at:</strong> Online at <a href="http://www.mara-database.org//login.html">http://www.mara-database.org//login.html</a>.</li><li class="no-bullet"><em>Often it is possible to download the data and to view the data visualized on maps.<br></em></li></ul>   <h4>Conley, McCord and Sachs (2007) Malaria Dataset</h4>   <ul><li><strong>Data:</strong> % of population at risk of malaria.</li><li><strong>Geographical coverage:</strong> Global – by country.</li><li><strong>Time span:</strong> 1960 - 2000 (observations every 5 years – including interpolations)</li><li><strong>Available at:</strong> Online <a href="https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0">here</a>.</li></ul>   <h4>WHO data on incidence of malaria cases</h4>   <ul><li><strong>Data:</strong> Incidence of malaria cases</li><li><strong>Geographical coverage:</strong> Global – by country.</li><li><strong>Time span:</strong> 1962-1997 – annual data.</li><li><strong>Available at:</strong> Online available at the <a href="http://84.89.132.1/~reynal/data_web.htm">website of Marta Reynal-Querol</a>.</li></ul>   <p>Other sources: Up-to-date information on the current state of malaria is published by the <a href="http://www.rollbackmalaria.org">Roll Back Malaria Partnership</a> – a partnership between WHO, UNICEF, UNDP and the World Bank.</p>

{
    "id": "wp-3000",
    "slug": "malaria",
    "content": {
        "toc": [],
        "body": [
            {
                "type": "text",
                "value": [
                    {
                        "text": "This article was first published in November 2015; last revised in Februrary 2022.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim\u2019s blood system and travels into the person\u2019s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Most victims are children. It is one of the leading causes of ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/child-mortality/",
                        "children": [
                            {
                                "text": "child mortality",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME's Global Burden of Disease study ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://vizhub.healthdata.org/gbd-compare/",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "children": [
                            {
                                "url": "#all-charts",
                                "children": [
                                    {
                                        "text": "See all interactive charts on malaria \u2193",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            }
                        ],
                        "spanType": "span-bold"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria deaths",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 1,
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. ",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria death estimates from WHO",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://ourworldindata.org/coronavirus",
                        "children": [
                            {
                                "text": "Coronavirus pandemic",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{ref}",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.who.int/publications/i/item/9789240040496",
                        "children": [
                            {
                                "text": "World malaria report 2021",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". Geneva: World Health Organization; 2021.{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region",
                "type": "chart",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria death estimates from IHME",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. ",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/malaria-deaths-by-region",
                "type": "chart",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria deaths by age group",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "At a global level, the most vulnerable age group to malaria deaths are children under five years old \u2014 in 2019 they accounted for 55 percent of total deaths.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/malaria-deaths-by-age",
                "type": "chart",
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria Death Rates",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 1,
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/malaria-death-rates",
                "type": "chart",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria death rates by age",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. ",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/malaria-death-rates-by-age",
                "type": "chart",
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria Incidence",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 1,
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/incidence-of-malaria",
                "type": "chart",
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "The history of malaria",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 1,
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Humanity\u2019s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) \u2013 Sickle-cell trait in human biological and cultural evolution. Science. 157:1134\u201340. Joy DA, Feng XR, Mu JB, et al. (2003) \u2013 Early origin and recent expansion of Plasmodium falciparum. Science. 300:318\u201321.{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "For most of that time humanity was exposed to the disease without any defense.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria\u2019s mark on the human body",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://vizhub.healthdata.org/gbd-compare/",
                        "children": [
                            {
                                "text": "https://vizhub.healthdata.org/gbd-compare/",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species\u2019 history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) \u2013 Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria\u2019s mark on history",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) \u2013 Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) \u2013 The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) \u2013 Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://economics.mit.edu/files/4127",
                        "children": [
                            {
                                "text": "ttps://economics.mit.edu/files/4127",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " John Luke Gallup and Jeffrey D. Sachs (2001) \u2013 The Economic Burden of Malaria ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.ncbi.nlm.nih.gov/books/NBK2624/",
                        "children": [
                            {
                                "text": "https://www.ncbi.nlm.nih.gov/books/NBK2624/",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria\u2019s mark on our drinks",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy \u2013 A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "#_ftnref1",
                        "children": [],
                        "spanType": "span-link"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria was common across half the world \u2013 since then it has been eliminated in many regions",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 2,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Malaria ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/malaria#the-history-of-malaria",
                        "children": [
                            {
                                "text": "left its mark",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "th",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-superscript"
                    },
                    {
                        "text": " century the disease was eliminated in many populous regions of the world, saving the lives of millions.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America \u2013 poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell\u2019s death see ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://www.olivercromwell.org/faqs8.htm",
                        "children": [
                            {
                                "text": "the FAQs at OliverCromwell.org",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ", on Friedrich Schiller see ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html",
                        "children": [
                            {
                                "text": "Bayerischer Rundfunk here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ", on Abraham Lincoln see ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://www.physical-lincoln.com/books.html",
                        "children": [
                            {
                                "text": "\u2018The Physical Lincoln",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "\u2019. Other famous victims \u2013 although it is not always possible to diagnose the disease of historical figures \u2013 were German painter Albrecht D\u00fcrer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The researchers estimate that historically \u2013 and up to around 1900 \u2013 our ancestors were at risk from malaria across about half of the world\u2019s land surface (53%).\u00a0 Since then the area where humans are at risk of malaria contracted to a quarter (27%).",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See \"Box 4.1 Malaria-related mortality in the 20th century\" in the World Health Organization's ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.who.int/whr/1999/en/whr99_en.pdf",
                        "children": [
                            {
                                "text": "World Health Report (1999)",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Why are these parts not malarious anymore?",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 4,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) \u2013 Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) \u2013 World Development Report (2009) - Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": " First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/yields-and-land-use-in-agriculture",
                        "children": [
                            {
                                "text": "expanding",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "url": "https://ourworldindata.org/yields-and-land-use-in-agriculture",
                        "children": [
                            {
                                "text": " agricultural land",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "All three factors \u2013 insecticides, land use change, and economic development \u2013 were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "#_ftnref3",
                        "children": [],
                        "spanType": "span-link"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) \u2013 The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327\u2013336. DOI: 10.1016/S1473-3099(04)01043-6. ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly",
                        "children": [
                            {
                                "text": "https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) \u2013 A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25\u2013146. Lysenko AJ, Beljaev AE (1969) \u2013 An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383\u201394.{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 5,
                "parseErrors": []
            },
            {
                "alt": "",
                "size": "wide",
                "type": "image",
                "filename": "Previous-prevalence-of-malaria-world-map.png",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria in the US",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 2,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://www.radicalcartography.net/index.html?9thcensus",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". This map shown here is available in high-resolution ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://www.radicalcartography.net/9thcensus/9th44.jpg",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 5,
                "parseErrors": []
            },
            {
                "alt": "Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870",
                "size": "wide",
                "type": "image",
                "filename": "The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700.png",
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "How can the world continue to make progress against malaria?",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 1,
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The world has already been very successful against this disease which is one of the most deadliest diseases in humanity's history. How was this possible and what can we do to continue this progress?",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Insecticide-treated bednets",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 2,
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "The world is making progress against malaria thanks to insecticide-treated bednets",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Even after ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://owid.cloud/malaria-past-prevalence",
                        "children": [
                            {
                                "text": "a century of progress",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://www.who.int/malaria/en/",
                        "children": [
                            {
                                "text": "http://www.who.int/malaria/en/",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME\u2019s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative",
                        "children": [
                            {
                                "text": "https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "The world is making progress against malaria",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity\u2019s most ingenious and successful way of transmission interruption \u2013 immunization through vaccines \u2013 is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark",
                        "children": [
                            {
                                "text": "rolled out",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss",
                        "children": [
                            {
                                "children": [
                                    {
                                        "text": "RTS,S",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-italic"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ", the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "But we have other weapons in our arsenal.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "One line of humanity\u2019s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "From 2000 to 2015 the number of malaria deaths fell by ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region",
                        "children": [
                            {
                                "text": "almost 40%",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ", from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/malaria",
                        "children": [
                            {
                                "text": "https://ourworldindata.org/malaria",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "A recent publication in ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "Nature",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": "{ref}Bhatt et al. (2015) \u2013 The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207\u2013211 (08 October 2015) doi:10.1038/nature15535. Online ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref} studied what made this success possible. The focus of the study was Africa, where \u2013 as the chart shows \u2013 most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The authors of the ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "Nature ",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": "study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study's authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "alt": "",
                "size": "wide",
                "type": "image",
                "filename": "Malaria-mortality-of-children-in-Africa.png",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "We can do more",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It\u2019s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is \u2018GiveWell\u2019 and on the very top of their ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.givewell.org/charities/top-charities",
                        "children": [
                            {
                                "text": "recommended charities",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " are two organizations that are fighting malaria \u2013 the ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "Against Malaria Foundation",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": " and the ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "Malaria Consortium",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ".",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The diseases many children die from are preventable \u2013 we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) \u2013 where more than 90% of all malaria deaths occur \u2013 shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart",
                        "children": [
                            {
                                "text": "https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": "{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "text": "If you want to know more before you donate, GiveWell\u2019s information on malaria can be found ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.givewell.org/international/health/malaria",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "text": "And if you want to donate right away to help the successful fight against malaria you can do so via the page of ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.givewell.org/charities/top-charities",
                                "children": [
                                    {
                                        "text": "GiveWell\u2019s recommended charities",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria",
                "type": "chart",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "A vaccine against malaria",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 2,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) \u2013 History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as\u00a0SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In\u00a0Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814.\u00a0doi: 10.1098/rstb.2011.0091.{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "This has changed with the malaria vaccine ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss",
                        "children": [
                            {
                                "children": [
                                    {
                                        "text": "RTS,S",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-italic"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ",\u00a0the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract",
                        "children": [
                            {
                                "text": "here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Malaria and economic prosperity",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 2,
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "There are high economic costs of malaria",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Malaria ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://owid.cloud/malaria-past-prevalence",
                        "children": [
                            {
                                "text": "was once prevalent",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " in many of today's richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) \u2013 Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the \"malaria penalty\" to GDP is as high as 9% in Nigeria and Chad respectively.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Azemar and Desbordes (2009){ref}C\u00e9line Az\u00e9mar and Rodolphe Desbordes (2009) \u2013 Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://jae.oxfordjournals.org/content/18/4/667",
                        "children": [
                            {
                                "text": "http://jae.oxfordjournals.org/content/18/4/667",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/malaria/",
                        "children": [
                            {
                                "text": "malaria",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " and ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/hiv-aids/",
                        "children": [
                            {
                                "text": "HIV",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". Slightly more than one-half of this is attributed to malaria.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita",
                "type": "chart",
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Data Quality & Definitions",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 1,
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The United Nations give the following definitions:{ref}See ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx",
                        "children": [
                            {
                                "text": "the UN's definitions here",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ".{/ref}",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "children": [
                            {
                                "text": "Ii = (Cases / Pop) * 100,000",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "children": [
                            {
                                "text": "Id = (Deaths / Pop) * 100,000",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Comparison of WHO and IHME malaria deaths",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "In our section on ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://ourworldindata.org/malaria/#deaths-due-to-malaria",
                        "children": [
                            {
                                "text": "Deaths Due to Malaria",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ", we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "For many countries\u00a0\u2014 although not all\u00a0\u2014 IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released\u00a0\u2014 hopefully this data will begin to converge with time.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "url": "https://ourworldindata.org/grapher/malaria-deaths-comparisons",
                "type": "chart",
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Data Sources",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 1,
                "parseErrors": []
            },
            {
                "type": "horizontal-rule",
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "World Health Organization (WHO)",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Data: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Data on cases, deaths (reported and estimates) and prevention and treatment",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Global \u2013 by country and WHO region",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Since 2000 (for reported deaths); shorter for other measures.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available at:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Online ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://apps.who.int/gho/data/node.main.A1362?lang=en",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "WHO data on malaria deaths and cases (1990-2006) is also available through ",
                                        "spanType": "span-simple-text"
                                    },
                                    {
                                        "url": " http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=",
                                        "children": [
                                            {
                                                "text": "Gapminder",
                                                "spanType": "span-simple-text"
                                            }
                                        ],
                                        "spanType": "span-link"
                                    },
                                    {
                                        "text": " where it can be plotted against a second indicator.",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-italic"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Data:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Death rates & absolute number of deaths from malaria",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Global, across all regions and countries",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Available from 1990 onwards",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available at:\u00a0",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Online ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://ghdx.healthdata.org/gbd-results-tool",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "World Development Indicators (WDI) \u2013 published by the World Bank",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Data:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population)",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Global \u2013 by country & world region",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "\u00a0Annual data \u2013 since 2000.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available at:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Online ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://data.worldbank.org/indicator/SH.MLR.TRET.ZS",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "United Nations \u2013 Millennium Development Goals Database",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Data: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Notified cases of malaria (per 100,000 people) and malaria death rate (all ages & ages 0-4)",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Global \u2013 by country and region.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Only very recent data.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Notified cases of malaria (per 100,000 people) ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A644",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
                            },
                            {
                                "text": "Malaria death rate (all ages) ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A663",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            },
                            {
                                "spanType": "span-newline"
                            },
                            {
                                "text": "Malaria death rate (ages 0-4) ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A664#MDG",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "DHS Malaria Indicator Survey (MIS)",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "children": [
                                            {
                                                "text": "Data: ",
                                                "spanType": "span-simple-text"
                                            }
                                        ],
                                        "spanType": "span-bold"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Detailed survey data from African countries",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Some African countries.",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "late 2000s",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available at: ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Online ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            },
                            {
                                "children": [
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-bold"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Data:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "\u00a0MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage:\u00a0 ",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": "Entire Africa \u2013 low level",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Mostly recent data",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available at:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Online at ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://www.mara-database.org//login.html",
                                "children": [
                                    {
                                        "text": "http://www.mara-database.org//login.html",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Often it is possible to download the data and to view the data visualized on maps.",
                                        "spanType": "span-simple-text"
                                    },
                                    {
                                        "spanType": "span-newline"
                                    }
                                ],
                                "spanType": "span-italic"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "Conley, McCord and Sachs (2007) Malaria Dataset",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Data:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " % of population at risk of malaria.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Global \u2013 by country.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " 1960 - 2000 (observations every 5 years \u2013 including interpolations)",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available at:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Online ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0",
                                "children": [
                                    {
                                        "text": "here",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "text": [
                    {
                        "text": "WHO data on incidence of malaria cases",
                        "spanType": "span-simple-text"
                    }
                ],
                "type": "heading",
                "level": 3,
                "parseErrors": []
            },
            {
                "type": "list",
                "items": [
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Data:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Incidence of malaria cases",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Geographical coverage:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Global \u2013 by country.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Time span:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " 1962-1997 \u2013 annual data.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    },
                    {
                        "type": "text",
                        "value": [
                            {
                                "children": [
                                    {
                                        "text": "Available at:",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-bold"
                            },
                            {
                                "text": " Online available at the ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "http://84.89.132.1/~reynal/data_web.htm",
                                "children": [
                                    {
                                        "text": "website of Marta Reynal-Querol",
                                        "spanType": "span-simple-text"
                                    }
                                ],
                                "spanType": "span-link"
                            },
                            {
                                "text": ".",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "parseErrors": []
                    }
                ],
                "parseErrors": []
            },
            {
                "type": "text",
                "value": [
                    {
                        "text": "Other sources: Up-to-date information on the current state of malaria is published by the ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "http://www.rollbackmalaria.org",
                        "children": [
                            {
                                "text": "Roll Back Malaria Partnership",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": " \u2013 a partnership between WHO, UNICEF, UNDP and the World Bank.",
                        "spanType": "span-simple-text"
                    }
                ],
                "parseErrors": []
            },
            {
                "top": [],
                "type": "all-charts",
                "heading": "Interactive charts on malaria",
                "parseErrors": []
            }
        ],
        "type": "linear-topic-page",
        "title": "Malaria",
        "authors": [
            "Max Roser",
            "Hannah Ritchie"
        ],
        "excerpt": "The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?",
        "dateline": "November 12, 2019",
        "subtitle": "The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?",
        "sticky-nav": [],
        "sidebar-toc": true,
        "featured-image": "Screen-Shot-2021-02-11-at-10.54.25.png"
    },
    "createdAt": "2019-10-03T14:03:36.000Z",
    "published": false,
    "updatedAt": "2023-08-18T10:02:30.000Z",
    "revisionId": null,
    "publishedAt": "2019-11-12T23:56:00.000Z",
    "relatedCharts": [
        {
            "slug": "child-deaths-from-malaria-ihme",
            "title": "Child deaths from malaria",
            "variantName": null,
            "keyChartLevel": 0
        },
        {
            "slug": "deaths-conflict-terrorism-per-100000",
            "title": "Death rate from conflict and terrorism",
            "variantName": "IHME, crude",
            "keyChartLevel": 0
        },
        {
            "slug": "death-rates-from-conflict-and-terrorism-gbd",
            "title": "Death rate from conflict and terrorism",
            "variantName": "IHME, age-standardized",
            "keyChartLevel": 0
        },
        {
            "slug": "malaria-death-rates",
            "title": "Death rate from malaria",
            "variantName": null,
            "keyChartLevel": 2
        },
        {
            "slug": "death-rate-from-malaria-ghe",
            "title": "Death rate from malaria",
            "variantName": "WHO, Global Health Estimates",
            "keyChartLevel": 2
        },
        {
            "slug": "death-rate-from-malaria-ihme",
            "title": "Death rate from malaria",
            "variantName": "IHME data",
            "keyChartLevel": 2
        },
        {
            "slug": "death-rate-from-malaria",
            "title": "Death rate from malaria",
            "variantName": "WHO, GHO data",
            "keyChartLevel": 2
        },
        {
            "slug": "deaths-from-conflict-and-terrorism",
            "title": "Deaths from conflict and terrorism",
            "variantName": "IHME, GBD",
            "keyChartLevel": 0
        },
        {
            "slug": "incidence-of-malaria",
            "title": "Incidence of malaria",
            "variantName": "WHO",
            "keyChartLevel": 2
        },
        {
            "slug": "malaria-deaths-by-age",
            "title": "Malaria deaths by age",
            "variantName": "IHME",
            "keyChartLevel": 2
        },
        {
            "slug": "global-malaria-deaths-by-world-region",
            "title": "Malaria deaths by world region",
            "variantName": "WHO",
            "keyChartLevel": 2
        },
        {
            "slug": "malaria-deaths-by-region",
            "title": "Malaria deaths by world region",
            "variantName": "IHME",
            "keyChartLevel": 2
        },
        {
            "slug": "malaria-deaths-comparisons",
            "title": "Malaria deaths: IHME vs. WHO estimates",
            "variantName": null,
            "keyChartLevel": 2
        },
        {
            "slug": "child-deaths-from-malaria",
            "title": "Malaria mortality in children",
            "variantName": null,
            "keyChartLevel": 2
        },
        {
            "slug": "malaria-prevalence-vs-gdp-per-capita",
            "title": "Malaria prevalence vs. GDP per capita",
            "variantName": null,
            "keyChartLevel": 2
        },
        {
            "slug": "child-deaths-from-malaria-number",
            "title": "Number of child deaths from malaria",
            "variantName": null,
            "keyChartLevel": 2
        },
        {
            "slug": "malaria-deaths-ihme",
            "title": "Number of deaths from malaria",
            "variantName": "IHME",
            "keyChartLevel": 2
        },
        {
            "slug": "number-of-deaths-from-malaria-who",
            "title": "Number of deaths from malaria",
            "variantName": "WHO GHO",
            "keyChartLevel": 2
        },
        {
            "slug": "number-of-deaths-from-malaria-ghe",
            "title": "Number of deaths from malaria",
            "variantName": "WHO GHE",
            "keyChartLevel": 2
        },
        {
            "slug": "children-sleeping-under-treated-bednet",
            "title": "Share of children sleeping under insecticide-treated nets",
            "variantName": null,
            "keyChartLevel": 2
        },
        {
            "slug": "share-of-children-with-a-fever-receiving-antimalarial-drugs",
            "title": "Share of children with a fever receiving antimalarial drugs",
            "variantName": null,
            "keyChartLevel": 2
        },
        {
            "slug": "share-of-the-population-with-malaria",
            "title": "Share of the population with malaria",
            "variantName": null,
            "keyChartLevel": 2
        }
    ],
    "publicationContext": "listed"
}

{
    "errors": [
        {
            "name": "iframe with src that is not a grapher",
            "details": "Found iframe with src that is not a grapher"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag image"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag image"
        },
        {
            "name": "too many figcaption elements after archieml transform",
            "details": "Found 11 elements after transforming to archieml"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag image"
        },
        {
            "name": "unhandled html tag found",
            "details": "Encountered the unhandled tag hr"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag separator"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unhandled html tag found",
            "details": "Encountered the unhandled tag hr"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag separator"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        },
        {
            "name": "unexpected wp component tag",
            "details": "Found unhandled wp:comment tag list"
        }
    ],
    "numBlocks": 138,
    "numErrors": 18,
    "wpTagCounts": {
        "html": 10,
        "list": 9,
        "image": 3,
        "column": 6,
        "columns": 3,
        "heading": 35,
        "paragraph": 67,
        "separator": 2
    },
    "htmlTagCounts": {
        "p": 67,
        "h2": 7,
        "h3": 5,
        "h4": 20,
        "h5": 1,
        "h6": 2,
        "hr": 2,
        "ul": 9,
        "div": 12,
        "figure": 3,
        "iframe": 9,
        "figcaption": 1
    }
}

2019-11-12 23:56:00

2024-02-27 00:30:12

[
    "Max Roser",
    "Hannah Ritchie"
]

The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?

2019-10-03 14:03:36

2023-08-18 10:02:30

https://ourworldindata.org/wp-content/uploads/2021/02/Screen-Shot-2021-02-11-at-10.54.25.png

{}

This article was first published in November 2015; last revised in Februrary 2022. Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim’s blood system and travels into the person’s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death. The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths. The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000. Most victims are children. It is one of the leading causes of [child mortality](https://ourworldindata.org/child-mortality/). Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME's Global Burden of Disease study [here](https://vizhub.healthdata.org/gbd-compare/). In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref} **[See all interactive charts on malaria ↓](#all-charts)** --- # Malaria deaths --- In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher. ### Malaria death estimates from WHO Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the [Coronavirus pandemic](http://ourworldindata.org/coronavirus).{ref}[World malaria report 2021](https://www.who.int/publications/i/item/9789240040496). Geneva: World Health Organization; 2021.{/ref} Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly. <Chart url="http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region"/> ### Malaria death estimates from IHME The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019. These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region. <Chart url="https://ourworldindata.org/grapher/malaria-deaths-by-region"/> ### Malaria deaths by age group The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart. At a global level, the most vulnerable age group to malaria deaths are children under five years old — in 2019 they accounted for 55 percent of total deaths. <Chart url="https://ourworldindata.org/grapher/malaria-deaths-by-age"/> --- # Malaria Death Rates --- The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals. <Chart url="https://ourworldindata.org/grapher/malaria-death-rates"/> ### Malaria death rates by age The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. <Chart url="https://ourworldindata.org/grapher/malaria-death-rates-by-age"/> --- # Malaria Incidence --- The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator. <Chart url="https://ourworldindata.org/grapher/incidence-of-malaria"/> --- # The history of malaria --- Humanity’s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) – Sickle-cell trait in human biological and cultural evolution. Science. 157:1134–40. Joy DA, Feng XR, Mu JB, et al. (2003) – Early origin and recent expansion of Plasmodium falciparum. Science. 300:318–21.{/ref} For most of that time humanity was exposed to the disease without any defense. ### Malaria’s mark on the human body The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: [https://vizhub.healthdata.org/gbd-compare/](https://vizhub.healthdata.org/gbd-compare/){/ref} Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species’ history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) – Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref} ### Malaria’s mark on history Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) – Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) – The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online [here](https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC).{/ref} A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) – Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: [ttps://economics.mit.edu/files/4127](https://economics.mit.edu/files/4127) John Luke Gallup and Jeffrey D. Sachs (2001) – The Economic Burden of Malaria [https://www.ncbi.nlm.nih.gov/books/NBK2624/](https://www.ncbi.nlm.nih.gov/books/NBK2624/){/ref} ### Malaria’s mark on our drinks One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy – A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.[](#_ftnref1) ## Malaria was common across half the world – since then it has been eliminated in many regions Malaria [left its mark](https://ourworldindata.org/malaria#the-history-of-malaria) on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world. But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20th century the disease was eliminated in many populous regions of the world, saving the lives of millions. What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America – poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell’s death see [the FAQs at OliverCromwell.org](http://www.olivercromwell.org/faqs8.htm), on Friedrich Schiller see [Bayerischer Rundfunk here](https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html), on Abraham Lincoln see [‘The Physical Lincoln](http://www.physical-lincoln.com/books.html)’. Other famous victims – although it is not always possible to diagnose the disease of historical figures – were German painter Albrecht Dürer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref} Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa. The researchers estimate that historically – and up to around 1900 – our ancestors were at risk from malaria across about half of the world’s land surface (53%). Since then the area where humans are at risk of malaria contracted to a quarter (27%). The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See "Box 4.1 Malaria-related mortality in the 20th century" in the World Health Organization's [World Health Report (1999)](https://www.who.int/whr/1999/en/whr99_en.pdf).{/ref} #### Why are these parts not malarious anymore? Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) – Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) – World Development Report (2009) - Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online [here](http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf).{/ref} First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for [expanding](https://ourworldindata.org/yields-and-land-use-in-agriculture)[ agricultural land](https://ourworldindata.org/yields-and-land-use-in-agriculture) had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place. All three factors – insecticides, land use change, and economic development – were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.[](#_ftnref3) ##### Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) – The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327–336. DOI: 10.1016/S1473-3099(04)01043-6. [https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext](https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly) I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) – A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25–146. Lysenko AJ, Beljaev AE (1969) – An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383–94.{/ref} <Image filename="Previous-prevalence-of-malaria-world-map.png" alt=""/> ## Malaria in the US The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time. Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans. ##### Proportion of deaths from malaria to deaths of all causes – US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography [here](http://www.radicalcartography.net/index.html?9thcensus). This map shown here is available in high-resolution [here](http://www.radicalcartography.net/9thcensus/9th44.jpg).{/ref} <Image filename="The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-–-US-Census-18700.png" alt="Proportion of deaths from malaria to deaths of all causes – US Census 1870"/> --- # How can the world continue to make progress against malaria? --- The world has already been very successful against this disease which is one of the most deadliest diseases in humanity's history. How was this possible and what can we do to continue this progress? ## Insecticide-treated bednets ### The world is making progress against malaria thanks to insecticide-treated bednets Even after [a century of progress](https://owid.cloud/malaria-past-prevalence) against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: [http://www.who.int/malaria/en/](http://www.who.int/malaria/en/){/ref} Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME’s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: [https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative](https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative){/ref} ### The world is making progress against malaria In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity’s most ingenious and successful way of transmission interruption – immunization through vaccines – is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has [rolled out](https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark) a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine [_RTS,S_](https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss), the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online [here](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract).{/ref} But we have other weapons in our arsenal. One line of humanity’s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone. The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll. From 2000 to 2015 the number of malaria deaths fell by [almost 40%](https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region), from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria [https://ourworldindata.org/malaria](https://ourworldindata.org/malaria){/ref} A recent publication in _Nature_{ref}Bhatt et al. (2015) – The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207–211 (08 October 2015) doi:10.1038/nature15535. Online [here](https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html).{/ref} studied what made this success possible. The focus of the study was Africa, where – as the chart shows – most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them. The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities. The authors of the _Nature _study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study's authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases. <Image filename="Malaria-mortality-of-children-in-Africa.png" alt=""/> ### We can do more Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations. Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further. To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It’s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is ‘GiveWell’ and on the very top of their [recommended charities](https://www.givewell.org/charities/top-charities) are two organizations that are fighting malaria – the _Against Malaria Foundation_ and the _Malaria Consortium_. The diseases many children die from are preventable – we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them. The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) – where more than 90% of all malaria deaths occur – shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: [https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart](https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart){/ref} It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world. * If you want to know more before you donate, GiveWell’s information on malaria can be found [here](https://www.givewell.org/international/health/malaria). * And if you want to donate right away to help the successful fight against malaria you can do so via the page of [GiveWell’s recommended charities](https://www.givewell.org/charities/top-charities). <Chart url="https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria"/> ## A vaccine against malaria Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) – History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) – Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806–2814. doi: 10.1098/rstb.2011.0091.{/ref} This has changed with the malaria vaccine [_RTS,S_](https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss), the world's first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) – Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online [here](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract).{/ref} ## Malaria and economic prosperity ### There are high economic costs of malaria Malaria [was once prevalent](https://owid.cloud/malaria-past-prevalence) in many of today's richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy. Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) – Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the "malaria penalty" to GDP is as high as 9% in Nigeria and Chad respectively. Azemar and Desbordes (2009){ref}Céline Azémar and Rodolphe Desbordes (2009) – Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: [http://jae.oxfordjournals.org/content/18/4/667](http://jae.oxfordjournals.org/content/18/4/667).{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of [malaria](https://ourworldindata.org/malaria/) and [HIV](https://ourworldindata.org/hiv-aids/). Slightly more than one-half of this is attributed to malaria. <Chart url="https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita"/> --- # Data Quality & Definitions --- The United Nations give the following definitions:{ref}See [the UN's definitions here](https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx).{/ref} The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000. _Ii = (Cases / Pop) * 100,000_ The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000. _Id = (Deaths / Pop) * 100,000_ ### Comparison of WHO and IHME malaria deaths In our section on [Deaths Due to Malaria](https://ourworldindata.org/malaria/#deaths-due-to-malaria), we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably. In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO. For many countries — although not all — IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released — hopefully this data will begin to converge with time. <Chart url="https://ourworldindata.org/grapher/malaria-deaths-comparisons"/> --- # Data Sources --- ### World Health Organization (WHO) * **Data: **Data on cases, deaths (reported and estimates) and prevention and treatment** ** * **Geographical coverage: **Global – by country and WHO region** ** * **Time span: **Since 2000 (for reported deaths); shorter for other measures.** ** * **Available at:** Online [here](http://apps.who.int/gho/data/node.main.A1362?lang=en). * _WHO data on malaria deaths and cases (1990-2006) is also available through [Gapminder]( http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=) where it can be plotted against a second indicator._ ### Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) * **Data:** Death rates & absolute number of deaths from malaria * **Geographical coverage:**Global, across all regions and countries * **Time span:**Available from 1990 onwards * **Available at: **Online [here](http://ghdx.healthdata.org/gbd-results-tool) ### World Development Indicators (WDI) – published by the World Bank * **Data:** Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population) * **Geographical coverage:** Global – by country & world region * **Time span:** Annual data – since 2000. * **Available at:** Online [here](http://data.worldbank.org/indicator/SH.MLR.TRET.ZS). ### United Nations – Millennium Development Goals Database * **Data: **Notified cases of malaria (per 100,000 people) and malaria death rate (all ages & ages 0-4)** ** * **Geographical coverage: **Global – by country and region.** ** * **Time span: **Only very recent data.** ** * **Available: **Notified cases of malaria (per 100,000 people) [here](http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A644). Malaria death rate (all ages) [here](http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A663). Malaria death rate (ages 0-4) [here](http://data.un.org/Data.aspx?d=MDG&f=seriesRowID%3A664#MDG). ### DHS Malaria Indicator Survey (MIS) * ****Data: ****Detailed survey data from African countries * **Geographical coverage: **Some African countries.** ** * **Time span: **late 2000s** ** * **Available at: **Online [here](http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis).** ** ### The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project * **Data:** MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk. * **Geographical coverage: **Entire Africa – low level * **Time span:** Mostly recent data * **Available at:** Online at [http://www.mara-database.org//login.html](http://www.mara-database.org//login.html). * _Often it is possible to download the data and to view the data visualized on maps. _ ### Conley, McCord and Sachs (2007) Malaria Dataset * **Data:** % of population at risk of malaria. * **Geographical coverage:** Global – by country. * **Time span:** 1960 - 2000 (observations every 5 years – including interpolations) * **Available at:** Online [here](https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0). ### WHO data on incidence of malaria cases * **Data:** Incidence of malaria cases * **Geographical coverage:** Global – by country. * **Time span:** 1962-1997 – annual data. * **Available at:** Online available at the [website of Marta Reynal-Querol](http://84.89.132.1/~reynal/data_web.htm). Other sources: Up-to-date information on the current state of malaria is published by the [Roll Back Malaria Partnership](http://www.rollbackmalaria.org) – a partnership between WHO, UNICEF, UNDP and the World Bank. <AllCharts heading="Interactive charts on malaria"/>

{
    "id": 3000,
    "date": "2019-11-12T23:56:00",
    "guid": {
        "rendered": "http://ourworldindata.org/?page_id=3000"
    },
    "link": "https://owid.cloud/malaria",
    "meta": {
        "owid_publication_context_meta_field": [],
        "owid_key_performance_indicators_meta_field": {
            "raw": "**630,000** people die from malaria every year.\n\n55% are children younger than 5 years old.",
            "rendered": "<p><strong>630,000</strong> people die from malaria every year.</p>\n<p>55% are children younger than 5 years old.</p>\n"
        }
    },
    "slug": "malaria",
    "tags": [],
    "type": "page",
    "title": {
        "rendered": "Malaria"
    },
    "_links": {
        "self": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/pages/3000"
            }
        ],
        "about": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/types/page"
            }
        ],
        "author": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/users/2",
                "embeddable": true
            }
        ],
        "curies": [
            {
                "href": "https://api.w.org/{rel}",
                "name": "wp",
                "templated": true
            }
        ],
        "replies": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/comments?post=3000",
                "embeddable": true
            }
        ],
        "wp:term": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/categories?post=3000",
                "taxonomy": "category",
                "embeddable": true
            },
            {
                "href": "https://owid.cloud/wp-json/wp/v2/tags?post=3000",
                "taxonomy": "post_tag",
                "embeddable": true
            }
        ],
        "collection": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/pages"
            }
        ],
        "wp:attachment": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/media?parent=3000"
            }
        ],
        "version-history": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/pages/3000/revisions",
                "count": 30
            }
        ],
        "wp:featuredmedia": [
            {
                "href": "https://owid.cloud/wp-json/wp/v2/media/40625",
                "embeddable": true
            }
        ],
        "predecessor-version": [
            {
                "id": 58019,
                "href": "https://owid.cloud/wp-json/wp/v2/pages/3000/revisions/58019"
            }
        ]
    },
    "author": 2,
    "parent": 0,
    "status": "publish",
    "content": {
        "rendered": "\n<div class=\"blog-info\">This article was first published in November 2015; last revised in Februrary 2022.</div>\n\n\n\n<p>Malaria is a disease that is transmitted from person to person by infected mosquitoes. The bite of an infected Anopheles mosquito transmits a parasite that enters the victim\u2019s blood system and travels into the person\u2019s liver where the parasite reproduces. There the parasite causes a high fever that involves shaking chills and pain. In the worst cases malaria leads to coma and death.</p>\n\n\n\n<p>The parasites are single-celled microorganisms of the Plasmodium group. Plasmodium falciparum is by far the most lethal in humans and responsible for most deaths.</p>\n\n\n\n<p>The annual death toll is certainly in the hundreds of thousands, but estimates differ between different global health organizations: The World Health Organization (WHO) estimates that 558,000 people died because of malaria in 2019; the Institute of Health Metrics and Evaluation (IHME) puts this estimate at 643,000.</p>\n\n\n\n<p>Most victims are children. It is one of the leading causes of <a href=\"https://ourworldindata.org/child-mortality/\">child mortality</a>. Every twelfth child that died in 2017, died because of malaria.{ref}This is according to the IHME&#8217;s Global Burden of Disease study <a href=\"https://vizhub.healthdata.org/gbd-compare/\">here</a>. In Sub-Saharan Africa malaria is responsible for 12% of all child deaths.{/ref}</p>\n\n\n\n<h2>Malaria deaths</h2>\n\n\n\n<p>In the visualizations we provide estimates of the total number of deaths from the World Health Organization (WHO) from 2000 onwards, and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD) from 1990 onwards. </p>\n\n\n\n<p>These estimates are notably different across various countries which affects the total number of reported deaths. IHME figures, as shown, tend to be higher.</p>\n\n\n\n<h4>Malaria death estimates from WHO</h4>\n\n\n\n<p>Since the beginning of the 21st century, the WHO has published global estimates of the number of people that die from malaria. Between 2000 and 2015 the global death toll fell by almost 40%: from 896,000 deaths in 2000 to 562,000 in 2015. Since then, progress has slowed. The number of deaths actually increased in 2020 as a result of disruptions due to the <a href=\"http://ourworldindata.org/coronavirus\">Coronavirus pandemic</a>.{ref}<a href=\"https://www.who.int/publications/i/item/9789240040496\">World malaria report 2021</a>. Geneva: World Health Organization; 2021.{/ref}</p>\n\n\n\n<p>Africa is the world region that is most affected by malaria: in 2019, 96% of global deaths from malaria occurred on the African continent. But Africa is also the world region that has achieved most progress: since 2000, deaths have fallen significantly.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"http://ourworldindata.org/grapher/global-malaria-deaths-by-world-region\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h4>Malaria death estimates from IHME</h4>\n\n\n\n<p>The Institute of Health Metrics and Evaluation (IHME) provide estimates of malaria deaths from the year 1990 onwards. </p>\n\n\n\n<p>Over this period we see a clear rise-peak-fall trend, increasing from around 850,000 deaths in 1990; peaking at around 965,000 in 2004; and then declining (although at varying rates) to around 650,000 in 2019.</p>\n\n\n\n<p>These estimates are notably higher than those of the WHO. Although divergent on the total number of malaria deaths, both the IHME and WHO estimate that more than 90 percent (9 in every 10 deaths) are from the African region.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-deaths-by-region\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h4>Malaria deaths by age group</h4>\n\n\n\n<p>The visualization categories the annual number of deaths by age group. These figures are those published by the IHME, Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. Note that you can view these trends for any country in the chart.</p>\n\n\n\n<p>At a global level, the most vulnerable age group to malaria deaths are children under five years old \u2014 in 2019 they accounted for 55 percent of total deaths.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-deaths-by-age\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Malaria Death Rates</h2>\n\n\n\n<p>The visualization shows the age-standardized death rate from malaria, measured as the number of deaths per 100,000 individuals.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-death-rates\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h4>Malaria death rates by age</h4>\n\n\n\n<p>The visualisation shows the breakdown of death rates from malaria (measured as the number of deaths per 100,000 individuals) by age category. </p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-death-rates-by-age\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Malaria Incidence</h2>\n\n\n\n<p>The map shows the number of new malaria cases per 100,000 individuals across the world. The malaria incidence is highest in the central part of Africa north and south of the equator.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/incidence-of-malaria\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>The history of malaria</h2>\n\n\n\n<p>Humanity\u2019s fight against malaria has a history of many thousand years.{ref}Wiesenfeld SL (1967) \u2013 Sickle-cell trait in human biological and cultural evolution. Science. 157:1134\u201340. Joy DA, Feng XR, Mu JB, et al. (2003) \u2013 Early origin and recent expansion of Plasmodium falciparum. Science. 300:318\u201321.{/ref}</p>\n\n\n\n<p>For most of that time humanity was exposed to the disease without any defense.</p>\n\n\n\n<h4>Malaria\u2019s mark on the human body</h4>\n\n\n\n<p>The history of humanity is so closely entangled with the history of malaria that the disease left its mark on our bodies. Sickle cell disorder is a genetic disease that deforms red blood cells to be sickle-shaped. Carriers suffer from attacks of pain from a young age and their lives are cut short by the condition: it causes around 55,000 deaths every year.{ref}The estimate of around 55,000 deaths caused by Sickle Cell Disorder is according to the Global Burden of Disease study by the Institute for Health Metrics and Evaluation. Results are online here: <a href=\"https://vizhub.healthdata.org/gbd-compare/\">https://vizhub.healthdata.org/gbd-compare/</a>{/ref}</p>\n\n\n\n<p>Why would such a genetic mutation not die out? The reason for the continued existence is that the same disorder hinders the malaria parasite from reproducing so that the carrier is provided with a protective advantage in environments where malaria exists. The prevalence of sickle cell disorder today is testament to the high-malaria environments in our species\u2019 history.{ref}See: Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V. (2002) \u2013 Protective Effects of the Sickle Cell Gene Against Malaria Morbidity and Mortality. In Lancet 2002; 359:1311-1312.{/ref}</p>\n\n\n\n<h4>Malaria\u2019s mark on history</h4>\n\n\n\n<p>Malaria did not only leave its mark on our body, but in many ways also on our history. Malaria is presumed to have been the secret ally that helped the barbarians bring about the downfall of Rome. The examination of the teeth and bones of the Romans by archeologists has recently brought together more and more evidence that the mosquito-borne fever once thrived in the warm, marshy river valleys of the Tiber and the Po in the Roman empire. The disease enfeebled the mightiest army of the ancient world directly through epidemics and indirectly by reducing the productivity in the agricultural sector and hastened the fall of Rome.{ref}See Robert Sallares (2001) \u2013 Malaria and Rome: A History of Malaria in Ancient Italy and Robert Sallares, Abigail Bouwman and Cecilia Anderung (2012) \u2013 The Spread of Malaria to Southern Europe in Antiquity: New Approaches to Old Problems. Online <a href=\"https://www.cambridge.org/core/journals/medical-history/article/spread-of-malaria-to-southern-europe-in-antiquity-new-approaches-to-old-problems/47D574F04979460A904FEC97627B82EC\">here</a>.{/ref}</p>\n\n\n\n<p>A disease that is powerful enough to afflict the mightiest armies also left its mark on the fate of societies and the lives in many regions of the world.{ref}Daron Acemoglu, Simon Johnson, James A. Robinson (2002) \u2013 Reversal of Fortune: Geography and Institutions in the Making of the Modern World Income Distribution. In The Quarterly Journal of Economics, Vol. 117, No. 4 (Nov., 2002), pp. 1231-1294. Online here: <a href=\"https://economics.mit.edu/files/4127\">ttps://economics.mit.edu/files/4127</a> John Luke Gallup and Jeffrey D. Sachs (2001) \u2013 The Economic Burden of Malaria <a href=\"https://www.ncbi.nlm.nih.gov/books/NBK2624/\">https://www.ncbi.nlm.nih.gov/books/NBK2624/</a>{/ref}</p>\n\n\n\n<h4>Malaria\u2019s mark on our drinks</h4>\n\n\n\n<p>One of the first medicines humanity discovered that actually had a beneficial effect was quinine, an extract from the bark of the cinchona tree.{ref}On the history of the first effective treatments see Kennedy \u2013 A Brief History of Disease, Science and Medicine.{/ref} The quinine powder was either drunk with wine or dissolved in water, a mixture that became known as Tonic Water. But Quinine is so bitter that Tonic Water with concentrations high enough to be effective against malaria were unpleasant to drink. The British colonial officers stationed in malarious India therefore started to add sugar, lime and gin and thereby created a drink that is still popular today: the Gin and Tonic.<a href=\"#_ftnref1\" name=\"_ftn1\"></a></p>\n\n\n\n<h3>Malaria was common across half the world \u2013 since then it has been eliminated in many regions</h3>\n\n\n\n<p>Malaria <a href=\"https://ourworldindata.org/malaria#the-history-of-malaria\">left its mark</a> on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world.</p>\n\n\n\n<p>But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today (in purple) and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today. Over the course of the 20<sup>th</sup> century the disease was eliminated in many populous regions of the world, saving the lives of millions.</p>\n\n\n\n<p>What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Historically malaria was prevalent in Europe and North America \u2013 poet Friedrich Schiller contracted the disease in Mannheim, Oliver Cromwell in Ireland, and Abraham Lincoln in Illinois.{ref}On the cause of Oliver Cromwell\u2019s death see <a href=\"http://www.olivercromwell.org/faqs8.htm\">the FAQs at OliverCromwell.org</a>, on Friedrich Schiller see <a href=\"https://www.br.de/radio/bayern2/sendungen/radiowissen/deutsch-und-literatur/friedrich-schiller-thema100.html\">Bayerischer Rundfunk here</a>, on Abraham Lincoln see <a href=\"http://www.physical-lincoln.com/books.html\">\u2018The Physical Lincoln</a>\u2019. Other famous victims \u2013 although it is not always possible to diagnose the disease of historical figures \u2013 were German painter Albrecht D\u00fcrer, who contracted the disease in the Netherlands, and several popes, who died of the disease as malaria was very prevalent in Italy until recently.{/ref}</p>\n\n\n\n<p>Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa.</p>\n\n\n\n<p>The researchers estimate that historically \u2013 and up to around 1900 \u2013 our ancestors were at risk from malaria across about half of the world\u2019s land surface (53%).&nbsp; Since then the area where humans are at risk of malaria contracted to a quarter (27%).</p>\n\n\n\n<p>The WHO reports that the global mortality rate has declined by 90% between 1900 and the end of the 20th century.{ref}See &#8220;Box 4.1 Malaria-related mortality in the 20th century&#8221; in the World Health Organization&#8217;s <a href=\"https://www.who.int/whr/1999/en/whr99_en.pdf\">World Health Report (1999)</a>.{/ref}</p>\n\n\n\n<h5>Why are these parts not malarious anymore?</h5>\n\n\n\n<p>Three factors were responsible for this global reduction of malarious regions:{ref}See Hay et al (2004) above and de Zulueta J. (1994) \u2013 Malaria and ecosystems: from prehistory to posteradication. In Parassitologia. 1994 August. 36(1-2):7-15. World Bank (2009) \u2013 World Development Report (2009) &#8211; Part I: Reshaping Economic Geography. Washington, DC: World Bank. Online <a href=\"http://documents.worldbank.org/curated/en/730971468139804495/pdf/437380REVISED01BLIC1097808213760720.pdf\">here</a>.{/ref}</p>\n\n\n\n<p> First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for <a href=\"https://ourworldindata.org/yields-and-land-use-in-agriculture\">expanding</a><a href=\"https://ourworldindata.org/yields-and-land-use-in-agriculture\"> agricultural land</a> had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place.</p>\n\n\n\n<p>All three factors \u2013 insecticides, land use change, and economic development \u2013 were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.<a href=\"#_ftnref3\" name=\"_ftn3\"></a></p>\n\n\n\n<h6>Map of past prevalence of malaria{ref} The original map was published in Simon I Hay, Carlos A Guerra, Andrew J Tatem, Abdisalan M Noor, and Robert W Snow (2004) \u2013 The global distribution and population at risk of malaria: past, present, and future. In The Lancet Infectious Diseases 2004 June; 4(6): 327\u2013336. DOI: 10.1016/S1473-3099(04)01043-6. <a href=\"https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext?version=printerFriendly\">https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)01043-6/fulltext</a> I have digitized the Figure 1 using image tracing in Adobe Illustrator. The historical mapping of the prevalence of malaria is based on the pioneering work of Lysenko in the 1960s: Lysenko AJ, Semashko IN. Geography of malaria (1968) \u2013 A medico-geographic profile of an ancient disease. In: Lebedew AW, editor. Itogi Nauki: Medicinskaja Geografija. Academy of Sciences, USSR; Moscow: 1968. pp. 25\u2013146. Lysenko AJ, Beljaev AE (1969) \u2013 An analysis of the geographical distribution of Plasmodium ovale. Bull World Health Organization; 40:383\u201394.{/ref}</h6>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full\"><img loading=\"lazy\" width=\"3105\" height=\"1433\" src=\"https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map.png\" alt=\"\" class=\"wp-image-49975\" srcset=\"https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map.png 3105w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-400x185.png 400w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-800x369.png 800w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-150x69.png 150w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-768x354.png 768w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-1536x709.png 1536w, https://owid.cloud/app/uploads/2022/03/Previous-prevalence-of-malaria-world-map-2048x945.png 2048w\" sizes=\"(max-width: 3105px) 100vw, 3105px\" /></figure></div>\n\n\n\n<h3>Malaria in the US</h3>\n\n\n\n<p>The map is taken from the US census from 1870. It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time.</p>\n\n\n\n<p>Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans.</p>\n\n\n\n<h6>Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870{ref} This is taken from the Statistical Atlas from the 9th Census of the United States 1870 (published 1874). All maps and charts from the Statistical Atlas from the 9th Census of the United States 1870 are online at Radical Cartography <a href=\"http://www.radicalcartography.net/index.html?9thcensus\">here</a>. This map shown here is available in high-resolution <a href=\"http://www.radicalcartography.net/9thcensus/9th44.jpg\">here</a>.{/ref}</h6>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><a href=\"http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700.png\"><img loading=\"lazy\" width=\"774\" height=\"1024\" src=\"http://ourworldindata.org/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-774x1024.png\" alt=\"Proportion of deaths from malaria to deaths of all causes \u2013 US Census 1870\" class=\"wp-image-4054\" srcset=\"https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-774x1024.png 774w, https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-113x150.png 113w, https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700-416x550.png 416w, https://owid.cloud/app/uploads/2013/11/The-Proportion-of-Deaths-from-Malaria-to-Deaths-of-all-Causes-\u2013-US-Census-18700.png 1486w\" sizes=\"(max-width: 774px) 100vw, 774px\" /></a></figure></div>\n\n\n\n<h2>How can the world continue to make progress against malaria?</h2>\n\n\n\n<p>The world has already been very successful against this disease which is one of the most deadliest diseases in humanity&#8217;s history. How was this possible and what can we do to continue this progress?</p>\n\n\n\n<h3>Insecticide-treated bednets</h3>\n\n\n\n<h4>The world is making progress against malaria thanks to insecticide-treated bednets</h4>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<p>Even after <a href=\"https://owid.cloud/malaria-past-prevalence\">a century of progress</a> against malaria, the disease remains devastating for millions. The World Health Organization estimates that 216 million suffered from the disease in 2016.{ref}Figures for 2016 according to the WHO: <a href=\"http://www.who.int/malaria/en/\">http://www.who.int/malaria/en/</a>{/ref}</p>\n\n\n\n<p>Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.{ref}The age-specific mortality figures are those published by the IHME\u2019s Global Burden of Disease [the WHO does not publish country-level data on malaria deaths by age]. The share of children younger than 5 among malaria victims fell slightly over the course of the last generation, from 79% in 1990 to 72% in 2015. Here is the data: <a href=\"https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative\">https://ourworldindata.org/grapher/malaria-deaths-by-age?stackMode=relative</a>{/ref}</p>\n</div>\n\n\n\n<div class=\"wp-block-column\"></div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<h4>The world is making progress against malaria</h4>\n\n\n\n<p>In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases, this means interrupting its transmission. But humanity\u2019s most ingenious and successful way of transmission interruption \u2013 immunization through vaccines \u2013 is not yet available for malaria. However, very recent developments are encouraging; at the time of writing (2019) the WHO has <a href=\"https://www.theguardian.com/global-development/2019/apr/23/malawi-trial-child-malaria-vaccine-landmark\">rolled out</a> a first large-scale trial of a vaccine.{ref}Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria. But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine. For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814. doi: 10.1098/rstb.2011.0091. This has possibly changed with the malaria vaccine <a href=\"https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss\"><em>RTS,S</em></a>, the world&#8217;s first licensed malaria vaccine, which has been approved by European regulators in 2015. See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract\">here</a>.{/ref}</p>\n\n\n\n<p>But we have other weapons in our arsenal.</p>\n\n\n\n<p>One line of humanity\u2019s attack on the mosquito-borne fever is to progressively reduce the area in which malaria is prevalent. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone.</p>\n\n\n\n<p>The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll.</p>\n\n\n\n<p>From 2000 to 2015 the number of malaria deaths fell by <a href=\"https://ourworldindata.org/grapher/global-malaria-deaths-by-world-region\">almost 40%</a>, from 896,000 deaths per year to 562,000, according to the World Health Organization.{ref}Both the WHO and the IHME report a strong decline of malaria deaths since 2000. But throughout this period the IHME consistently estimates the number of annual deaths to be higher. For more details on the differences between these two global sources see our entry on malaria <a href=\"https://ourworldindata.org/malaria\">https://ourworldindata.org/malaria</a>{/ref}</p>\n\n\n\n<p>A recent publication in <em>Nature</em>{ref}Bhatt et al. (2015) \u2013 The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature 526, 207\u2013211 (08 October 2015) doi:10.1038/nature15535. Online <a href=\"https://www.nature.com/nature/journal/v526/n7572/abs/nature15535.html\">here</a>.{/ref} studied what made this success possible. The focus of the study was Africa, where \u2013 as the chart shows \u2013 most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them.</p>\n\n\n\n<p>The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities.</p>\n\n\n\n<p>The authors of the <em>Nature </em>study estimate that bed nets alone were responsible for averting 451 million cases of malaria in Africa between 2000 and 2015. The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying (IRS) and the treatment of malaria cases with artemisinin-based combination therapy (ACT). The study&#8217;s authors estimate that the three interventions averted 663 million cases of malaria in the 15 year period. Insecticide-treated bed nets were by far the most important intervention of the three, preventing 68% of the averted cases.</p>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"800\" height=\"462\" src=\"https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-800x462.png\" alt=\"\" class=\"wp-image-54610\" srcset=\"https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-800x462.png 800w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-400x231.png 400w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-150x87.png 150w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-768x444.png 768w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-1536x888.png 1536w, https://owid.cloud/app/uploads/2022/11/Malaria-mortality-of-children-in-Africa-2048x1184.png 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\" /><figcaption>Malaria mortality rate of children in 2000 and 2019{ref}Citation: Institute for Health Metrics and Evaluation (IHME), Malaria Atlas Project. Global Malaria Incidence, Prevalence, and Mortality Geospatial Estimates 2000-2019. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME), 2020. <a href=\"https://doi.org/10.6069/CG0J-2R97\">https://doi.org/10.6069/CG0J-2R97</a>&nbsp;<br>Shown is the mortality rate due to plasmodium falciparum \u2013 direct link to the interactive maps as published by the IHME <a href=\"http://ihmeuw.org/5dhp\">http://ihmeuw.org/5dhp</a>&nbsp;<br>For the background see: Weiss, D. J., Lucas, T. C. D., Nguyen, M., Nandi, A. K., Bisanzio, D., Battle, K. E., Cameron, E., Twohig, K. A., Pfeffer, D. A., Rozier, J. A., Gibson, H. S., Rao, P. C., Casey, D., Bertozzi-Villa, A., Collins, E. L., Dalrymple, U., Gray, N., Harris, J. R., Howes, R. E., \u2026 Gething, P. W. (2019) \u2013 <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31097-9/fulltext\">Mapping the global prevalence, incidence, and mortality of Plasmodium falciparum, 2000\u201317: A spatial and temporal modelling study</a>. In The Lancet, 394(10195), 322\u2013331. <a href=\"https://doi.org/10.1016/S0140-6736(19)31097-9\">https://doi.org/10.1016/S0140-6736(19)31097-9</a>{/ref}</figcaption></figure>\n\n\n\n<p></p>\n</div>\n</div>\n\n\n\n<div class=\"wp-block-columns is-style-sticky-right\">\n<div class=\"wp-block-column\">\n<h4>We can do more</h4>\n\n\n\n<p>Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations.</p>\n\n\n\n<p>Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further.</p>\n\n\n\n<p>To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. It\u2019s not always the case that donations do much good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. A charity evaluator that is doing very rigorous work is \u2018GiveWell\u2019 and on the very top of their <a href=\"https://www.givewell.org/charities/top-charities\">recommended charities</a> are two organizations that are fighting malaria \u2013 the <em>Against Malaria Foundation</em> and the <em>Malaria Consortium</em>.</p>\n\n\n\n<p>The diseases many children die from are preventable \u2013 we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them.</p>\n\n\n\n<p>The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it.{ref}The latest data for Sub-Saharan Africa (from 2013) \u2013 where more than 90% of all malaria deaths occur \u2013 shows that fewer than half of all children under five sleep under an insecticide treated bed-nets. See the chart here: <a href=\"https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart\">https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria?tab=chart</a>{/ref}</p>\n\n\n\n<p>It requires commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world.</p>\n\n\n\n<hr class=\"wp-block-separator\"/>\n\n\n\n<ul><li>If you want to know more before you donate, GiveWell\u2019s information on malaria can be found <a href=\"https://www.givewell.org/international/health/malaria\">here</a>.</li><li>And if you want to donate right away to help the successful fight against malaria you can do so via the page of <a href=\"https://www.givewell.org/charities/top-charities\">GiveWell\u2019s recommended charities</a>.</li></ul>\n</div>\n\n\n\n<div class=\"wp-block-column\">\n<iframe style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/share-of-children-younger-than-5-who-sleep-under-an-insecticide-treated-bednet-to-prevent-malaria\"></iframe>\n\n\n\n<p></p>\n</div>\n</div>\n\n\n\n<hr class=\"wp-block-separator\"/>\n\n\n\n<h3>A vaccine against malaria</h3>\n\n\n\n<p>Alphonse Laveran discovered already in 1880 that the Plasmodium parasite is the cause for malaria.{ref}See Francis EG Cox (2010) \u2013 History of the discovery of the malaria parasites and their vectors. In Parasites and Vectors. Online here.{/ref} But all earlier attempts of developing a vaccines were unsuccessful. Malaria vaccines such as&nbsp;SPf66 were insufficiently effective and until recently none of the scientific efforts led to a licensed vaccine.{ref}For an overview see Adrian V. S. Hill (2011) \u2013 Vaccines against malaria. In&nbsp;Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12; 366(1579): 2806\u20132814.&nbsp;doi: 10.1098/rstb.2011.0091.{/ref}</p>\n\n\n\n<p>This has changed with the malaria vaccine <a href=\"https://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss\"><em>RTS,S</em></a>,&nbsp;the world&#8217;s first licensed malaria vaccine, which has been approved by European regulators in 2015. The vaccine is undergoing pilot trials in select countries and it is hoped to provide protection from the parasite in the future.{ref}See RTS,S Clinical Trials Partnership (2015) \u2013 Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial. In The Lancet, Volume 386, ISSUE 9988, P31-45, July 04, 2015. Online <a href=\"https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60721-8/abstract\">here</a>.{/ref}</p>\n\n\n\n<h3>Malaria and economic prosperity</h3>\n\n\n\n<h4>There are high economic costs of malaria</h4>\n\n\n\n<p>Malaria <a href=\"https://owid.cloud/malaria-past-prevalence\">was once prevalent</a> in many of today&#8217;s richest countries, but it was eliminated there in the last decades. Today malaria is highly prevalent in some of the poorest countries in the world, as the chart show. This is partly because the poor finances make it hard to fight the disease, but there is also an effect in the opposite direction. The disease lowers the productivity of the economy.</p>\n\n\n\n<p>Okorosobo et al. (2011){ref}Tuoyo Okorosobo, Fola Okorosobo, Germano Mwabu, Juliet Nabyonga Orem, Joses Muthuri Kirigia (2011) \u2013 Economic Burden of Malaria in six Countries of Africa. In European Journal of Business and Management, Vol 3, No.6, 2011.{/ref} estimate that the &#8220;malaria penalty&#8221; to GDP is as high as 9% in Nigeria and Chad respectively.</p>\n\n\n\n<p>Azemar and Desbordes (2009){ref}C\u00e9line Az\u00e9mar and Rodolphe Desbordes (2009) \u2013 Public Governance, Health and Foreign Direct Investment in Sub-Saharan Africa. In Journal of African Economies Volume 18 Issue 4Pp. 667-709. doi: 10.1093/jae/ejn028. Online here: <a href=\"http://jae.oxfordjournals.org/content/18/4/667\">http://jae.oxfordjournals.org/content/18/4/667</a>.{/ref} find that in the median sub-Saharan African country, foreign direct investments could have been one-third higher in the absence of <a href=\"https://ourworldindata.org/malaria/\">malaria</a> and <a href=\"https://ourworldindata.org/hiv-aids/\">HIV</a>. Slightly more than one-half of this is attributed to malaria.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-prevalence-vs-gdp-per-capita\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Data Quality &amp; Definitions</h2>\n\n\n\n<p>The United Nations give the following definitions:{ref}See <a href=\"https://web.archive.org/web/20210814224446/http://mdgs.un.org/unsd/mi/wiki/6-6-Incidence-and-death-rates-associated-with-malaria.ashx\">the UN&#8217;s definitions here</a>.{/ref}</p>\n\n\n\n<p>The malaria incidence rate (Ii) is the number of new cases of malaria (Cases) divided by the total population (Pop) and multiplied by 100,000.</p>\n\n\n\n<p><em>Ii = (Cases / Pop) * 100,000</em></p>\n\n\n\n<p>The malaria death rate (Id) is the number of deaths due to malaria (Deaths) divided by the total population (Pop) and multiplied by 100,000.</p>\n\n\n\n<p><em>Id = (Deaths / Pop) * 100,000</em></p>\n\n\n\n<h4>Comparison of WHO and IHME malaria deaths</h4>\n\n\n\n<p>In our section on <a href=\"https://ourworldindata.org/malaria/#deaths-due-to-malaria\">Deaths Due to Malaria</a>, we present regional estimates from the World Health Organization (WHO) and the Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD). These estimates in some cases differ notably.</p>\n\n\n\n<p>In the chart we have plotted annual deaths from malaria by country, from IHME estimates (on the y-axis) versus estimates from WHO (on the x-axis). Also shown is the line of parity: countries that lie along this line have the same estimated number of deaths from the IHME and WHO; countries which lie above this line have higher estimates from IHME; and those below have higher estimates from WHO.</p>\n\n\n\n<p>For many countries&nbsp;\u2014 although not all&nbsp;\u2014 IHME estimates tend to be higher than WHO figures. The discrepancy between these estimates results from differences in methodology, data coverage and sourcing. Figures shown in this entry from both IHME and WHO will continue to be updated as new data is released&nbsp;\u2014 hopefully this data will begin to converge with time.</p>\n\n\n\n<iframe loading=\"lazy\" style=\"width: 100%; height: 600px; border: 0px none;\" src=\"https://ourworldindata.org/grapher/malaria-deaths-comparisons\" width=\"300\" height=\"150\"></iframe>\n\n\n\n<h2>Data Sources</h2>\n\n\n\n<h4>World Health Organization (WHO)</h4>\n\n\n\n<ul><li><strong>Data: </strong>Data on cases, deaths (reported and estimates) and prevention and treatment<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global \u2013 by country and WHO region<strong><br></strong></li><li><strong>Time span: </strong>Since 2000 (for reported deaths); shorter for other measures.<strong><br></strong></li><li><strong>Available at:</strong> Online <a href=\"http://apps.who.int/gho/data/node.main.A1362?lang=en\">here</a>.</li><li class=\"no-bullet\"><em>WHO data on malaria deaths and cases (1990-2006) is also available through <a href=\" http://www.gapminder.org/world/#$majorMode=chart$is;shi=t;ly=2003;lb=f;il=t;fs=11;al=30;stl=t;st=t;nsl=t;se=t$wst;tts=C$ts;sp=6.14645161290322;ti=2009$zpv;v=0$inc_x;mmid=XCOORDS;iid=phAwcNAVuyj1jiMAkmq1iMg;by=ind$inc_y;mmid=YCOORDS;iid=pp59adS3CHWfGZUVJ2L-dCw;by=ind$inc_s;uniValue=8.21;iid=phAwcNAVuyj0XOoBL_n5tAQ;by=ind$inc_c;uniValue=255;gid=CATID0;by=grp$map_x;scale=log;dataMin=282;dataMax=119849$map_y;scale=lin;dataMin=0;dataMax=610$map_s;sma=49;smi=2.65$cd;bd=0$inds=\">Gapminder</a> where it can be plotted against a second indicator.</em></li></ul>\n\n\n\n<h4>Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)</h4>\n\n\n\n<ul><li><strong>Data:</strong> Death rates &amp; absolute number of deaths from malaria</li><li><strong>Geographical coverage:</strong>Global, across all regions and countries</li><li><strong>Time span:</strong>Available from 1990 onwards</li><li><strong>Available at:&nbsp;</strong>Online <a href=\"http://ghdx.healthdata.org/gbd-results-tool\">here</a></li></ul>\n\n\n\n<h4>World Development Indicators (WDI) \u2013 published by the World Bank</h4>\n\n\n\n<ul><li><strong>Data:</strong> Children with fever receiving antimalarial drugs (% of children under age 5 with fever), use of insecticide-treated bed nets (% of under-5 population)</li><li><strong>Geographical coverage:</strong> Global \u2013 by country &amp; world region</li><li><strong>Time span:</strong>&nbsp;Annual data \u2013 since 2000.</li><li><strong>Available at:</strong> Online <a href=\"http://data.worldbank.org/indicator/SH.MLR.TRET.ZS\">here</a>.</li></ul>\n\n\n\n<h4>United Nations \u2013 Millennium Development Goals Database</h4>\n\n\n\n<ul><li><strong>Data: </strong>Notified cases of malaria (per 100,000 people) and malaria death rate (all ages &amp; ages 0-4)<strong><br></strong></li><li><strong>Geographical coverage: </strong>Global \u2013 by country and region.<strong><br></strong></li><li><strong>Time span: </strong>Only very recent data.<strong><br></strong></li><li><strong>Available: </strong>Notified cases of malaria (per 100,000 people) <a href=\"http://data.un.org/Data.aspx?d=MDG&amp;f=seriesRowID%3A644\">here</a>.<br>Malaria death rate (all ages) <a href=\"http://data.un.org/Data.aspx?d=MDG&amp;f=seriesRowID%3A663\">here</a>.<br>Malaria death rate (ages 0-4) <a href=\"http://data.un.org/Data.aspx?d=MDG&amp;f=seriesRowID%3A664#MDG\">here</a>.</li></ul>\n\n\n\n<h4>DHS Malaria Indicator Survey (MIS)</h4>\n\n\n\n<ul><li><strong><strong>Data: </strong></strong>Detailed survey data from African countries</li><li><strong>Geographical coverage: </strong>Some African countries.<strong><br></strong></li><li><strong>Time span: </strong>late 2000s<strong><br></strong></li><li><strong>Available at: </strong>Online <a href=\"http://ghdx.healthmetricsandevaluation.org/series/dhs-malaria-indicator-survey-mis\">here</a>.<strong><br></strong></li></ul>\n\n\n\n<h4>The MARA/ARMA (Mapping Malaria Risk in Africa/Atlas du Risque de la Malaria en Afrique) project</h4>\n\n\n\n<ul><li><strong>Data:</strong>&nbsp;MARA LITe malaria prevalence data, distribution of the Anopheles gambiae, entomological inoculation rates, related climate data and malaria distribution maps and estimated populations at risk.</li><li><strong>Geographical coverage:&nbsp; </strong>Entire Africa \u2013 low level</li><li><strong>Time span:</strong> Mostly recent data</li><li><strong>Available at:</strong> Online at <a href=\"http://www.mara-database.org//login.html\">http://www.mara-database.org//login.html</a>.</li><li class=\"no-bullet\"><em>Often it is possible to download the data and to view the data visualized on maps.<br></em></li></ul>\n\n\n\n<h4>Conley, McCord and Sachs (2007) Malaria Dataset</h4>\n\n\n\n<ul><li><strong>Data:</strong> % of population at risk of malaria.</li><li><strong>Geographical coverage:</strong> Global \u2013 by country.</li><li><strong>Time span:</strong> 1960 &#8211; 2000 (observations every 5 years \u2013 including interpolations)</li><li><strong>Available at:</strong> Online <a href=\"https://www.dropbox.com/s/3o7ds4vyksjwp5k/MalariaPopRisk.dta?dl=0\">here</a>.</li></ul>\n\n\n\n<h4>WHO data on incidence of malaria cases</h4>\n\n\n\n<ul><li><strong>Data:</strong> Incidence of malaria cases</li><li><strong>Geographical coverage:</strong> Global \u2013 by country.</li><li><strong>Time span:</strong> 1962-1997 \u2013 annual data.</li><li><strong>Available at:</strong> Online available at the <a href=\"http://84.89.132.1/~reynal/data_web.htm\">website of Marta Reynal-Querol</a>.</li></ul>\n\n\n\n<p>Other sources: Up-to-date information on the current state of malaria is published by the <a href=\"http://www.rollbackmalaria.org\">Roll Back Malaria Partnership</a> \u2013 a partnership between WHO, UNICEF, UNDP and the World Bank.</p>\n",
        "protected": false
    },
    "excerpt": {
        "rendered": "The deadly disease transmitted by mosquitoes is one of the leading causes of death in children. How did we eliminate the disease in some world regions and how can we continue progress against malaria?",
        "protected": false
    },
    "date_gmt": "2019-11-12T23:56:00",
    "modified": "2023-08-18T11:02:30",
    "template": "",
    "categories": [
        44,
        46,
        171
    ],
    "menu_order": 177,
    "ping_status": "closed",
    "authors_name": [
        "Max Roser",
        "Hannah Ritchie"
    ],
    "modified_gmt": "2023-08-18T10:02:30",
    "comment_status": "open",
    "featured_media": 40625,
    "featured_media_paths": {
        "thumbnail": "/app/uploads/2021/02/Screen-Shot-2021-02-11-at-10.54.25-150x84.png",
        "medium_large": "/app/uploads/2021/02/Screen-Shot-2021-02-11-at-10.54.25-768x428.png"
    }
}

Links from other tables

3 rows from post_id in post_tags
39 rows from sourceId in posts_links
0 rows from wordpressId in posts_unified
62 rows from postId in post_links
11 rows from postId in post_charts
1 row from postId in post_broken_chart_links