gms | German Medical Science

Kongress Medizin und Gesellschaft 2007

17. bis 21.09.2007, Augsburg

Epidemiology of malaria in a holoendemic area: improving mortality estimations

Meeting Abstract

  • Heribert Ramroth - Universitätsklinikum Heidelberg, Heidelberg, Germany
  • Robert Ndugwa - Universitätsklinikum Heidelberg, Heidelberg, Germany
  • Bocar Kouyaté - Centre National de Recherche et de la Formation sur le Paludisme, Ouagadougou, Burkina Faso
  • Olaf Müller - Universitätsklinikum Heidelberg, Heidelberg, Germany
  • Heiko Becher - Universitätsklinikum Heidelberg, Heidelberg, Germany

Kongress Medizin und Gesellschaft 2007. Augsburg, 17.-21.09.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gmds317

The electronic version of this article is the complete one and can be found online at:

Published: September 6, 2007

© 2007 Ramroth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: Malaria is the leading cause of death among children below the age of five in sub-Saharan Africa but precise estimates on the burden of malaria are lacking. We attempt to improve the estimates by combining a series of clinical and intervention studies, in a rural setting in Nouna, Burkina Faso.

Material and Methods: Meta-Analysis using original study data, with children under 5 years who participated in several clinical studies between June 1999 and December 2004 1-5. Data collected by the Demographic Surveillance System (DSS) in the Nouna research zone was used for monitoring mortality (ascertained from the verbal autopsy questionnaire). Person-years (PY) of observations were computed and age-standardized mortality rates for all-causes and malaria adjusted for missing causes of death were calculated.

Results: The study sample contains 6387 children (mean follow-up: 2.8 years; 16061 PY). During the study period, 443 deaths were recorded (malaria: 45.6%, unknown cause of death: 25.1%). The malaria specific mortality rate was 16.0 (95% CI: 14.3-17.8) per 1000 PY (All-cause mortality: 26.7 per 1000 PY). All-cause mortality rates declined significantly over years of follow-up (from 28.0 to 16.3 per 1000 PY in 2000 to 2004 respectively) but malaria mortality rates remained rather stable (from 13.0 to 11.8 per 1000 PY in 2000 to 2004 respectively). Decline in all-cause and malaria-specific mortality were observed with increasing age.

Discussion: The observed malaria-specific mortality rate is high when compared to the estimated rate of Rowe et al. 6 for rural high intensity regions in middle Africa, who report a rate of 11.4 per 1000 PY (95% CI: 9.8-12.9) which may be explained by a higher transmission in Burkina Faso. In further analysis, linkage of the malaria morbidity and the mortality data should provide information to strengthen our estimates.


Muller O, Becher H, Baltussen A et al. Effect of zinc supplementation on malaria morbidity among West African children: a randomized double-blind placebo-controlled trial. B M J 2001;322:1567-72.
Yé Y. Incorporating Environmental factors in Modelling Malaria Transmission in under five children in Rural Burkina Faso. Heidelberg: University of Heidelberg; 2006.
Muller O, Traore C, Kouyate B et al. Effects of insecticide-treated bednets during early infancy in an African area of intense malaria transmission: a randomized controlled trial. Bull World Health Organ 2006 February;84(2):120-6.
Kouyaté B, Somé F, Jahn A et al. Effects of a community intervention on malaria in rural Burkina Faso: randomised controlled trial. Tropical Medicine and International Health 2006;Upcoming.
Stich A, Oster N, bdel-Aziz I et al. Malaria in a holoendemic area of Burkina Faso: a cross-sectional study. Parasitology Research 2006;98(6):596-9.
Rowe AK, Rowe SY, Snow RW et al. The burden of malaria mortality among African children in the year 2000. Int J Epidemiol 2006 February 28.