Controversy over Estimates in Malaria Deaths Raises Need for Stronger Health Information Systems

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Malaria causes data doubt

New malaria estimates raise data doubt

Malaria deaths may be twice as high as previously estimated with more deaths occurring in persons over 5 years of age than previously estimated.

 On 3 February 2012 the Institute for Health Metrics and Evaluation (IHME) published in a study in The Lancet in which the researchers estimate that malaria kills 1.2 million people each year: twice as many as formerly believed. IHME estimates highlight that deaths among older children and adults are much higher than WHO estimates.

According to IHME  in 2010 children under 5 accounted for 58% of malaria deaths. WHO estimates under 5s account for 86%. Advocates for increased Child Survival funding are concerned about how estimates will be interpreted and potential impact on their efforts to maintain a child-centered approach. WHO issued a statement saying that WHO and IHME estimates are the same statistically, with the exception of over fives in Africa. WHO emphasizes that quality of the IHME data must be scrutinized before reaching any conclusions.

Ministries of Health are caught in the middle of this debate, not wanting to take sides against a partner and donor. Ministries and National Malaria Programs recognize that the reason for the debate is the lack of data, a problem that will not easily be resolved by disease specific funding alone.

Donors, particularly the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), use this opportunity to point out the urgent need to revitalize health information systems. This controversy in estimates points to the need for reliable primary cause of death data to inform programming decisions.

The fact that there can be such vastly different estimates of malaria mortality points to a need for comprehensive Health Systems Strengthening. While disease specific funding has made a difference in reducing mortality, it is difficult to know how to focus efforts and resources for the most efficient health gains without reliable data. Countries need their own reliable source of information on which to base their strategic decisions and priorities, in the absence of this foundation health gains cannot be sustained in the long-term.

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2 Responses to “Controversy over Estimates in Malaria Deaths Raises Need for Stronger Health Information Systems”

  1. sbfphc Says:

    The challenge of differing estimates is a question of methodologies. This points back to your main concern about inadequacies in the health information system. Most of the estimates – either the higher or lower – are NOT based on parasitological diagnoses (RDT, microscopy or PCR). Using clinical diagnosis, including verbal autopsies as was done in the new study, tends to overestimate malaria since not all fevers – a primary sign in clinical diagnosis – is not malaria – especially in dry season and in areas where transmission is reducing because of effective intervention. Sometimes the accuracy of clinical diagnosis is lower than 50% compared to 95% for a good RDT – but all this varies by levels of endemicity and season. Until we can get a health information system for malaria that is based on parasitological diagnosis, supported by community surveys using RDTs, we may never know the full extent of the disease.

    • erinbaldridge Says:

      Wow, great to have a comment before I’ve even finished posting! Sorry about having the draft public- I’m nw to blogging.
      I greatly appreciate this comment:

      “Until we can get a health information system for malaria that is based on parasitological diagnosis, supported by community surveys using RDTs, we may never know the full extent of the disease.”

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