Attempts to quantify the epidemiological and economic burden of malaria have so far neglected to specifically address the burden of epidemic malaria. Moreover, the data on the effectiveness and cost effectiveness of interventions in epidemics is extremely limited. Answering such key questions in an epidemic prone context is perhaps more challenging than doing so in epidemic areas for a number of reasons. In spite of these problems, we estimate that in Africa, there are 11 million malaria episodes and 137,500-275,000 malaria deaths each year attributable to epidemics, which is equivalent to some 4% of estimated annual malaria cases worldwide and 12-25% of estimated annual worldwide malaria deaths, including up to 50% of the estimated annual worldwide malaria mortality in persons >15 years of age. The possible economic impact of malaria epidemics is described and the limited evidence on the effectiveness and cost-effectiveness of interventions in areas of low or seasonal transmission is reviewed.
American Journal of Tropical Medicine and Hygiene 2004 71 (Suppl 2) 136-140