Epidemiologists have recently paid greater attention compared to the past to epidemiology of clinical malaria as opposed to the epidemiology of malarial infection

Epidemiologists have recently paid greater attention compared to the past to epidemiology of clinical malaria as opposed to the epidemiology of malarial infection. This change of emphasis has been stimulated in part by the need for better clinical definitions of malaria in the evaluation of control measures such as malaria vaccines and insecticide-treated materials. For the two most frequent forms of this condition which are cerebral malaria and severe malarial anaemia, study of the epidemiology of severe malaria in Africa has shown different epidemiological patterns. Severe malarial anaemia is seen most frequently in areas of very high malaria transmission and most frequently in young children. In contrast, cerebral malaria predominates in areas of moderate transmission, especially where this is seasonal, and it is seen most frequently in older children. Study of patients with uncomplicated malaria has established the relationship between fever and parasite density and has demonstrated ways of defining fever thresholds. Algorithms have been developed to help in the diagnosis of malaria in the absence of parasitological confirmation but this approach has proved difficult because of the overlap in symptoms and signs between malaria and other acute febrile illnesses such as pneumonia.
According to the World Health Organisation (WHO), Malaria transmission occurs in five WHO regions. An estimated 3.4 billion people in 91 countries and territories are at risk of being infected with malaria worldwide, and 1.1 billion are at high risk (>1 in 1000 chance of getting malaria in a year). According to the World Malaria Report 2016, there were 212 million cases of malaria globally in 2015 (uncertainty range 148–304 million) and 429 000 malaria deaths (range 235 000–639 000), which is a decrease in malaria cases and deaths of 22% and 50% since 2000, respectively. The burden was heaviest in the WHO African Region, where an estimated 92% of all malaria deaths occurred, and in children aged under 5 years, who accounted for more than two thirds of all deaths.

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