In allocating public health resources, the guiding principle should be an evidence-based quantification of need. A significant effort to categorize diseases by their global morbidity and mortality impact has developed during the last decade, epitomized by the Global Burden of Diseases and the Disease Control Priorities projects. But despite these efforts, the evidence base for allocating resources for malaria control on a global scale is poor.
National reporting on malaria continues to be fanciful; Kenya, for example, reported only 135 malaria deaths in 2002 to the World Health Organization. In addition, less than half (22/49) of the malaria-endemic countries in Africa provided information for the most-recent reporting year, 2003; the rest were older. Information on the global burden of malaria remains the subject of best guesses rooted in national reporting systems, informed estimation based on epidemiological data linked to historical malaria distributions, or unvalidated models of malaria distribution in Africa. As a corollary, resource allocations for malaria interventions remain driven by perceptions and politics, rather than an objective assessment of need. This status quo is untenable when global and national financial resources must be defined to meet needs for new, expensive antimalarial drugs and commodities to prevent infection, and to ensure that these interventions are optimally targeted.
It has been almost 40 years since the last global map of malaria endemicity was constructed, and a decade since the need for maps of malaria transmission in Africa was first advocated. Although substantial progress has been made, an evidence-based map of malaria transmission intensity for Africa remains illusive, and there have been no recent efforts to construct a credible evidence-based global malaria map.
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