I find it interesting how people pay attention to global health statistics.

A few nights back, one of the founders of the group “Nothing but Nets”, Rick Reilly, was interviewed one of the best watched, and most trusted news reports – The Colbert Report.

He talked about how he initially got interested in addressing malaria: he was in Venice and heard a news clip on the BBC that described how nearly 3000 children die every day from malaria in Africa (translation= roughly one million deaths a year). My own husband has also asked me about this figure after seeing it on TV during an advertisement for the same organization – Nothing but Nets – during the Beijing Olympics.

The reality is that it is just an estimate, it is hard to come up a very exact estimate of malaria cases and deaths. And based on a great article this morning on Time.com, it appears that like HIV/AIDS we seem to have been relying on faulty estimates for our best-guess estimate of malaria cases for some time. The new estimates of the number of annual incident cases of malaria have been downwards revised to now *ONLY* about 250 million cases a year. Only 800,000 people likely die from malaria every year. Last fall, UNAIDS embarrassingly also had to downward revise their their estimates of HIV/AIDS globally. Oh my: only 33 million people infected?!?

The truth is, these numbers matter a lot. People do pay really close attention to them, and they do influence the decisions of donors. That said, there has been some good work done recently which suggests that is it not just disease burden that matters to donors (see for example the work of Jeremy Shiffman).

In the case of malaria, however, I think we do have the ability to do a bit better. Most of the data that comes out now is based on entomological patterns, estimates from epidemiological surveillance, and administrative records from health services. While this disease-based measure of incident cases is probably important, the truth of the matter is that the way in which malaria is diagnosed – or not diagnosed – and treated in most of the developing world is based on symptoms, not true disease. There is a wealth of household survey data that would provide us a better estimate of fever, which is an imperfect proxy for malaria. From a resource allocation perspective, given that we do treat based on symptoms, the resources required to treat this epidemic should take this into consideration.

We’ll never know exactly how many people are infected or die from most tropical diseases. We as researchers, however, should become better and emphasizing the limitations of our knowledge and our estimates. For now, they are not much more than really good guesses.

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