The Question: How many children under the age of five died in sub-Saharan Africa in 2013 because of or associated with poor-quality antimalarial drugs?
What We Found: We used data from 39 countries in sub-Saharan Africa to find the answer to our question. To do this, we found the product of the number of private sector antimalarials consumed by malaria-positive children in 2013, the proportion of private sector antimalarials consumed that were of poor quality and the case fatality rate (CFR) of under-five malaria-positive children who did not receive appropriate treatment in each country. We estimate that 122,350 (interquartile range [IQR]: 91,577–154,736) of all under-five malaria deaths were associated with consumption of poor-quality antimalarials, representing 3.75% (IQR: 2.81–4.75%) of all under-five deaths in the countries we sampled.
Why It Matters: There are an estimated 207 million cases of malaria worldwide annually, resulting in an estimated 627,000–1,238,000 deaths, the majority in sub-Saharan Africa, and children under 5 years of age in this region have the highest risk of contracting and dying from malaria. Many antimalarials sold in sub-Saharan Africa—potentially up to 35 percent—are poor-quality (falsified, substandard, or degraded), and the burden of disease caused by this problem is inadequately quantified.