Global, regional, and national burden of malaria, 1990–2021: Findings from the global burden of disease study 2021

Background

Malaria is an infectious disease transmitted by mosquitoes and caused by Plasmodium parasites. This study analyzes data from the Global Burden of Disease (GBD) Study 2021 to systematically assess global epidemiological trends and the malaria burden from 1990 to 2021, providing scientific insights for malaria prevention and control.

Methods

Using GBD 2021 data, we analyzed trends in malaria incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, regions, and Socio-demographic Index (SDI). A Bayesian age-period-cohort model was employed to predict the future burden of malaria, while the average annual percent change (AAPC) was calculated to describe overall trends in age-standardized rates (ASR) and counts from 1990 to 2021.

Results

From 1990 to 2021, significant decreases were observed in the global age-standardized incidence rate (ASIR, AAPC = −7.25%; 95% CI: −11.68%, −2.81%), prevalence rate (ASPR, AAPC = −14.42%; 95% CI: −15.99%, −12.84%), mortality rate (ASMR, AAPC = −0.06%; 95 % CI: −0.08%, −0.05%), and age-standardized DALY rate (AAPC = −4.86%; 95 % CI: −5.81%, −3.91%). However, no significant changes were found in ASIR for East Asia (AAPC = −0.30%; 95% CI: −0.96%, 0.37%), high-income Asia Pacific (AAPC = −0.03%; 95% CI: −0.07%, 0.01%), and Southern Sub-Saharan Africa (AAPC = 1.09%; 95% CI: −29.12%, 31.30%), while the remaining 14 regions showed a decline. The ASIR, ASPR, ASMR, and age-standardized DALY rates for malaria, as well as total cases and deaths, did not significantly differ between males and females across all age groups. Notably, the highest incidence, prevalence, and mortality rates were observed in children under five years of age. Between 1990 and 2021, the ASIR, ASPR, ASMR, and age-standardized DALY rate for malaria were inversely correlated with SDI levels.

Conclusions

Although global malaria burden has steadily declined, malaria remains a serious public health threat, particularly in sub-Saharan Africa and Southeast Asia, especially among children under five. To address the continuing threat of malaria, immediate implementation of stronger and more effective global control strategies is essential.