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Volume 11, Number 9—September 2005

Research

Malaria Attributable to the HIV-1 Epidemic, Sub-Saharan Africa

Eline L. Korenromp*†Comments to Author , Brian G. Williams*, Sake J. de Vlas†, Eleanor Gouws‡, Charles F. Gilks*, Peter D. Ghys‡, and Bernard L. Nahlen*
Author affiliations: *World Health Organization, Geneva, Switzerland; †Erasmus University Medical Center, Rotterdam, the Netherlands; ‡Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland

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Table 2

Estimated HIV-1 impact on malaria cases and deaths, sub-Saharan Africa, 2004*

Country† Urban, % Population at risk for malaria, by intensity of transmission, %
HIV-1 prevalence in adults, %
Malaria incidence/1,000 py‡
Malaria deaths/1,000 py‡
Low or unstable High National§ Urban-rural ratio¶ Increase due to HIV, % Increase due to HIV, %
Angola 34 53 46 3.9 1.6# 291 1.2 1.8 4.2
Benin 42 0 100 1.9 1.8 434 0.4 2.4 1.4
Botswana 49 13 0 37.3 1.0 3.5 28.0 0.028 114.4
Burkina Faso 17 0 100 4.2 3.1 538 0.8 3.1 2.9
Burundi 9 64 21 6.0 3.6 209 2.4 1.4 8.6
Cameroon 49 24 74 6.9 1.7 317 1.9 1.8 6.5
Central African Republic 41 0 100 13.5 1.2 419 3.2 2.3 11.3
Chad 24 14 86 4.8 1.3 451 1.1 2.6 4.1
Congo 65 0 100 4.9 1.6# 380 1.1 2.1 3.8
Côte d'Ivoire 44 0 100 7.0 2.1 402 1.6 2.2 5.2
Democratic Republic of the Congo 30 10 85 4.2 1.6 423 0.9 2.4 3.3
Equatorial Guinea 48 2 97 11.6 1.6# 401 2.5 2.3 8.50
Eritrea 19 83 16 2.5 1.6# 197 1.3 1.4 4.2
Ethiopia 16 50 14 4.4 4.8 142 1.7 1.0 5.9
Gabon 81 0 96 8.1 1.9 287 1.9 1.5 6.0
Gambia 31 0 100 1.2 0.7 429 0.3 2.3 1.0
Ghana 36 2 98 3.1 1.2 401 0.8 2.1 2.6
Guinea 28 1 99 3.2 1.6# 468 0.7 2.6 2.2
Guinea-Bissau 32 0 100 3.8 1.6# 480 0.7 2.7 2.7
Kenya 33 57 21 6.7 1.8 164 2.9 1.1 10.4
Liberia 45 0 100 5.9 1.6# 437 1.1 2.5 4.0
Madagascar 30 36 60 1.7 0.7 327 0.4 1.9 1.3
Malawi 15 22 77 14.2 1.6# 435 3.5 2.6 13.3
Mali 30 10 90 1.9 1.5 464 0.4 2.7 1.5
Mauritania 58 59 41 0.6 1.6# 221 0.2 1.4 0.72
Mozambique 32 4 96 12.2 1.2 437 2.8 2.4 10.3
Namibia 31 8 0 21.3 1.3 2.3 14.5 0.018 52.4
Niger 21 11 89 1.2 3.2 496 0.2 2.9 0.8
Nigeria 44 1 99 5.4 1.1 420 1.2 2.3 4.3
Rwanda 6 60 7 5.1 3.6** 129 2.6 0.9 8.9
Senegal 47 3 97 0.8 1.1 395 0.2 2.2 0.65
Sierra Leone 37 0 100 1.8 1.6# 440 0.4 2.5 1.4
Somalia 28 96 3 0.7 1.6# 148 0.4 1.1 1.3
South Africa 57 15 0 21.5 1.3 3.5 17.0 0.028 62.1
Sudan 36 42 56 2.3 1.6# 281 0.7 1.7 2.5
Swaziland 26 69 0 38.8 1.6# 21 26.1 0.17 107.0
Tanzania 32 21 75 8.8 2.7 372 2.0 2.1 7.4
Togo 33 0 100 4.1 2.6 445 0.9 2.5 3.0
Uganda 14 20 73 4.1 1.9 437 1.1 2.6 4.1
Zambia 40 16 83 16.5 2.1 396 3.6 2.3 14.0
Zimbabwe 35 54 0 24.6 1.2 16 16.7 0.128 61.9
Average†† 34 23 67 6.9 2.0 320 1.3 1.8 4.9
Median 33 14 85 4.8 1.6 396 1.2 2.2 4.2

*Malaria incidence and deaths denote estimates in the absence of HIV, all age groups combined. Abbreviations: /1,000py = per 1,000 person-years.
†Excluded from analysis were the following small countries: Lesotho and the islands The Seychelles, Reunion, Comoros and Mauritius, which are at negligible malaria risk, and Sao Tome & Principe and Cape Verde, which may be subject to stable malaria transmission but whose transmission intensity has not been precisely characterized in the Malaria Risk in Africa model.
‡Calculated by using country-specific age distributions.
§Estimates by UNAIDS/World Health Organization (WHO) for end of 2003 (28).
¶From estimates by UNAIDS/WHO for end of 2003 or from national household surveys (11). Same ratios assumed for children as for adults.
#In the absence of reliable urban/rural data, we applied the median urban/rural ratio across countries with urban and rural data.
**In the absence of specific urban and rural data, the estimate for neighboring Burundi, which was judged to be similar in HIV epidemiology, was applied.
††Weighted according to population size, except for the increases in malaria incidence and deaths due to HIV-1, which are weighted according to the absolute number of malaria cases and deaths in each country.

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