Mexico's quest for a complete mortality data set.

As Bernard Nahlen of the Global Fund to fight AIDS, Tuberculosis and Malaria told the Bulletin: “In children in higheendemic areas, indirect, malariae related mortality may be just as or even more important than the burden of acute, direct malariaeattributable more tality — but it is even more difficult to measure.” To further clarify the picture, WHO recommends that specific, direct, acute malariaeattributable mortality also be tracked. This is done mainly through demographic surveillance sites (DSS) where disease and deaths are continue ously monitored in selected populations and cause of death is ascertained by interviewing bereaved relatives. A synthesis of available data by WHO and the US Centers for Disease Control and Prevention (CDC) published in 2005, showed that direct malariaeattributable mortality in sube Saharan Africa among children aged under five years accounted for about 18% of all deaths in this ageegroup, or between 700 000 and 900 000 children. However, even these “latest” figures refer only to 2000. With surveys and precise longitudinal monitoring costly to implement and difficult for poor countries to sustain, it often takes a long time to collect and analyse enough data for a reliable estimate, while problems in data availability and interpretation make comparisons between subsequent estimates difficult. DSS are also typie cally smallescale, and extrapolation to the wider continent needs to make use of malaria risk maps. Summing up the problem, Nahlen says that extrapolating malaria mortality rates to the wider continent is “fraught with difficulties”. Malaria is such a nebulous disease that the chances of getting the numbers wrong are great, and this may adversely affect decisionemaking. “We must have accurate mortality and case data so we can evaluate proe grammes and see the effects of intere ventions,” says Angus Spiers, UNDP’s Global Fund Malaria Advisor in Angola. How will WHO and governments know if funding is headed to the right areas? How will they know if intere ventions such as insecticideetreated mosquito nets are working? And how can they determine how much more money needs to be spent on combating the disease? “We need reliable malaria statistics to be able to target control resources and evaluate their impact,” says Dr Allan Schapira, Coordinator in WHO’s Global Malaria Programme. “As long as the distribution of the problem is known and funding is available, the resources will be channelled to those in need, provided that the delivery systems can do the channelling. However, a gross underestimation in a particular area may cause insufficient funding of a given programme.” No one doubts that malaria places a heavy burden on the countries that can least afford it. But to know just how big a toll the disease takes and whether the projects that are currently in place to fight it are actually working, requires more ingenuity and investment than had perhaps been anticipated, when the Roll Back Malaria movement was initiated, Schapira says. O Karen Iley, Lusaka