Mortality from malaria in France, 2005 to 2014

Abstract

IntroductionMalaria is a notifiable disease in all European Union and European Economic Area countries except Belgium and France, where only autochthonous malaria is notifiable. Although morbidity caused by malaria has been assessed, little is known about mortality incidence.ObjectiveOur aim was to estimate the number of imported malaria-related deaths in hospital in metropolitan France.MethodsWe matched individual deaths reported between 1 January 2005 and 31 December 2014 to the French National Reference Centre for malaria (FNRCm) with malaria-related deaths from two other sources: the French National Registry on medical causes of death and the French national hospital discharge database. A capture-recapture method with log-linear modelling was used. Age, sex and place of death stratification were applied to remove heterogeneity.ResultsThe estimated malaria-related deaths in metropolitan France during the study period were 205 (95% confidence interval (CI): 191-219). The annual mean number of malaria-related deaths was estimated at 21 (95% CI: 19-22). The FNRCm malaria-related deaths surveillance had a 38% sensitivity (95% CI: 32-44). Among 161 in-hospital individual malaria-related deaths reported from three data sources, the sex ratio (male to female) was 2.6. Median age of the patients was 57 years, ranging from 1 to 89 years.ConclusionThe pertinent finding of this report is that malaria-related death records were significantly less complete [corrected] than case records. Therefore, data comparison of imported malaria morbidity and mortality between countries should imperatively be assessed using standard indicators weighted according to the completeness of health surveillance systems.

Keywords: FNRCm; France; Plasmodium; capture-recapture; malaria; surveillance; travellers.

Figure 1

Flowchart of malaria-related deaths from two sources, CépiDc and PMSI, metropolitan France, 2005–2014 (n = 151)

Figure 2

Venn diagram over the distribution of individual deaths, showing overlap and unique cases for three data sources according to the experts’ classification of cause of death, metropolitan France, 2005–2014 (n = 161)