Global burden of malaria and neglected tropical diseases in children and adolescents, 1990–2019: a population-based, cross-sectional study

ObjectivesTo estimate the global burden of malaria and neglected tropical diseases (NTDs) in children and adolescents aged 0-19 years and to analyse trends to inform public health and policy decisions.DesignPopulation-based, cross-sectional study.SettingGlobal analysis across 204 countries and territories.ParticipantsChildren and adolescents aged 0-19 years with malaria and NTDs, stratified by age, gender and location from 1990 to 2019.Main outcome measuresYearly incidence, prevalence, and disability-adjusted life years (DALYs) for malaria and NTDs, age-standardised incidence rates (ASIRs) and age-standardised DALY rates (ASDRs).ResultsThe global burden of malaria and NTDs among children and adolescents aged 0-19 years remains substantial. In 2019, 195.6 million cases of malaria and NTDs were recorded globally, resulting in 43.9 million (95% Uncertainty Interval (UI): 25.0-70.4 million) DALYs. The incidence rate increased until 2005 and then declined. Sub-Saharan Africa had the highest ASDR, while high-income regions had the lowest. Significant ASDR reductions occurred in Andean Latin America and South Asia. The burden was highest in low-Socio-Demographic Index (SDI) regions, with malaria accounting for over 93% of DALYs among children under five. Females had slightly higher incidence rates, while DALYs were evenly distributed between genders. There was an inverse association observed between SDI and ASDRs.ConclusionsMalaria and NTDs continue to disproportionately affect children and adolescents in low-SDI regions, especially sub-Saharan Africa. Sustaining gains while accelerating control efforts is the key to successful control progress and ambiguous elimination goals for both malaria and NTDs.