Malaria: What is it and Why I Believe Our Generation Can Defeat it

By Kwabena Amponsah-Manager

What is Malaria?

Malaria is a tropical disease that is caused by the bite from the female Anopheles mosquito. The parasite is known as Plasmodium. Globally about 22 countries are plagued by malaria, most of them in the tropical regions and a few sub-tropical countries.

Symptoms of Malaria:

The symptoms of malaria include fever, anemia, chills, lost of appetite, general body weakness, nausea, convulsions and headache. The most characteristic symptom of malaria is the cycle of sudden chills followed by fever and sweating.

Occurrence:

There are more than 400 million cases of malaria annually. If not treated, the infection can be fatal, especially in infants, pregnant mothers and seniors. Malaria kills between one and three million people, the majority of whom are young children in sub-Saharan Africa, where 90% of malaria-related deaths occur.

The most serious form of the disease is caused by Plasmodium falciparum which is one of several species of the parasite that cause the disease. A milder form of the disease results from the species Plasmodium vivax, Plasmodium ovale and Plasmodium malariae.

Prevention and Treatment of Malaria:

The most effective means of preventing the disease is to prevent the bite from the mosquito. Insecticide treated mosquito nets and insect repellents are first line preventive measures. Mass preventive measures such as spraying insecticides inside houses and draining standing water where mosquitoes lay their eggs are also employed by governments and institutions.

Currently there is no effective vaccine against malaria though a few are in development (GSK is a leader in this aspect). A variety of antimalarial medications are available. In the last 5 years, treatment of P. falciparum infections in endemic countries has been altered by the use of combinations of drugs containing an artemisinin derivative. Severe malaria is treated with intravenous or intramuscular quinine or, increasingly, the artemisinin derivative artesunate. Several drugs are also available to prevent malaria in travelers to malaria-endemic countries (prophylaxis). An example of prophylactic malaria drug is Malarone. Chloroquine used to be most commonly prescribed medicine against malaria but the parasite developed resistance to the drug. It is still being used to treat and prevent malaria though not as effective as it used to be. In places where drug resistance parasites have not yet been confirmed, such as Central America and parts of the Middle East, Chloroquine is still the drug of choice prevent and treat P. falciparum and P. vivax infections.

For reasons not fully understood, a number of diseases appear to provide some resistance to malaria. Notable ones include sickle cell disease, thalassaemias, glucose-6-phosphate dehydrogenase, Duffy antigens. Some people have red blood cells that lack proteins called Duffy antigens on their surface. Duffy antigens act as receptors for Plasmodium vivax merozoites, so people without Duffy antigens are resistant to infection from this parasite. Again, individuals who live in malaria-endemic regions acquire immunity to malaria through natural exposure to malaria parasites. In fact, naturally acquired immunity to falciparum malaria protects millions of people routinely exposed to Plasmodium falciparum infection from the disease.

Even though malaria has not received the global attention required for a killer of such profile, wealthy foundations, some private companies, and smart governments across the world are beginning to wake and make malaria a priority. However, there are still skeptics who doubt humans’ ability to eradicate malaria. Early November of 2010 a series of papers published in a respected scientific journal, the Lancet cast a gloomy cloud over any hope of dealing with malaria, at least in our lifetime. The papers concluded by urging governments, donor agencies and foundations to focus more on minimizing the prevalence of malaria and not on eradicating the killer.

Generally speaking, and not necessarily referring to the Lancet papers, considering mankind’s quest to conquer the universe, occupy Space, and pursue every kind of technology to make life easier and better, it would be intellectuality  dishonest and morally criminal for humans to accept the theory that malaria is ineradicable.

A few decades ago, significant portion of North America was plagued with malaria in the same fashion as African countries are going through.  In fact, it was not until the late 1890′s that scientists even learnt that the disease is caused by a parasite and that it is a mosquito that transmits the parasite from person to person. The assumption in those days was that malaria was caused by some environmental factors. The word malaria actually comes from the Italian “mala aria”, meaning “bad air” because it was generally believed that malaria was caused by breathing in bad or foul air and vapors emanating from swamps, marshy lands and latrines.

It is important to remember that 70 to 80 years ago, Americans traveling to the Eastern Tennessee Valleys had the same fear they now have when traveling to Togo or Ivory Coast because of malaria. With the creation of the U.S. Tennessee Valley Authority (TVA) in 1933 which established an organized malaria control program, the doubts began to fade. At the time, malaria affected 30 percent of the population in the region where the TVA was incorporated. After implementing aggressive research and control operations, the disease was essentially eradicated in the TVA region by 1947.

The US did not win the battle over malaria overnight. Efforts to control malaria became national focus as far back as the early 20th century during the occupation of American military in Cuba and the construction of the Panama Canal. It is recorded that malaria (and yellow fever) caused significant number of deaths among the workers of the canal. This triggered an aggressive program of malaria control which in 10 years had already made remarkable progress.

Malaria can be defeated, albeit, not overnight. The funding available for anti-malaria campaigns, and research and development is tiny compared to the challenges.

In the long run, I believe that prevention of malaria is the cost-effective route to take rather than treatment of the disease. However, for preventive measures to make the required impact, funding would have to be ramped up.

Current statistics show that in many of the malaria endemic countries, funding is less than US$1 per capita, and in fact it is less than US$0.5 in 16 malaria endemic countries, making up about 710 million people.

Much as I wanted this to be educational rather than political, I cannot help but state that malaria could be eradicated from the earth at negligible percentage of the cost of the Iraq war. It has been estimated by Economist Jeffrey Sachs that malaria can be controlled for US$3 billion in aid per year. (The cost of the Iraq war stands at $774 billion at the time of writing this article)

Our generation must stand trial for genocide for inaction on a problem that kills a child every 30-40 seconds. It is every 30-40 seconds!

Further Reading:

 

Chloroquine

Wellems TE (October 2002). “Plasmodium chloroquine resistance and the search for a replacement antimalarial drug”. Science 298 (5591): 124–6. doi:10.1126/science.1078167. PMID 12364789. http://www.sciencemag.org/cgi/pmidlookup?view=long&pmid=12364789.

 

 

 

Malaria in Sub-Saharan Africa

Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI (2005). “The global distribution of clinical episodes of Plasmodium falciparum malaria”. Nature 434 (7030): 214–7. doi:10.1038/nature03342. PMID 15759000.

 

 

 

The Artesunate Anti-Malaria Drug

Dondorp AM, Day NP (July 2007). “The treatment of severe malaria.”. Trans. R. Soc. Trop. Med. Hyg. 101 (7): 633–4. doi:10.1016/j.trstmh.2007.03.011. PMID 17434195. http://linkinghub.elsevier.com/retrieve/pii/S0035-9203(07)00093-4.