World Malaria Day

It was World Malaria Day on the 25th of April. The statistics on the frequency of infection are absolutely staggering with 300 to 500 million new cases per year and 1.5 to 2.7 million deaths, mostly amongst children in Sub Saharan Africa. This is a major impediment to development in the region as well as a tragic loss of human life and a cause of indescribable distress to families.The traditional treatment was chloroquine, which was fairly effective until the 1960s, but significant resistance has emerged to it since. Other newer (and more expensive) agents are available and effective but as ever with Africa the logistics of getting the drugs to the people who need them are a problem as well as the problem of cost itself. There is an additional problem that chloroquine is over used, frequently as a treatment for colds, and there is significant over diagnosis of malaria. This is of course understandable as the disease is of course best treated early.

There is also considerable debate about mosquito control including with the use of DDT. Once heralded as the solution to the malaria problem and very extensively used in the 1950s and 1960s before falling from favour and now being proposed in a limited fashion as impregnation of mosquito nets and in houses. DDT was undoubtedly highly effective in killing mosquitoes but widespread use is a significant environmental problem. The above link seems a pretty reasoned analysis of its current place.

Amongst the most effective of recent innovations has been the increased provision of mosquito nets impregnated with insecticide for up to 5 years (the insects almost exclusively bite at night). However, this are not usable everywhere. I can also anecdotally report that sleeping under a mosquito net is a real pain.

Whether or not malaria could ever be eradicated is a difficult question as is the likelihood of a successful vaccine. Of course there are also four strains of malaria: vivax, ovale, malariae and the most feared, the one associated with significant mortality, is falicparum that particularly afflicts Africa.

The final solution to malaria (if there is one) will no doubt be complex. However, more than anything I would submit this is a disease that merits having great amounts of effort, publicity and money thrown at it; possibly even more than is at the moment.

As an aside when I went to Kenya I took Lariam. It made me quite nauseated but I did not get malaria. A friend who also went to Africa at the same time took it but still got malaria. He said it was really just like the flu only vastly worse. He only had a mild dose. The mortality in significant even in healthy adults from here who lack the immunity built up over years as the Africans have. Prophylaxis may not be perfect but if going to a malaria zone be sure to take some prophylactics. Final aside Oliver Cromwell the subject of one of my other recent blogs may have died of malaria.

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