Bad air

[qatarperegrine]

I've been reading a lot about malaria since I got back from Africa. It's something of which I've been dimly aware, in a "must take preventative action to make sure I don't get this" kind of way, but I didn't know much about the disease.

I didn't know, for example, that it's caused not by a virus or bacterium but by a protozoan called plasmodium, which has a long and complex life cycle involving mosquito saliva, livers, red blood cells and even human brains. Ick. Actually, only one of the four species of plasmodium -- P. falciparum -- infects the brain, but that's the one that causes 90% of fatalities.

I had no idea of the vastness of the malaria problem. A conservative estimate is that someone dies of malaria every 30 seconds -- between one and three million people a year, in other words. Ninety percent of them are in Africa; seventy percent are under age 5. And that doesn't even include the millions of children every year who survive but with permanent damage. Robert Gwadz, head of the malaria department at the National Institute of Health, says, "It's possible that due to malaria, almost every child in Africa is in some way neurologically scarred." As a result, malaria is a significant contributor to economic stagnation and poverty: according to a Lancet article cited on Wikipedia, it costs Africa $12 billion a year in health care expenditures, reduced productivity, and reduced tourism. That number is particularly notable since Jeffrey Sachs suggests in The End of Poverty that $2-3 billion a year would be sufficient to control malaria in Africa -- not to eradicate it completely, but to reduce fatalities to near zero.

I also had no idea that there was precedent for malaria control. Malaria used to be prevalent in the U.S. and southern Europe, until the mosquitos that carry it were wiped out in the 1930s and 40s through means I would otherwise find quite dubious -- ample use of DDT and the drainage of millions of acres of wetlands. While I think of malaria as a tropical disease, a National Geographic article chronicles its history planetwide:

The disease has been with humans since before we were human. Our hominin ancestors almost certainly suffered from malaria. The parasite and the mosquito are both ancient creatures—the dinosaurs might have had malaria—and this longevity has allowed the disease ample time to exploit the vulnerabilities of an immune system. ...

Few civilizations, in all of history, have escaped the disease. Some Egyptian mummies have signs of malaria. Hippocrates documented the distinct stages of the illness; Alexander the Great likely died of it, leading to the unraveling of the Greek Empire. Malaria may have stopped the armies of both Attila the Hun and Genghis Khan.

... At least four popes died of it. It may have killed Dante, the Italian poet. George Washington suffered from malaria, as did Abraham Lincoln and Ulysses S. Grant. In the late 1800s, malaria was so bad in Washington, D.C., that one prominent physician lobbied--unsuccessfully--to erect a gigantic wire screen around the city. A million Union Army casualties in the U.S. Civil War are attributed to malaria, and in the Pacific theater of World War II casualties from the disease exceeded those from combat. Some scientists believe that one out of every two people who have ever lived have died of malaria.

Shocking.

Reading all of this makes me feel very grateful that I can pop a doxycycline, spray on some DEET, and rest assured that even if I catch malaria despite these precautions, effective treatments are available. Malaria is no AIDS; despite all the problems finding a vaccine and dealing with disease-resistant strains, it is still an eminently treatable disease. This makes it all the more tragic that so many people die of it. The reinforcing cycle of disease and poverty depresses me: poverty leads millions of Africans to suffer and die from a disease that could be prevented or cured, while meanwhile the sequelae of malaria infection -- death, disability, brain damage -- cause even more poverty.

And now, a fun fact about malaria: before antibiotics were invented, doctors purposefully infected syphilis sufferers with malaria, because syphilis bacteria can't survive the alarmingly high fever that is a hallmark of malaria. The hapless patients could then be treated with quinine. Some of them didn't survive, but hey, they were going to die of syphilis anyway, so what the heck.

(Main sources for this entry: "Bedlam in the Blood," from this month's National Geographic; Wikipedia; Jeffrey Sach's The End of Poverty.)

Comments

[lasa.livejournal.com]

We're currently running a fundraiser for "Nothing but Nets" at my church. The more you find out about malaria, the more you want to do something.
http://www.nothingbutnets.net/?gclid=CJPOgvz6to0CFSQYZAodQkOo8w

My grandfather was infected by it in his twenties and nearly died.

[qatar.livejournal.com]

IIRC, my grandfather had it too -- possibly acquired in north Africa during WWII, though. (Mum, am I getting this right?)

[y-pestis.livejournal.com]

Mum hasn't replied yet but I think you're right. Not sure it was ever identified as such but he'd have periods of "being poorly" that seemed to match malaria.

[materjibrail.livejournal.com]

Yes, I always heard from Mum and Dad that it was malaria. The "feeling poorly" that you remember was Meniere's though; Malaria was fevers and chills and staying in bed, as I remember it. And quinine was in there somewhere.

[rmitz.livejournal.com]

The kicker is that now we know that very very low levels of DDT are just as effective against malaria as the horse-pill doses we used to use...levels that would probably be perfectly safe to wildlife and humans except everyone and his mom is all "DDT always bad!" and won't listen any further.

[qatar.livejournal.com]

Yeah, that's pretty much what the National Geographic article said. It also said that most of the environmental problems from DDT were from agricultural use, not malaria prevention -- and that the darn stuff was so very cheap, and so seemingly innocuous, that in both cases many times the necessary doses were needed.

DDT is a big part of the malaria eradication campaign going on in Zaire. I never thought I'd be happy to hear that, but now I've read that article, I am. :-)

[gustavolacerda.livejournal.com]

I lived in Angola '89-'92, where malaria was known to happen. I remember hearing that our village mayor was in a serious condition for a month or two.

From what I heard, getting malaria was bigtime suckage, but not the end of the world. Interesting fact: if you do get infected, you might be better off staying in Africa, where the doctors know the beast well.

[qatar.livejournal.com]

The friend I was visiting in Gabon has gotten malaria multiple times. It does sound distinctly un-fun, but it also sounds like with the newer drugs (and the understanding that it's possible to cure it entirely, without the lifelong relapses previous generations used to have) it's really not THAT big a deal to a normally healthy adult.

Here's what I wonder, though. In Africa, 70% of malaria deaths are to children under the age of 5. When adults get malaria, they tend not to die. Is that because malaria is only dangerous to children, or is it because, if you've survived to adulthood in a place like Zaire, it's because you have some malaria resistance already? In other words, if I were to move to Zaire and get malaria, would my chances of a dying resemble a Zairian adult's (because I have an adult immune system) or a Zairian child's (because my immune system is worthless against malaria)? I suspect the latter.

[qatar.livejournal.com]

Also: what were you doing in Angola? :-)

[materjibrail.livejournal.com]

I remember a sermon from a priest from somewhere in east africa ( details hazy) years ago, in which he said that Malaria and T.B. killed more people in his country than AIDS.