Malaria is one of the 21st century’s great plagues. It is responsible for anywhere from 1 to 3 million deaths per year, most of them in sub-Saharan Africa. Efforts to eradicate the disease are mounting: in the year 2000, just 3% of children under 5, in sub-Saharan Africa, slept with mosquito nets; by 2008, that figure had risen to 56%. Aid groups now project that aggressive preventive measures can protect 100% of the population by the end of 2010 and reduce the number of deaths to near zero by 2015.
Doing so requires an aggressive and coordinated effort by governments across the region, in concert with world health experts, the UN’s WHO, aid organizations and local communities. Malaria, originally named “the bad air” because it was thought to be airborne, is actually a water and blood-borne disease, transmitted by a particular variety of mosquito. The scarcity of safe drinking water across much of the region leads to ill-advised practices like leaving whatever standing water one can find at hand for human consumption.
This allows mosquitoes to breed and proliferate. Advanced plumbing, with enclosed water systems, could help prevent the constant rampant spread of the disease, but other measures need to be taken first in order to secure the region’s water resources and ensure equitable distribution, to prevent water-linked trade and military conflicts and the further deterioration of troubled civil infrastructure, the collapse of which favors contagion.
Water-related conflict is an increasing threat to political stability across Africa, and ongoing “low-intensity” conflicts, including some that are taking thousands of lives, undermine basic pillars of organized society, like sustained agriculture, water quality, transport infrastructure, communications infrastructure, electricity and public health contact points. Populations deprived of one or more of these basic services are more likely to suffer from epidemic contagion.
Malaria is a disease that “comes back to visit”, according to Dr. Maghan Keita, of Villanova University, who addressed a gathering hosted by the Blood:Water Mission charity organization, on 19 November 2009, on Villanova’s campus. The Blood:Water Mission event was held to highlight both the gravity of the malaria pandemic, including the millions of deaths, but also to report on promising successes in spreading awareness and prevention to some of the most affected populations.
Dr. Keita, a leading Africana studies scholar who has studied epidemiology and migration in Africa, says sickle-cell anemia and other responses and after-effects of malaria infection can migrate in the blood of people never exposed directly to malaria itself, causing debilitating conditions and even death for some people. The malaria patient can also experience the direct return of the infection, even after it is treated, so prevention is the single most necessary mode of combating the disease in human beings.
LLIN (also known as long-lasting insecticidal nets) and other ITN (insecticide-treated nets) are now the front-line preventive measure of choice across sub-Saharan Africa. They can be up to 100% effective in mitigating the threat of mosquito-borne infection during sleep, not only due to the protective barrier they provide, but also as a result of being infused with insecticidal chemicals that can kills mosquitoes on contact, without endangering the health of human beings using them.
A UNICEF report on the subject notes the need to ensure the pesticides are safe for deployment in such proximity to human beings:
- In all cases, national governments must approve the use of insecticides prior to importing them into the country.
- ITNs, LLINs and insecticide treatment kits are for domestic use and can be handled by family members.
- It is advisable to order untreated nets set-packed with an insecticide treatment kit so that the net can be treated prior to use. It is also important that the user is made aware from the beginning that the net needs re-treatment.
- Each insecticide treatment kit is for the treatment of one ITN and consists of a measured dose of insecticide, a measuring bag, protective gloves and instructions on how to impregnate one net.
- The insecticide is public health grade and WHOPES (World Health Organization Pesticide Evaluation Scheme) approved.
The plant variety artemisia annua, a Chinese wormwood, has been found to have strong anti-malarial properties, and is being planted in Africa in hopes it will take to the sub-Saharan climate, and help produce a potent, locally grown pharmaceutical treatment to prevent or treat malaria. According to USAID:
The fight against malaria increasingly uses Chinese sweet wormwood, but demands for the plant have exhausted supplies, leading USAID to promote new plantings in East Africa. The Agency is working with the World Health Organization (WHO) to transplant the ancient Chinese remedy to Africa, where the soil and climate are suitable. Artemisinin is the extract of wormwood that is useful against malaria. Planting of 450 hectares of Artemisia annua began in Kenya in January 2005. In spring 2005, 450 hectares will be planted in Tanzania. “By this time next year, we will be looking at the extraction of 20 metric tons of artemisinin,” said Dr. Dennis Carroll, malaria expert with the Bureau for Global Health (GH). Malaria kills more than one million people each year.
The artemisia annua shrub appears to have been found to also work against certain parasitic worms that can infect human beings leading to a number of disease symptoms. As reported on the Science and Development Network:
Different forms of bilharzia — also known as schistosomiasis — occur throughout the tropics. Together, they kill 15,000 people each year, according to the World Health Organization. The disease is caused by five species of worm that enter humans through their skin as juveniles, then mature and reproduce in the blood vessels. The worm eggs are usually evacuated from the body in urine or stools but some remain in the body leading to disease symptoms, which include damage to the kidneys, spleen and bladder.
The plant produces extracts that might be able to help combat parasites that are developing a dangerous resistance to current modes of treatment. The hope is that use of the artemisia extract to fight malaria and/or parasitic worms, could also lead to new research as to how to target and eventually eradicate such disease agents. It is estimated that as many as 15 million cases of malaria infection were treated by way of artemisinin-based combination therapies (ACT), a “cocktail” of drugs that work in sequence and in concert to destroy the parasites that cause the disease.
The WHO reported that by the end of 2006, demand had risen to 150 million cases. Logistical challenges related to treating 150 million to 200 million cases across dozens of countries are one of the chief remaining obstacles to effective global prevention and eradication of malaria. In many countries the response is fourfold: nets, chemical treatments, drugs and landfill, to eliminate standing water. Only nets are minimally problematic in terms of side-effects and environmental fallout.
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Originally published November 23, 2009, at CafeSentido.com
The Poet Economist 