FAQ's: What is the Current Status of Malaria?

  • Africa: Malaria has been a serious problem in SubSaharan Africa for many years. Malaria causes an estimated 2.7 million deaths per year, with most of these deaths occurring in Africa. Ninety percent of the world's malaria cases occur in Africa. Now, malaria outbreaks are being reported in some locations of Africa that had been previously thought to be at elevations too high for malaria transmission. Some scientists hypothesize this is due to climatic change, while others hypothesize that this is due to human migration. Also, malaria has resurged in certain locations of Africa that had previously had effective control programs, such as Madagascar, South Africa, and Zanzibar.
  • 1980s: Malaria case numbers increased markedly during the 1980s in the Indian Subcontinent and Southeast Asia.
  • 1990s: Malaria case numbers increased markedly during the 1990s in South America, the Indian Subcontinent, and Southeast Asia. These increases are largely linked to cessation of malaria vector control programmes.
  • Drug Resistance: Drug resistance is a growing problem, Chloroquine is an extremely safe, cheap, and formerly very effective drug, but in Southeast Asia, portions of South America, and a large and increasing area of Africa chloroquine resistance levels are high. In some areas of Southeast Asia there is resistance to all the major drugs. Drug resistance is often connected with a legacy of foolishly overusing or underdosing antimalarial drugs. Some countries even laced salt with chloroquine.
  • Vector Resistance to Insecticides: Malaria mosquitoes are developing resistance to the major classes of insecticides which have been used to control the disease. Portions of the effort to eradicate malaria during the 1950s and 1960s were scientifically naive and politically uncommitted. Funding for vector control was cut prematurely in areas, leading to resurgence in malaria cases and spread of insecticide-resistant vector populations. The insecticide resistance picture varies with vector species and region.
  • Demographic Change: Population and demographic changes have resulted in more people moving into malaria-endemic areas, thereby increasing transmission. Migration and the creation of new habitats have resulted in people who have no natural immunity to the disease being exposed. This results in epidemic malaria that is characterized by much higher rates of disease and death.
  • Environmental Change and Human Mobility: Human environmental changes such as road building, mining, deforestation, logging, and new agricultural and irrigation projects have created new breeding sites. Malaria transmission in newly logged or exploited areas explodes just as a crop of outsiders with no immunity to the disease come into work camps. This is particularly a problem in the Amazon in Brazil. Indigenous people also suffer unprecedented onslaughts of malaria. Incidence of malaria among Yanomami Indians in the Amazon have leapt almost seventy-fold since contact with settlers and gold miners, who are often plying their trades illegally. Now, a quarter of Yanomami die of malaria, and others of tuberculosis, whereas malaria was practically unknown among the Yanomami previously.
  • Deterioration and Abandonment of Control Efforts: In many regions, including the Indian subcontinents, Madagascar, and portions of South America and Southeast Asia, malaria control programs have deteriorated or been abandoned because of political lack of commitment, and lack of willingness to see things through to completion.
  • Political Indifference and Budget Cuts: Malaria research and control budgets in many countries suffered huge cuts during the 1980s and 1990s, yet malaria was spreading, sometimes to people such as the Yanomami, who had had no previous exposure to it. Public health is often the last consideration when politicians allocate funding. The creation of wars and refugees provides conditions ideal to the aggressive spread of malaria among displaced persons.
  • What About the Developed World? Malaria is primarily a disease characteristic of the developing world. However, portions of the southern United States and Western Europe, i.e. Italy are formerly malaria-endemic regions. The former vectors are still present in these areas. Although people's lifestyles in developed countries have changed greatly since the early 1900s, with the widespread use of screening and the advent of air conditioning, television and other reasons to stay indoors during the summer, it is a "gamble" as to when and where limited local malaria transmission could resume. Competent vectors are present, while parasitemic persons [returned travellers and persons coming from malaria endemic areas] are sometimes present in these areas.
  • What About the Future? Although hypotheses vary about the effect of increased urbanization, population movements, and possible climatic change on malaria, one thing is certain: without the political will to control malaria on both the part of developing nations and in terms of scientific, technical and financial assistance from the resource-wealthy developed world, malaria will continue to be a very serious health problem.

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