Malaria

This blog condenses a section from The End of Poverty by Jeffrey Sachs.

An African Problem

HIV/AIDS, Tuberculosis, Yellow Fever, Tetanus, Hepatitis, Dengue Fever, the Plague, Typhoid, UTIs, osteoporosis and malnutrition are a few diseases that a sub-Saharan African might face. Some are very unlikely (Dengue), others are unlikely, but significant (HIV has a prevalence of 4-6% in Uganda), and some disease are common hardships (malnutrition, osteoporosis). Outside all of these diseases, malaria deserves its own category. Malaria kills nearly 3 million African's per year and climate scientists and epidemiologists, looking at climate predictions, believe that an additional 146 million Africans could die before the end of the century from mosquito-borne disease. Furthermore, people with HIV are twice as likely to contract malaria - HIV exists all over the world, but 1 our of every 17 Ugandans has HIV.

Malaria is an infection from the paramecium (I think these are the things we looked at in 6th grade science with Mr. Sexton. With some pond water wedged between a slide and cover slip, it is easy to pick up the on the tail of the paramecium) Plasmodium. The little critters of Plasmodium vivax are less deadly, but are also more common in other tropical areas outside Africa (ie South America or India). Moreover, the mosquitoes outside Africa are more likely to sting cattle than humans, so transmission of malaria to humans is less likely outside Africa (African mosquitos sting humans nearly 100 percent of the time; Indian mosquitos sting humans one-third of the time). On the other hand, the species Plasmodium falciparum are a particularly dangerous and more lethal brand of malaria causing paramecium - this paramecium is more common in Africa (where mosquitos are more likely to sting you!).

Nature has already seemingly tipped the tables against Africa in the way of species distribution of Plasmodium and mosquitos, but even climate exacerbates the problem. If Bilal has malaria and a mosquito stings me right after stinging Bilal, I will not contract malaria. The paramecium must first mature inside the mosquito gut and work its way to the mosquito's salivary glands for injection - this generally takes about two weeks. Incidentally, a mosquito generally has a life span of about two weeks. So, normally, a mosquito would need to be born, sting the malaria-ridden Bilal the same day, and sting me just before the mosquito dies - a seemingly improbable scenario of well orchestrated timing. Unfortunately, Africa's wet (in the rainy season) climate supports lots of mosquitos and the warm weather decreases the time it takes for the Plasmodium to complete its life cycle (sporogony). Both of these factors, more mosquitoes and a higher chance that the Plasmodium becomes active inside the mosquito, significantly amplifies the malaria problem in Africa.

A Disease of Poverty

Malaria is completely treatable and can often be prevented. Bed nets, pesticide treatment, eliminating standing water, and using DDT in endemic areas can drastically reduce the risk of contracting malaria. Further, malaria is typically easy to diagnose and treatment can be a handful of pills or a day of injections for severe cases (three rounds of injections over a day). Engeye Health Clinic routinely treats Malaria successfully (a handful of cases every day). When health care is available and preventative measures are taken, malaria is more unpleasant than the flu, but not deadly.

Unfortunately, millions of Africans cannot afford health care (Engeye charges about $1.20 to treat any patient including the necessary medications, but most clinics charge 10 times that - most people here are subsistence farmers with no cash). Bed nets are about $10 and even though most kids share a bed with their siblings, there are usually six kids in a family. Three mosquito nets could easily be five percent or more of a family's income. Looking at a 1946 geographical distribution of malaria I see that America, Eastern Europe, and Spain once had malaria, but turning to the 1994 distribution map, it is clear that malaria is now a disease of the impoverished world. Some families are forced to cut corners by buying their own quinine tablets at a discount store (this is generally the most expensive treatment - malaria is resistant to the other treatments), but buy expired tablets or an incomplete dose helping to fuel resistance while not curing the bout of malaria. Some people simply live with malaria year-round (chronic malaria).

The Costs of Malaria

I wish that there was a number I could assign to the costs of malaria. I seem to remember the Carter Center doing a study on the costs of the Guinea Worm to a small region of yam farmers in Africa - the costs were easily in the millions over one year. I can only imagine the economic devastation for Africans having to take off work or having to treat multiple family members in one year. It is widespread and perhaps the most common ailment at Engeye, infecting students, businesses, the subsistence farmers and their ability to earn money for their families. But the devastation can most easily seen by analogy. What delayed the economically critical Panama Canal for more than three decades? Malaria and Yellow Fever (another mosquito-borne disease). If some tiny mosquitos could stop the well armed (with cash, steam/coal powered earth moving equipment, and lots and lots of guns) American government from completing an important trade route, what are the economic consequences of malaria to unarmed (no health insurance, no money, no means to combat malaria) subsistence farmers of West Nilers? I imagine that the consequences are much greater, but are likely not worth adding up to the people that can make a difference.

The aid from "rich countries" to fight malaria is in the tens of millions of dollars; Sachs estimates that 2-3 BILLION dollars is needed (I think Bush earmarked 5 MILLION per year to fight malaria in 2006). America contributes 0.18 percent of GNP to foreign assistance (it has pledged 0.7 percent) or about 20 billion dollars per year, it spends 27 times that number on the military (about half of your tax dollars).

Malaria and Me!

I have come fully prepared and fully committed not to get malaria (although, after seeing malaria and its treatment, I'm not nearly as worried about it as I was before leaving America). I am armed with 270 malarone tablets (250mg atovaquone/100 mg proguanil daily) and everywhere I have stayed has bed nets. I don't use mosquito spray, but I've only had a small handful of bites the last few months. I miss some (1 so far, mostly in the first month) doses of malarone (sometimes I forget my age, my memory gets worse with short term stuff - so a tablet every day is rough), but I can proudly tout that I have taken 98.9 percent of my pills so far.