Medical Challenges : Malaria

I am going to talk about a bane that has been scourging humanity for at least fifty thousand years. This foe is
malaria.

Malaria, a tropical disease that has been called one of the most complex health problems facing humanity in
the 21st century, is at once a failure, a puzzle, and a serious challenge. The disease is caused by protozoan
parasites of the genus Plasmodium. Five species of the plasmodium parasite can infect humans; the most
serious forms of the disease are caused by Plasmodium falciparum. Usually, people get malaria by being
bitten by an infective female Anopheles mosquito. When a mosquito bites an infected person, a small amount
of blood is taken, which contains microscopic malaria parasites. About one week later, when the mosquito
takes its next blood meal, these parasites mix with the mosquito's saliva and are injected into the person
being bitten. The parasites multiply within red blood cells and make them burst, causing symptoms that
include symptoms of anemia (light-headedness, shortness of breath, tachycardia, etc.), as well as other
general symptoms such as fever, chills, nausea, flu-like illness, and, in severe cases, coma, and death.

Generally, the approach to tackle the disease was through mosquito control, preventive drugs or post-
infection treatments.

• Mosquito control consists of removing or poisoning the breeding grounds of the mosquitoes.
Eradication of malaria through the elimination of mosquitoes has been successful in some areas such
as Europe or North America. Nonetheless, these techniques are environmentally hostile and have so
far been futile in many parts of the developing world, mainly the African continent. The introduction
of sterile insect technique has attracted much attention. Transgenic insects that are resistant to malaria
could in effect replace wild mosquitoes. However, the modification of ecosystems could lead to
unknown consequences.
• Several drugs, most of which are also used for treatment of malaria, can be taken preventively.
Generally, these drugs are taken daily or weekly, at a lower dose than would be used for treatment of a
person who had actually contracted the disease. Use of prophylactic drugs is seldom practical for full-
time residents of malaria-endemic areas, and their use is usually restricted to short-term visitors and
travelers to malarial regions. This is due to the cost of purchasing the drugs, negative side effects from
long-term use, and because some effective anti-malarial drugs are difficult to obtain outside wealthy
nations.
• Therapy drugs are taken once a person is already infected. Chloroquine is very cheap and, until
recently, was very effective, which made it the antimalarial drug of choice for many years in most
parts of the world. However, resistance of Plasmodium falciparum to chloroquine has spread recently
from Asia to Africa, making the drug ineffective against the most dangerous Plasmodium strain in
many affected regions of the world. A new group of antimalarial drugs has brought new hope in the
fight against malaria - known as artemisinin-based combination therapies.
 Medical Challenges: Malaria

After years spent bringing the disease under control, the number of people dying from malaria is now higher
than it was 30 years ago and has spread to new countries. Although it is mainly a disease of tropical and sub-
tropical countries, malaria has been identified in eastern European countries such as Russia and Turkey and
recently a handful of cases were diagnosed in the US. This resurgence is explained by the fact that resistance
of the disease to drugs and mosquitoes to insecticides has developed.

Reminding you that about 3.3 billion people, half of the world's population in 107 countries, are at risk of
malaria and that every 20 seconds a child dies from malaria in Africa, the most effective way to deal with this
ongoing disaster is through a long-term commitment that involves multiple interventions, disciplines,
strategies and organizations. One of the means to develop important new tools critical for the eradication of
malaria is through biomedical research. The current funding of US$ 1.5 billion is equivalent to less than 50
cents per person at risk. At this rate, with current research techniques, if it takes 10 years to develop a vaccine
against HIV, it will take 5 million years to do so against malaria. If you are a cool-hearted businessperson and
have listen to these statistics without any sort of emotional reaction, think about this: "Because malaria
causes so much illness and death, the disease is a great drain on many national economies. Since many
countries with malaria are already among the poorer nations, the disease maintains a vicious cycle of disease
and poverty." The economic burden of malaria is high as it impedes endemic countries’ economies by as
much as 1.3 %.

Mauritius was once a country with high levels of endemic malaria with tens of thousands of cases a year in
the 1940s. The disease has now mainly become an imported illness. There have been 36, 38 and 42 cases for
the years 2005, 2006 and 2007 respectively. However, the control of malaria in Mauritius is continuously
maintained with the support of the WHO. The programme to contain malaria includes environmental controls
on mosquito breeding, selective spraying of the airport, seaport, ships, and planes, the follow-up of travelers
from countries with endemic malaria, and free preventive drugs for Mauritian travelers visiting these
countries. Following many years of continual containment of the disease, staff trained to deal with Malaria
are being put on stand-by and redeployed on other duties. The malaria unit now carries responsibility for the
general surveillance of all infectious diseases in Mauritius. The various methods of surveillance are the
following:
a) active detection of cases

(i) among people, Mauritians or foreigners, coming from malaria-infected zones, who are regularly
visited,(ii) for every person suffering from fever ;
b) passive detection in health centers ;
c) in vivo test for chloroquino-resistance for all cases of Plasmodium falciparum ;
d) entomological surveillance.
Such methods are costly but effective since it can be said that endemic malaria is as dead as the dodo.