Although AIDS gets headline treatment, the most vicious killer in Africa is still malaria. Millions are dying of this disease, with severe effects on economies. There is however, new hope on the horizon: both the WHO and the OAU have declared war on the mosquito.
Gro Harlem Brundtland, former Prime Minister of Norway, took up her post as the new director general of the World Health Organisation (WHO), with a battle cry: "Lets roll back malaria!" This demand, made in her acceptance speech on May 12, 1998 in Geneva, reflects growing concern at the prevalence of the disease which the ancient Chinese knew as 'the mother of fevers,' and which continues to claim 2.7m lives each year.
Thanks to Gro Brundland, malaria is now top of the next decade's agenda for the WHO in communicable disease. Her call for a concerted global effort to achieve the eradication of malaria derived its inspiration from a motion by the African member states, which in turn was based on a decision made by the Organisation for African Unity (OAU) in June 1997.
A glance at available statistics starkly reveals the impetus of this African campaign to focus the scientific community's attention onto malaria. World-wide, malaria occurs in about 100 countries, with many countries reporting malaria resurgence; but sub-Saharan Africa is most severely affected. Each year, about 500m people fall sick with malaria: 90% of these in Africa. Malaria causes 1.4-2.4m deaths every year in Africa alone. This averages at 5,479 deaths everyday. Many of these occur in children.
Apart from the social and psychological damage inflicted, there are enormous economic costs implicit in such high figures. The exact cost of malaria to the African economy has never been calculated - how many work days are lost in industry? How many times can fields not be taken care of or harvested in time? The OAU estimates an economic loss of $5m per day, or $2,000m per year. The WHO estimates that malaria cost Africa directly or indirectly about $1.8bn in 1995. This is more than twice the estimated 1987 cost.
The challenge of preventing or effectively treating malaria is not new. In the mid-1950s, concerted efforts were made to eradicate the disease through the use of the insecticide DDT. Spraying with DDT turned out to be dangerous and a health hazard in itself however, since DDT was found to enter the food chain with detrimental effects extending even to mothers' milk. Most African countries were in any case never actually included in the eradication campaign, which was officially ended in 1969. Today spraying with pyrethroids is used with less harmfull results,' but this by no means represents a total solution.
The drying out of large swampy areas, favoured breeding ground of the mosquito, has been successful in some countries, and indeed eradicated malaria from Italy. However, the malaria parasite, as a living organism, obeys evolution - and in the 1960s, reports of resistance to first line anti-malarial drugs came from SE Asia. The race between new drugs and new resistances has not stopped since then. The concept of Primary Health Care, introduced in the late 1970s, whose basic aim was to provide immediate healthcare to everyone, did not change things much. In 1985 it was clear that malaria was resurging, and in 1986, WHO's expert panel concluded that a magic solution could not be relied upon, and that furthermore, malaria patterns were determined by a variety of socioeconomic as well as biological, climatic and geographic factors.
Mass movements of people such as occur during war, are thus just as important in causing epidemics as agriculture patterns and weather conditions. Exceptional rains and population movements were blamed for malaria epidemics in southern Africa in 1996. The El Nino disasters of this year have prompted similar experiences, particularly in Kenya where people in the Bomet district were dying at a rate of three or four a day in March. …