How to Eliminate Malaria

Sri Lanka is the latest country to be declared malaria free by the WHO.

How did they do it?

According to the New York Times:

In 2000, outside the rebel-controlled areas in the northeast, malaria cases began dropping as the government, with donor help, deployed a mix of indoor spraying, bed nets, rapid diagnostic kits and medicines that combined artemisinin, an effective treatment, with other drugs.

The government also screened blood samples drawn — for any reason — in public clinics and hospitals for malaria infection, and officials established a nationwide electronic case-reporting system.malariaeradication

In war-torn areas, the disease retreated more slowly, although the Tigers often cooperated with malaria-control teams because their villages and fighters also suffered.

Nonetheless, in a population of 20 million, it took years to get rid of the last few hundred annual cases. Most were soldiers and itinerant laborers, often from India, who worked in remote slash-and-burn farming areas and in logging and gem-mining camps.

Someone tell African policymakers that bed nets and behavior change are not enough.

Every other region of the world appears to be willing and able to combine vector (mosquito) control with other strategies of containing malaria with success (and enthusiastic donor support). But for some reason mosquito control is still lagging in Africa, even in otherwise strong and stable states. In some instances this has been due to environmental concerns while in others it has been due to the misplaced priorities of public health officials, donors, development agencies, and academic researchers.

The result:

About 3.2 billion people – nearly half of the world’s population – are at risk of malaria. In 2015, there were roughly 214 million malaria cases and an estimated 438 000 malaria deaths. Increased prevention and control measures have led to a 60% reduction in malaria mortality rates globally since 2000. Sub-Saharan Africa continues to carry a disproportionately high share of the global malaria burden. In 2015, the region was home to 89% of malaria cases and 91% of malaria deaths. 

214 million malaria cases amount to lots and lots of lost productivity. Also, losing one Miami every year in deaths is simply unacceptable.

More on this here. 

Why are Africans getting shorter?

South Asia still posts the lowest average height for adults in the world (see image below). But a remarkable finding of a recent study is that adult Africans (among other low income regions of the world) have gotten shorter, on average, since the 1970s.

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

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What explains deceleration in average adult heights on the Continent?

One obvious explanation is a decline in nutrition amid rising populations and declining agricultural productivity (Africa barely registered a green revolution). Another major culprit is the economic disaster that visited the Continent from the late 1970s to the early 1990s — which resulted in poor nutrition and an unchecked disease burden. Lastly, there is the issue of water and sanitation, especially in the context of a rapidly urbanizing population, which has direct implications for the realized disease burden.

The Catholic Church and AIDS: A Sorry Case of Denial

The Church’s continued ostrich approach to the catastrophe that is HIV/AIDS on the continent:

Pope Benedict XVI on Saturday signed off on an African roadmap for the Roman Catholic Church that calls for good governance and denounces abuses, while labelling AIDS a mainly ethical problem. Benedict signed the apostolic exhortation called “The Pledge for Africa” during a visit to the West African nation of Benin, his second trip to the continent as pontiff.

The document says AIDS requires a medical response, but is mainly an ethical problem.

Changes in behaviour are required to combat the disease, including sexual abstinence and rejection of promiscuity, it adds. “The problem of AIDS in particular clearly calls for a medical and a pharmaceutical response,” it says. “This is not enough however. The problem goes deeper. Above all, it is an ethical problem.”

More on this from the Daily Nation.

I have written against the Church’s policy on birth control here, here and here.

the cost of malaria, and the continent’s disease burden

Academics have already established that the economic costs of malaria and Africa’s general disease burden are not trivial. Think of lots of man-hours wasted due to illness and government expenditures on medication, time and money that could be used to build roads and what not.

To illustrate the point, not anyone is immune from Malaria. Drogba, the illustrious Ivorian forward, got malaria and had to take a few days off from his duties at the London club, Chelsea.

“He has this virus and, obviously, he lost power and training.”

“He lost his condition. He’s had treatment and now he’s OK. He’ll come back immediately in the best condition.”