Conquering the Intolerable Burden of Malaria: Promises to Scale Up

14 Apr 2008 Malaria is endemic in over 100 countries containing half the world’s population. Close to two million persons die yearly from malaria—over 5,000 per day, mainly young children. Plasmodium falciparum, one of the four human malaria parasites, causes the most severe disease, manifesting in anemia, low birth weight, cerebral malaria, metabolic derangements, and dire sequelae including cognitive impairment. The greatest burden of malaria is in sub-Saharan African due to the pervasiveness of Anopheles gambiae, the female of which prefers humans for its blood meals. P. vivax is now recognized as causing up to 400 million clinical episodes of malaria yearly, with added dangers due to its relapsing nature Recent advances in malaria research and public health practice have resulted in use of artemisinin-based combination treatments (ACTs) for patients exposed to drug resistant malaria; long-lasting insecticide treated nets (LLINs) for personal protection; intermittent preventive treatment (IPT) for pregnant women; and a renewed interest in insecticide residual spraying (IRS) of dwellings with DDT and alternate insecticides. Organizations stimulating the major increases in malaria research, control and prevention are the Multilateral Initiative on Malaria, Global Fund for HIV/AIDS, TB, and Malaria, World Health Organization, Bill & Melinda Gates Foundation, and the U.S. President’s Malaria Initiative. Southern African countries, Rwanda, Ethiopia, and Zanzibar Island report sharp decreases in the malaria burden giving hope that sustained control and elimination of this scourge may be possible. Joel Breman
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