In , an estimated , people died of malaria—most were young children in sub-Saharan Africa. Within the last decade, increasing numbers of partners and resources have rapidly increased malaria control efforts. CDC brings its technical expertise to support these efforts with its collaborative work in many malaria-endemic countries and regions. Malaria occurs mostly in poor tropical and subtropical areas of the world. In many of the countries affected by malaria, it is a leading cause of illness and death.
In areas with high transmission, the most vulnerable groups are young children, who have not developed immunity to malaria yet, and pregnant women, whose immunity has been decreased by pregnancy.
The costs of malaria — to individuals, families, communities, nations — are enormous. Malaria occurs mostly in poor, tropical and subtropical areas of the world. Africa is the most affected due to a combination of factors:. Malaria is one of the most severe public health problems worldwide. It is a leading cause of death and disease in many developing countries, where young children and pregnant women are the groups most affected.
The most vulnerable are persons with no or little immunity against the disease. In areas with high transmission such as Africa south of the Sahara , the most vulnerable groups are:. The Gridded Population of the World GPW data set has undergone a substantial improvement in the number of input units and in the target years of estimation.
This table describes these improvements, and also refers to the new Global Rural-Urban Mapping Project GRUMP data collection, which shows how many people live in urban versus rural areas. Information courtesy of Socioeconomic Data and Applications Center. And, as Europeans improved their housing with windowpanes, screens and doors, they lessened malaria risks there.
Growing cities and changing land use also removed many mosquito breeding grounds, but these precautions were often not taken in Africa.
Snow said solving the malaria problem boils down to understanding where people live in relation to the malaria risk, and that's why the GPW, GRUMP, and population prediction data are so important. Analysis using GPW and UN projected population growth suggests million births will occur within the malaria-infested areas of the world in the next five years, according to Tatem, but even that isn't a clear indicator of future malaria numbers.
For example, the population boom will possibly cause those areas to become more urban, thus reducing mosquito habitat.
At the turn of the 20th century, about 77 percent of the world's population was at-risk of contracting malaria. By , that number had fallen to 46 percent. But in , it went back up to 48 percent because of population growth in at-risk areas. This underscores the need for accurate population data, and for a thorough understanding of how population distribution affects the spread of infectious diseases. Despite his frustrations, Snow continues to conduct research in Kenya and work with African governments to control the problem.
Malaria by the Numbers. Image courtesy of James Gathany and the Centers for Disease Control and Prevention In the s, scientists found that using bed nets significantly decreased the chance of getting malaria, yet fewer than 5 percent of African children sleep under them, according to Snow. In addition, limited funding leads to the use of cheaper drugs to which the malaria parasite has developed resistance, which makes them ineffective. GRUMP adds a new dimension to the gridded population data by consistently defining how many people live in urban versus rural areas.
It's a lifetime of work. World Health Organization. Malaria left its mark on our history, our bodies, drinks, and for thousands of years the deaths of people in all corners of the world. But in the last few generations, humanity gained ground in this long-lasting battle against the disease. The map shows in which regions of the world malaria is prevalent today in purple and where it was prevalent in the past. Just a few generations ago malaria was common in many more places around the world than it is today.
Over the course of the 20 th century the disease was eliminated in many populous regions of the world, saving the lives of millions. What the map makes clear is that malaria is not a tropical disease, but a disease that was eliminated everywhere except for the tropics. Since then the disease has been eliminated not only there, but also in East Asia and Australia and in many parts in the Caribbean, South America, and Africa.
Three factors were responsible for this global reduction of malarious regions: First, public health measures, especially the widespread use of insecticides to attack the mosquito. Second, the drainage of swampland for expanding agricultural land had the side effect of restricting the breeding grounds for mosquitoes. And third, social and economic development which not only made treatment available to those that were infected, but also led to improvements in housing conditions which lowered the chances of infection in the first place.
All three factors — insecticides, land use change, and economic development — were major reasons that Europe and the other regions shown in shades of yellow, orange, and red are free of malaria today.
The map is taken from the US census from It shows in detail what the previous section discussed. Shown is the share of all deaths caused by malaria in the American Southeast more at that time. Malaria was very prevalent in this region that is free of malaria today. Particularly along the coasts and along the Mississippi malaria killed many Americans. How was this possible and what can we do to continue this progress?
Even after a century of progress against malaria, the disease remains devastating for millions. The World Health Organization estimates that million suffered from the disease in Fortunately only a small fraction of malaria victims die of the disease. But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today.
In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases this means interrupting its transmission.
However, very recent developments are encouraging; at the time of writing the WHO has rolled out a first large-scale trial of a vaccine. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone.
The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria. The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll. From to the number of malaria deaths has almost halved , from , deaths per year to ,, according to the World Health Organization. A recent publication in Nature 17 studied what made this success possible. The focus of the study was Africa, where — as the chart shows — most of the recent reduction was achieved.
The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets. The bed nets protect those who sleep under them. The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets.
This is similar to the positive externality effect that vaccination has on communities. The authors of the Nature study estimate that bed nets alone were responsible for averting million cases of malaria in Africa between and The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying IRS and the treatment of malaria cases with artemisinin-based combination therapy ACT.
Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations. Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further.
To continue the improvement in global health more has to be done, and more can be done. Some of the most important research in global development asks the question where donations can do the most good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work.
But in some areas we can achieve extraordinary progress by making funding available. The diseases many children die from are preventable — we therefore know that we can continue this reduction of child mortality, if we choose to do so. What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them.
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