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Malarial fevers have been a scourge of humanity throughout much of the inhabited Afro-Eurasian landmass, ever since they emerged from Africa with migrating humans as many as 100,000 years ago. Historians of disease estimate that malaria has probably killed more people than any other disease.
Malaria, one of the oldest diseases afflicting human beings, is a parasitical infection of the blood that produces high fevers and debilitation. It first emerged in Africa, and as human beings migrated outward approximately 100,000 years ago, they brought malarial infections with them.
Early migrants crossing the land bridge from Asia into North America at the end of the last ice age apparently did not sustain the chain of infection, and it is generally held that malaria became established in the Western hemisphere following European contacts with the New World in the late fifteenth and early sixteenth centuries. Malaria became the first truly global infection that was carried by a vector (an organism carrying a pathogen)—in this case, the mosquito, and today the parasitical infection is found in a broad tropical band that stretches around the globe.
There are four species of single-celled microorganisms (Plasmodium falciparum, P. vivax, P. malariae, and P. ovale) that live in both anopheles mosquitoes and human beings and that cause malarial infections in human beings. The most common form outside of tropical Africa, vivax malaria, is also the most widely distributed. The most common form in tropical Africa, falciparum malaria, is the most virulent. All four types of parasite are transmitted to human beings via the bite of the female anopheles mosquito. One part of the parasite’s life cycle takes place within the female mosquito; another part takes place within the human being. Because there are different malarial parasites and many different subspecies of anopheles mosquitoes, the ecological conditions that support malarial infection vary from one microecology to another; therefore, the global picture of malarial infection can be described as a mosaic of local infections.
Most anopheles mosquitoes breed in standing water. Low-lying marshy areas and the edges of streams and rivers have long been associated with danger to human health, and malaria was probably one of the earliest scourges of the river-basin civilizations, such as the Nile, Tigris-Euphrates, Indus Valley, and Huang (Yellow) River. Malaria is also associated with environmental transformation. The cutting down of forests to create arable land often provides a suitable habitat for the breeding of anopheles mosquitoes. Infected people or animals, even during short visits, are able to introduce the parasite into the new environment and establish the disease. It is likely that malaria spread outward from the river-basin civilizations into other early agricultural societies.
Both European and African immigrants introduced malaria to the Americas, and the disease became one of the most severe public health problems in the hemisphere. The incidence of malaria in the middle latitudes of North America and Western Europe decreased markedly during the twentieth century, however. In North America this was achieved through public health interventions such as the installation of window and door screens, chemical therapy (with quinine and, later, synthetic antimalarial drugs), the use of mosquito larvicides, and the draining of mosquito habitats. In Western Europe the extension of mixed farming systems is largely credited with the reduction in infection; there, anopheline mosquitoes began to take their blood meals primarily from domesticated livestock, which are not susceptible to the disease. Malaria continues to be a significant problem in South and Central America, South and Southwest Asia, the Western Pacific, and Africa. Over the course of the twentieth century, the annual number of deaths from malaria has risen in Africa, which is today the global center of malarial infection.
Following the outbreaks of epidemic malaria during World War I, the League of Nations established a commission to survey the global status of the disease. Malariologists were enthusiastic about the prospects of reaching malaria sufferers and providing them with quinine to relieve their symptoms and break the parasite’s life cycle. These hopes proved elusive, however, as the global demand for quinine greatly outstripped the supply.
Following World War II, malariologists turned their attention to the destruction of the mosquito vector, and a major World Health Organization initiative was launched to spray DDT to eliminate the anopheles threat. This was initially successful, and the global rates of infection plummeted—until the overuse of DDT produced resistance in the mosquito population.
Since the 1970s, malarial parasites have become increasingly resistant to synthetic antimalarial drugs. Synthetic antimalarials in combination with artemisinin, a natural product long used in China, is currently the best hope of the medical community for fighting the disease. Considerable attention has also been focused on the efficacy of insecticide-impregnated bed nets that protect against the mosquito’s bite.
Bibliography:
- Carter, R., & Mendis, K. N. (2002). Evolutionary and historical aspects of the burden of malaria. Clinical Microbiology Reviews, 15(4), 564–594.
- De Zulueta, J. (1987). Changes in the geographical distribution of malaria throughout history. Parassitologia, 29, 193–205.
- Harrison, G. (1978). Mosquitoes, malaria, and man. New York: E. P. Dutton.
- Humphreys, M. (2001). Malaria: Poverty, race, and public health in the United States. Baltimore: Johns Hopkins University Press.
- Litsios, S. (1996). The tomorrow of malaria. Wellington, New Zealand: Pacific Press.
- Poser, C. M., & Bruyn, G. W. (1999). An illustrated history of malaria. New York: CRC Press–Parthenon.
- Sallares, R. (2002). Malaria and Rome: A history of malaria in ancient Italy. New York: Oxford University Press.
- Warrell, D. A., & Gilles, H. M. (Eds.). (2002) Essential malariology (4th ed). London: Edward Arnold.
- Webb, J. L. A., Jr. (2009). Humanity’s Burden: A global history of malaria. New York: Cambridge University Press.
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