allAfrica.com: Zimbabwe: What You Should Know About Malaria (Page 1 of 1)

In the words of Samuelson, R.J., a learned South African judge in the apartheid era, the Third World (a.k.a. developing countries) "has been shattered forever, a casualty of the end of the Cold War . . . Discipline will be imposed not only by stingy taxpayers in richer countries but also by multinational companies that control large private investment."

Is Africa to be regarded as an excrescence to be excised, a papilloma to be played with, a mere embarrassing appendage to the rest of the world? Africa is the world's largest man-made island (by virtue of the Suez Canal), and now its health policies have to dance to a tune composed in London or Washington.

Saner, objective advice would make us think twice about becoming yet another dead fish in the polluted stream of commercial greed and corruption.

Yet we don't have the access to resources and logical argument which seems to be the standard in this ever faster, ever evanescent Gadarene struggle.

I do not pretend to have the answer on the larger issue of where mankind is heading (only the Almighty knows that), but on issues such as malaria in Africa, I do have some first-hand knowledge which seems to be unavailable (or, ignored) by so-called experts on malaria in WHO, Geneva, and beyond.

Malaria was elucidated scientifically around the Mediterranean, and the concept of it as a disease entity was first proposed in the medical school at Alexandria (Egypt). So its African roots go far back, even before the birth of Christ.

At that time, it was thought to be the consequence of living in low-lying areas, or swamps, and, indeed, the modern name, mal-aria, means "bad air". The idea of it being transmitted by a vector - the mosquito - developed during the first part of the 19th century, and at that time there was no effective treatment.

When our country was colonised, the black man died of measles and the white man died of blackwater fever, a complication of malaria. (They both died, as they still do, of sexually transmitted infections). They died because of a new infection, to which they had no natural or acquired immunity.

Measles now has an effective, and safe, vaccine: malaria has a cure. In both scenarios, the issue is getting the person to the correct destination, and for each disease this exercises minds, and chews up a lot of fuel, to ensure the patient is safe.

In Africa, the cause of malaria is a parasite, called plasmodium. The commonest in Zimbabwe, and the most malignant, is P. falciparum, so called because of its shape when viewed under the microscope. We also have, in our Eastern Districts, the more chronic form, P. ovale. The parasite is transmitted by a mosquito known as Anophelene. It has a characteristic resting posture, with its nose down and the abdomen pointing skywards.

Unlike its cousin, the Culicine, which makes a buzzing noise and is often called the "nuisance" mosquito, it is silent, and can inflict a bite without even the awake human knowing. It feeds on mammalian blood after dark, usually between the hours of midnight and 4am. And, of course, it is only the female mosquito that bites! In fact, the mosquito only needs blood to breed, and a female's abdomen can swell up to 27 times the empty size to accommodate the blood in order that it may produce eggs, which are laid in shallow, clear and still water.

Eggs of the Anophelene mosquito are rapidly hatched and produce pupa, which are often visible in discarded old tyres, rainwater gutters of houses and, it has been claimed, in cattle hoofmarks which collect and retain water.

They seem to prefer local sites (in other words, near to the primary victim) so that daughter mosquitoes, when they are mature, can readily find a source of blood.

But, if necessary, they will fly long distances to get to the site of another blood meal. For this, the adult female mosquito, especially A.funestus, which is about 10 times more "efficient" at infecting human hosts than the other types of Anophelene we have here, is equipped with an extremely strong sense of smell.

You think your husband's feet stink? The mosquito can smell them a mile away! The blood enters the mosquito's digestive tract through its needle-sharp proboscis. In order to make the flow as quick and as unobtrusive as possible, the female mosquito injects some saliva in the process. Unfortunately, that's where the plasmodium - the malaria-transmitting parasite - sits if the mosquito is infected. And so, the victim is unconsciously infected.

I will not bother the reader with the processes that the immature P.falciparum goes through; suffice to say that after eight to 10 days the patient develops the symptoms of malaria, and will require treatment.

Zimbabwe should be proud of its role in promoting a new form of treatment, based on a combination of artemesinin and lamufantrine in the late 1990s, when then old standard treatment of chloroquine and SP was increasingly showing resistance, partly because it was also used as a cheap preventive ("prophylactic") and partly because of incorrect application or adherence.

I make no pretence of preferring the primary route of prevention (not getting bitten, hence bednets, indoor residual spraying, avoiding unnecessary risks, and skin repellants and mosquito coils), but, if you want to take a tablet, use the combination -- dapsone/pyrimethamine.

Always, I repeat, always remember that any preventive measure, even if recommended by a doctor, has its limitations, and if you're in a known or suspected malaria area and get a high temperature and dizziness, it can be malaria.

After all, the female mosquito is sharper, and more focused than you!

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