QUESTION

What are some examples of attempts of fighting this disease that happened in the past?

ANSWER

The battle against malaria has been going on, in one form or another, for literally thousands of years. The ancient Chinese mention the symptoms of the disease in a medical scroll as early as 2700 BCE – even more remarkably, a herb called Artemesia has been used in traditional Chinese medicine for more than 2000 years to treat malaria, and compounds extracted from that same herb are the basis for some of the most effective modern medications, known as artemisinin-based combination therapies (ACTs). Indigenous tribes in the Americas also had traditional medicines to treat malaria; having conquered the New World, the Spanish learned of a bark, from the Cinchona tree, which could cure malaria. Quinine, extracted from this same tree bark, is still used today to treat malaria.

However, back then the causes of malaria were not known—it wasn’t until the late 19th century that a more complete understanding of malaria would emerge. The first key development in this process was the observation of the parasites that cause malaria in a patient’s blood, which was first done by Charles Louis Alphonse Laveran in 1880.

A few years later, in 1897, a British army doctor called Ronald Ross discovered that the parasite was transmitted via the bite of infected mosquitoes, of the genus Anopheles. This latter finding allowed for the emergence of the first programmes for malaria control, which focused on vector control, through insecticide use and elimination of water bodies used by the mosquito larvae. An early example of the success of this approach came in the building of the Panama Canal; started in 1906, progress was initially slow, due to the enormous proportion of workers who fell ill from yellow fever and malaria. With vector control, the number of cases plummeted, and the canal was finally opened in 1914.

While prophylactic quinine had also been part of the control strategy during the building of the Panama Canal, it played a much more secondary role to vector control. Using similar strategies, focusing primarily on killing adult mosquitoes through insecticide spraying (mainly DDT), the United States of America successfully eliminated malaria from its shores in the early 1950s. Prior to this, transmission had occurred across most of the south-east of the country.

In the last 50 years, access to early diagnosis and effective treatment have gained a more prominent role among many malaria control strategies, although prevention is still seen as crucial. Many developing countries, where malaria is still rife, have set up national control programmes, which seek to ensure that all communities have access to adequate care and information about malaria prevention.

A key tool in the prevention arsenal has been the long-lasting insecticide treated bednet; sleeping underneath one prevents bites from the mosquitoes that carry malaria, which are most active in the evenings and at night, especially in children and pregnant women, who are among the people most at risk from infection. Bednet distribution has been a major focus of many malaria campaigns, and very successful in many places; in 2008, for example, bednet coverage was estimated at over 80% of the at-risk population in Djibouti, Mali, Ethiopia and Sao Tome and Principe.