QUESTION

What factors cause Africans to get this disease?

ANSWER

The highest number of malaria cases every year occur in Africa, not because of anything specifically due to the people living there (in fact, they may be better protected against malaria than most—I will come onto this later) but because malaria transmission is very high in many parts of sub-Saharan Africa and sufficient preventative measures are still lacking in some places.

Malaria transmission requires specific environmental criteria, such as sufficient temperature and rainfall. These conditions are met in many countries in Africa, and unlike some other parts of the world, temperatures are suitable year-round for the development of the Anopheles mosquitoes that act as the vector for mosquito, meaning that in some places, transmission can occur throughout the year. In addition, many people do not take appropriate preventative measures against malaria; in some cases, this is due to a lack of means to buy items such as insecticide-treated bednets, and in other cases people have not been educated about the dangers of malaria or how to prevent it, so they do not know what preventative measures they should be undertaking.

Organisations such as the World Health Organisation, the US Agency for International Development, the Global Fund, the Roll Back Malaria consortium and Malaria No More are working to improve both access to preventative measures, such as bednets and indoor residual spraying, while also educating people about the need for prevention and also what to do if they suspect themselves or a family member has malaria. These efforts have already reduced the burden of malaria in Africa; the number of deaths is dropping every year, and they hope to have eliminated deaths from malaria altogether by the year 2015.

I mentioned that Africans may be better protected against malaria naturally—scientists have noted that populations living in areas with high levels of malaria have some genetic protection against infection. One example of this is the Duffy antigen. People who are negative for this gene seem to be protected against Plasmodium vivax and P. knowlesi malaria (it was originally thought they were resistant to infection, but more recent evidence from Kenya suggests in fact they still get infected, but do not get as sick). Another is the gene for sickle cell anaemia; despite causing highly debilitating and even lethal anaemia if both copies of the gene are inherited, a single copy of the gene confers strong resistance against malaria. Both of these genetic traits are highly prevalent in African populations.

In addition, early exposure to malaria results in the acquisition of immunity to infection. This, over time, Africans who survive childhood malaria go on to be less susceptible as adults. The exception to this are pregnant women; in order to support the growing foetus, a pregnant women’s immune system becomes much weaker (otherwise there is a risk of the immune system rejecting the foetus). As such, even if she had high levels of acquired immunity to malaria prior to her pregnancy, once pregnant she becomes much more susceptible. This is particularly true for a woman’s first pregnancy.