Malaria, an age old disease proves hard to control

Malaria, an age old disease proves hard to control

Tantri Yuliandini, The Jakarta Post, Jakarta

Hundreds of years ago, malaria was thought to be caused by
harmful gasses from swamps (hence the name mal aria, Latin for
bad air), and was greatly feared due to the high death toll it
brought.

Today -- despite the fact that the actual cause, the
anopheline mosquito, has been known for more than a century --
malaria remains one of the world's most problematic health
issues, as it has tended to re-emerge time and again despite
aggressive efforts to control the communicable disease.

World Health Organization (WHO) data show approximately 300
million people worldwide have been affected by malaria, and
between 1 and 1.5 million people die from it every year.

While previously widespread, malaria is now mainly confined to
Africa, Asia and Latin America where the problems of controlling
the disease are aggravated by inadequate health structures and
poor socioeconomic conditions.

In Indonesia, malaria is endemic to most areas, with the
eastern part of the country being the most severely affected.

Around 100 million of its more than 200 million people are at
risk of malaria and approximately 1.5 million cases are detected
annually, according to WHO.

A massive effort by WHO to control malaria in 1950 succeeded
in bringing down the estimated number of malaria cases from
between 110 and 115 million to less than one million in the
Southeast Asian region.

A similar effort in Indonesia during the 1960s, staged by the
ministry of health, was so successful that Java and Bali have
since been deemed relatively free of malaria.

However, since 1995 the number of malaria cases reported has
been steadily increasing, especially in Central Java and
Yogyakarta.

A massive outbreak of malaria occurred between 1998 and 1999
in some areas of South Sumatra, Yogyakarta, Central Java, Lampung
and North Sumatra. Some 18,812 cases of malaria and 21 deaths
were reported from the outbreak.

More recently, the communicable disease was reported to have
killed 54 people in Banyumas, Central Java. Some 10,000 people
were reported to have been infected by the disease in the region.

This came as a shock, as the ministry had been implementing
its program called Gerakan Basmi Kembali Malaria (Rollback
Malaria Program) since 1998.

The Director General of Communicable Diseases and
Environmental Health at the Ministry of Health, Umar Fahmi
Achmadi, told The Jakarta Post Monday that globally, the re-
emergence of malaria was caused by an increase in the world's
temperature, usually known as global warming, which had created
an environment ideal for the breeding of the anopheline mosquito.

Malaria parasites are transmitted from one person to another
by the female anopheline mosquito. The males do not transmit the
disease as they feed only on plant juices.

Like all other mosquitoes, the anophelines breed in water,
each species having its preferred breeding grounds, feeding
patterns and resting places.

"The anophelines are known to breed faster and more
aggressively in higher temperatures," Umar said.

There are about 380 known species of anopheline mosquito in
the world, but only 60 or so are able to transmit the parasite.

"Out of the 380 species, at least 18 are found in Indonesia
but we have not yet determined how many are able to transmit
malaria parasites," he said.

Among the 18 species are Anopheline maculatus, An. sundaicus,
An. aconitus, An. barbirostris, An. subpictus, An. balabacensis,
An. koliensis and An. farauti.

Umar said the recent malaria outbreaks could also have been
triggered by the population's high mobility, especially during
the Muslim and Christmas holidays last month.

"People have been moving into and out of endemic areas to
visit friends and relatives -- they are highly susceptible to
malaria as they have not developed immunity to the disease."

People living in endemic regions where transmission is high
can gradually develop immunity to malaria.

Malaria is caused by protozoan parasites of the genus
Plasmodium. Four species of Plasmodium can produce the disease in
its various forms, but one, the P. falciparum, is the most
widespread and dangerous of the four, and if left untreated can
lead to fatal cerebral malaria or a state of unrousable coma.

The situation has become even more complex over the last few
years with the increase in resistance to the drugs normally used
to combat the malaria parasites, especially chloroquine.

Umar said the increased resistance to drugs was being caused
by the lack of discipline among people taking malaria medicine,
the distribution of imitation drugs and the limited ability of
some people to absorb the medicine.

"Patients tend to stop medication once they feel better. This
doesn't eliminate the parasites wholly but only makes them woozy
and in the long run makes them immune to the drugs."