Taking fight against malaria to high land
I used to wake up early in the morning with my siblings and hike the trail from the cool highlands to cultivate our fields in the lowlands when growing up in the Kilimanjaro region of Tanzania in the early 1970s.
My parents would tell us that we must go down the mountain in the morning, work hard on the farm during the day, and return quickly to our highland home in the evening to get away from ngilingili (mosquito) bites, which spread the deadly disease known as itheng’u (malaria).
Back then there was no World Malaria Day, such as we marked Wednesday to mobilise awareness and action, but we certainly knew about the disease.
Hearing of this year’s theme – Sustain Gains, Save Lives: Invest in Malaria – prompted me to reflect on my youth on the slopes of the Pare Mountains, in the Kilimanjaro region.
My parents would tell me of a time in the late 1950s when malaria dramatically decreased in the lowlands in the shadows of the Pare Mountains.
White Land Rovers were travelling about the area fumigating dwellings en mass. Years later I learned that this was part of the Pare-Taveta Malaria Scheme aimed at determining whether malaria transmission could be arrested through concerted effort and the impact on public health. What the world learned was that malaria “ceased to be of significance in the area treated”, but that it came back with a vengeance when the effort was not sustained.
In 1972 my older brother, Joseph, learned this the hard way. He’d stay with my uncle during the week in order to attend primary school, and return to our highland home on the weekend.
I’ll never forget the time Joseph returned home babbling incoherently and in a very confused state. I saw my mother crying and hysterically declaring that my brother was going to die.
I too remember being nearly overcome with anxiety and dread at the thought of losing my closest brother, and having a renewed fear of itheng’u.
My father rushed out and brought a clinical officer from a mission clinic to our home, who examined my brother and informed us that he had severe malaria that had attacked his brain. He was treated with quinine injections and cured. Through her tears of happiness, my mum said that if this had happened in her childhood, before modern medicines were available, my brother would have died.
For his part, Joseph stopped spending nights at my uncle’s house, and now walked the arduous trip down and up the mountain daily to attend school. That was our only known recourse to prevent malaria.
Today, thanks to scientific research and development, we see that malaria has declined markedly.
We no longer run away from the lowland to the highland to escape the mosquitoes and the malaria.
We have the tools to fight it. As a research scientist in Korogwe, Tanzania, I’ve been working on insecticide-treated nets, indoor residual spraying, appropriate diagnostic tests, effective antimalarial drugs and, more recently, a malaria vaccine candidate called RTS,S to build up our arsenal of control measures.
However, we still encounter cases of severe malaria and deaths due to malaria, especially among children who come from remote communities where health services are not readily accessible, which are further hampered by poor communication and transport services.
With more than 650 000 people dying annually from malaria, the challenge of controlling and eliminating this disease is not finished.
As declared this year by Roll Back Malaria: “Whether the malaria map will keep shrinking, as it has in the past decade, or be reclaimed by the malaria parasites, depends, to a great extent, on the resources that will be invested in control efforts over the next years.” To control efforts, let me add scientific research.
The challenge here as well will be commitment at the global and national levels to consolidate our gains and move toward defeating this disease.
In the week of World Malaria Day 2012, let us envision a place where we all live at the top of the mountain in a world free of malaria.
l Lusingu, MD, PhD, is Principal Research Scientist of the Tanzania National Institute for Medical Research at Tanga Centre; co-chair of the Clinical Trials Partnership Committee for the RTS,S malaria vaccine candidate, and Principal Investigator for the RTS,S malaria vaccine candidate trial at Korogwe, Tanga, Tanzania.