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Malaria's Impact Vastly Underestimated, Report Says

Malaria is a cause of poverty, not vice versa. This is one of the many notable conclusions drawn by a bevy of eminent parasitologists, epidemiologists, and economists who thoroughly examined malaria's impact on health, cognitive and behavioral functioning, and economic growth in endemic countries. Their findings were published earlier this year as a special supplement, "The Intolerable Burden of Malaria: a New Look at the Numbers," in the American Journal of Tropical Medicine and Hygiene.

The project was a "very ambitious" effort to reexamine critically the accuracy underlying malaria morbidity and mortality numbers that have been routinely cited for half a century, says Joel Breman of the Fogarty International Center at the National Institutes of Health in Bethesda, Md. Breman, who is also a senior scientific advisor to the Multilateral Initiative on Malaria, served as the chief coordinator and editor of the supplement.

Determining true morbidity numbers for malaria or its effects such as its impact on learning abilities proved tricky and, in some cases, elusive. "The goal was not to be definitive, but rather to stimulate people into thinking more about and breaking down the issues," Breman says. "To my mind, these are the best data we now have" describing the multifaceted impacts of the disease.

For decades, scientists and public health staffs described the impact of malaria by citing the 1 million deaths caused annually by the disease, intoning this figure almost as a mantra, Bremen says. However, effects such as low birth weight, anemia, and consequent infant mortality that arise from malarial infections among pregnant women and infants constitute a very large and often hidden burden. For instance, malaria may account for as many as 1.75 million deaths a year in African children under age five alone. Based on these findings, the overall malaria mortality rate may well be as high as 2.7 million deaths per year, well above the standard figure, Breman notes.

In one of the most intriguing studies within the supplement, two Harvard economists argue that climate and ecological factors are the main determinants of disease severity, not poverty. For example, despite intensive investments over seven years to control malaria in Garki, Nigeria, during the 1960s, the remarkable vectorial capacity of local mosquitoes overcame control measures that worked well elsewhere, they say. Moreover, they assert, poverty results directly from a high incidence of malaria. "Nobody has put this idea forward before, and so persuasively," Breman says.

The economists determined that even after controlling for factors such as colonial history and geographical isolation, countries with high rates of malaria had income levels two-thirds lower than those of malaria-free countries in 1995. Furthermore, economic growth in countries with endemic malaria was 1.3% lower per person per year in 1965, even after factors such as initial poverty, life expectancies, and economic policies were taken into account. Reducing disease by 10% from 1965 to 1990 resulted in a 0.3% annual jump in economic growth, they found.

Breman and his fellow authors expect the supplement to stir discussions. "We want people to question the figures and their implications," he says. Such interest will help to focus increased attention on research into the economic, psychosocial, and neurological effects of malaria as well as the epidemiology, immunology, and microbiology of the disease, he predicts.

The authors also hope that their findings will lead to funding increases for malaria research, which currently lags woefully, Breman says. "There's no doubt that there have been increases in attention to and research funding for malaria in recent years, but it's still not at all commensurate with the problem."

Christine Stencel
Christine Stencel is a communications manager and science writer at ASM.