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Fri January 3, 2014

Why Ending Malaria May Be More About Backhoes Than Bed Nets

Originally published on Mon January 6, 2014 7:16 am

Wiping out malaria is a top goal for many leaders in global health.

Fewer people are dying now from the mosquito-borne disease than at any other time in history. "And there's a very, very strong belief now that malaria can be eliminated," says Joy Phumaphi, who chairs the African Leaders Malaria Alliance.

But when you look at the overall numbers on malaria, eradication almost seems like a pipe dream.

In 2010, malaria was ranked as the seventh biggest killer in the developing world. More than 200 million people got malaria in 2012, and more than 600,000 of those infected died.

By comparison, the world recorded just a few hundred cases of polio last year and less than a hundred cases of guinea worm — two other diseases at the top of the eradication list.

So why are global health leaders so optimistic about someday ending malaria? Perhaps because there has been a precedent. And it happened right here in the U.S.

The federal government drove out malaria from the American South in the early part of the 20th century. And the lessons learned from that successful campaign could help control the disease in developing countries, says Daniel Sledge, a political scientist at the University of Texas, Arlington.

"It's almost impossible for us to imagine," Sledge says. "But in the rural South, as late as the 1930s, the extent of malaria was in many ways comparable to what it is today in sub-Saharan Africa."

Sledge and his colleague recently analyzed archived public records to try to determine what factors helped to eliminate malaria in Alabama.

The findings were surprising. It wasn't getting people to sleep under insecticide-treated bed nets, or getting better medications to people who do get infected — two major tactics used to control malaria today in sub-Saharan Africa and Southeast Asia.

Instead, the parasite left the U.S., in large part, because the government destroyed mosquito breeding grounds.

"The primary factor leading to the demise of malaria was large-scale drainage projects, which were backed up by the creation of local public health infrastructure," he says. Sledge and his colleague described their findings this September in the American Journal of Public Health.

There had been some speculation that malaria went into decline when tenant farmers started to move out of the hardest hit areas to seek jobs in factories up north, Sledge says. But that wasn't the case.

"We found that the population actually increased in highly endemic areas over the course of the 1930s," he says.

To wipe out mosquito breeding grounds, the U.S. government had to dig more than 30,000 miles of drainage ditches and canals, the Pan American Health Organization reported in 1963. So this strategy comes with its own set of problems, including damage to the environment.

Large-scale drainage projects aren't central to most malaria control programs in Africa and Asia today. But Sledge thinks the American experience with the parasite could be instructive for efforts to wipe out the disease globally.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

It's MORNING EDITION from NPR News. I'm David Greene.

RENEE MONTAGNE, HOST:

And I'm Renee Montagne. Malaria is among the most lethal infections in the developing world. Fewer people are dying from the disease now than any time in history, but some say even more could be done by replicating the malaria eradication methods used in the American South a long time ago. NPR's Jason Beaubien begins his report with what's being done today in Africa.

JASON BEAUBIEN, BYLINE: A new report from the World Health Organization chronicles a steady decline both in malaria cases and deaths. More people are now sleeping under mosquito nets than ever before. And powerful new anti-malarial drugs are more widely available than even a few years ago. Joy Phumaphi, the former health minister of Botswana, says the tools are finally in place to start pushing malaria out of Africa.

JOY PHUMAPHI: There's a very, very strong belief now that malaria can be eliminated.

BEAUBIEN: Despite this optimism, it should be noted that more than 200 million people got sick with malaria last year and more than 600,000 of them died. Phumaphi, who's now with the African Leaders Malaria Alliance, recognizes that there is still a long way to go before malaria will be eliminated. And she says it remains a major drag on economic development across the continent.

PHUMAPHI: The countries that shoulder the highest burden, countries like Mozambique, like Tanzania, like DRC, like Nigeria, it is a huge burden.

BEAUBIEN: Obviously sick farmers can't farm. Absent employees can't produce. Sick children can't study. In fact, sick kids put further strain on African mothers.

PHUMAPHI: Once a child presents with fever, a mother has to take care of that child. The mothers are the main bread winners in the rural communities because they are the ones who go and plow the fields. If there are market women that wants to go and sell their produce on the market, the mother cannot do that anymore.

BEAUBIEN: The current attack on malaria in Africa relies heavily on blocking infections by getting people to sleep under insecticide-treated bed nets and on improving treatment for people who do get infected. A new study looking at how malaria was eliminated in the American South in the first half of the 20th century, however, found other factors were key to wiping out the disease here in this country.

DANIEL SLEDGE: The primary factor leading to the demise of malaria was large-scale drainage projects which were backed up by the creation of local public health infrastructure.

BEAUBIEN: Daniel Sledge, an assistant professor at the University of Texas Arlington, says efforts by the U.S. federal government to eliminate mosquito breeding grounds were crucial in driving malaria out of the American South. And he says this was an extremely important public health intervention in our history.

SLEDGE: It's almost impossible for us to imagine. In the rural South as late as the 1930's, the extent of malaria was in many ways comparable to sub-Saharan Africa today.

BEAUBIEN: Sledge analyzed archived public records to try to determine what drove the decline of malaria in Alabama. There'd been some speculation that malaria went into decline when tenant farmers started to move out of the worst affected areas to seek jobs in Northern factories. But Sledge says this wasn't the case.

SLEDGE: We found that in highly endemic areas, population actually increased over the course of the 1930s.

BEAUBIEN: He says in the U.S. malaria elimination wasn't a fluke of history, or the by-product of economic migration; it was the result of a concerted federal government program to drain mosquito breeding grounds. Large-scale drainage projects aren't central to most current malaria control programs in Africa and elsewhere in the developing world. Sledge says the U.S. history around this could be instructive for efforts to wipe out the disease globally. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.