Bed nets. Insecticide. Preventative medicine. These are the tools that are most known for fighting malaria—and for good reason. Tactics like these have saved millions of lives. However, when a country manages to eliminate most incidences of malaria, the traditional techniques lose their impact. One group of researchers, realizing the need for new strategies against malaria, decided to not focus on mosquitoes (the traditional tactic) but on humans themselves. Ultimately, studying human behavior can help eradicate malaria by targeting weak spots in preventative plans and providing a clearer implementation of resources. To better understand malaria, its far-reaching impacts and the importance of a new human-centered technique, it is helpful to start from the beginning.

What is Malaria and How Was it Treated in the Past?

Malaria has plagued humans for, quite literally, as long as humanity remembers. The earliest written records  — Mesopotamian cuneiform tablets — describe symptoms characteristic of the disease. Scientists found human remains dating back to 3200 BC with malaria antigens. Ancient scholars called the illness the “king of diseases.” It certainly lives up to the title. It is thousands of years old and it has killed hundreds of millions of people.

Anopheles mosquitoes, most active at dusk and night-time, are responsible for the malaria parasite’s spread. Carried in the insect’s stomach, the parasite enters the human bloodstream through the mosquitoes’ saliva (the same substance that makes bites itch and swell) as they feed.

Humans first exhibit symptoms a week or so after infection. If untreated, the disease quickly becomes serious. Sufferers feel flu-like symptoms, including body aches, fatigue, vomiting and diarrhea. Patients can die within 48 hours after they first exhibit symptoms.

In 1820, chemists developed quinine, the first modern pharmacological treatment for malaria. In the 1900s, the men who identified the malaria parasite, demonstrated that mosquitoes were responsible for transmission and developed the mosquito-repelling insecticide DDT all won Nobel Prizes for their respective discoveries. Understanding and preventing malaria were matters of great international importance.

What is Malaria’s Global Presence Today?

Fighting this disease remains a top global priority. Modern preventative measures now include insecticide-treated bed nets (to keeps the nocturnal malaria-carrying mosquitos away) and indoor sprays. Children in high-transmission areas are also eligible for seasonal malaria chemoprevention. Thanks to a surge in global humanitarian attention, the disease’s presence has fallen worldwide. Between 2010 and 2017, malaria incidence decreased by nearly 20 percent and fatalities decreased by nearly 30 percent.

However, the World Health Organization (WHO) estimates that 216 million clinical cases still occurred worldwide in 2016 alone, resulting in 445,000 deaths. The disease causes a massive drain on economies, due to healthcare costs and loss of workforce efficiency. In sub-Saharan Africa, where potent strains of the parasite thrive, those damaging effects are especially notable. Malaria and its effects cost Africa a stunning $12 billion every year and, because people living near unclean water sources and insecure housing are most at risk, malaria disproportionally affects the impoverished. By prohibiting individuals from attending work or school, let alone its potential to kill, malaria perpetuates the cycle of poverty. While reducing prevalence is a key factor, eradication continues to be the ultimate goal. That means the end to malaria’s ill-effects on communities, particularly impoverished ones.

How Studying Human Behavior Can Help Eradicate Malaria

When regions successfully employ traditional tactics, as many have, they find themselves with a new problem. “Lingering cases” is a term used to describe when a region no longer experiences outbreaks, but that the disease still exists locally. In general, eliminating any illness gets harder the fewer instances of it that occur. Tracking the carrier mosquitoes is infeasible, if not impossible. However, researchers in Zanzibar took a new approach – they decided to track humans instead.

In July 2019, the Johns Hopkins Center for Communication Programs published an article in Malaria Journal that details the reasoning behind the new technique. While indoor measures work, people are not necessarily confined to the home at nighttime. One Zanzibari woman remarked in an interview, “When you are outside, you can’t really wear the bed nets, can you?” Existing steps against malaria are not effective outdoors, which makes it nearly impossible to eliminate the last few cases.

Researchers conducted over 60 in-depth interviews and studied routine human movements: between homes, stores, public spaces, religious services and even special events, like weddings. They found many insights. For example, men were at the highest risk for infection because they most often work or socialize outside after dark. There is also a notable population of seasonal workers that come to Zanzibar from Tanzania’s mainland. These individuals rarely own mosquito nets nor insecticides to spray their residences. Better understanding the movements of people vulnerable to malaria, as well as those that find themselves periodically unprotected, is important. That information allows scientists to create better-targeted interventions, including community support programs, outdoor areas with preventative measures, and basic indoor resources for those without.

Small scale use of these techniques has proven effective, and the researchers behind this investigation believe they could be scaled up successfully. Best of all, 26 other countries have similarly low rates of malaria incidence. If Zanzibar, a high-transmission area for the parasite, could push back against this disease so successfully, other countries could benefit greatly from the same changes.

Conclusion

Malaria, a disease that has lasted for around 5000 years, has never been closer to eradication. The last century has seen a great surge in momentum for fighting this illness. The results are stunning; millions of lives saved, several countries eliminated the disease entirely, and dozens more are nearing that goal. In turn, people have prospered. For every dollar invested in African malaria control, the continent sees 40 dollars in economic growth. Much of that prosperity goes back to impoverished people, who can thrive with less illness and more economic efficiency. Now, researchers are pursuing the “last mile” strategies. Studying human behavior can help eradicate malaria by preventing remote cases. Total eradication and the end of malaria’s drain on the impoverished has never been closer.

– Molly Power
Photo: Wikimedia