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For this assignment I have chosen to focus on malaria because it is a disease that I am not very well oriented with. I viewed this as an opportunity to better inform myself on this disease and started out by writing down a short list of areas and topics that I would like to look further into. I would like to brief myself on the past, present, and possible future of malaria because I feel like it will provide me with a good base in going forward with my research. I would also like to examine how the disease is handled differently as an epidemic vs. an endemic, as this will further enrich my understanding of these types of scenarios. As a sociology student I also have interest in the sociological factors that attribute to the spread and prevention of the disease and wonder how other things such as the economy and climate change impact the spread of the disease.
Due to the way history was documented it is quite difficult to find an accurate timeline of the evolution of malaria that begins with its first appearance. But with some patience, and reviews of several peer reviewed scholarly articles as well as non-academic sources I have been able to find something that paints a good picture of how long malaria has been around. Malaria has been around for so long some of its victims have included Neolithic dwellers, early Chinese and Greeks, princes and paupers. Ancient writing and artifacts show evidence of malarias long reign. There are clay tablets that have cuneiform script from Mesopotamia speaking about deadly fevers which suggest malaria. Recently detected was malaria antigen in Egyptian remains dating from 3200 and 1304 BC. Malarias suspected spread into Rome in the first century AD was a turning point in European history. The disease more than likely traveled down the Nile to the Mediterranean from the African rain forest, then spread east to the Fertile Crescent, and north to Greece (Arrow, Panosian and Gelband 2004). Due to what little knowledge was known about diseases, I would say it is safe to assume that many passed off this disease as something else, such as witchcraft or other illnesses, during earlier days. There were myths about evil spirits being the cause of fevers and there were extreme efforts to remove these spirits. This resulted in many stigmas against those who became ill with malaria, among other diseases, until malaria was finally demystified (Neghina and Lacobiciu 2010).
Mid 18th century defines the word malaria, which comes from the Italian word malaria, meaning, bad air. This term originally denoted from the unwholesome atmosphere caused by the exhalations of marshes, to which the disease was formerly attributed (Malaria n.d.). This is yet another display of how peoples understanding of the disease has evolved over time. Today we know that malaria is caused by becoming infected with protozoan parasites from the genus Plasmodium transmitted by female anopheles mosquitoes. Our understanding of this is due to the discovery of the parasites in the blood of malaria patients by Alphonse Laveran in 1880. In 1897, the sexual stages in the blood were discovered by William MacCallum in birds infected with a related haematozoan, Haemoproteus columbae, and the transmission cycle in culicine mosquitoes and birds infected with Plasmodium relictum was elucidated by Ronald Ross in 1897. The Italian malariologists Giovanni Battista Grasso, Amico Bignami, Giuseppe Bastianelli, Angelo Celli, Camillo Golgi and Ettore Marchiafava demonstrated that human malaria was transmitted by mosquitoes too. The discoveries of malaria parasites developing in the liver before the blood was done by Henry Shortt and Cyrill Garnham in 1948. The final stage in the cycle, the dormant stages in the liver, was demonstrated in 1982 by Wojciech Krotoski (Cox 2010). Due to these discoveries and ongoing research the way malaria is managed has changed quite a bit, especially in the past 15 years, both on an individual and population level. Artemisinin based combination therapies (ACT), as well as the widespread distribution of insecticide-treated bed nets, played major roles to the impressive reduction in malaria transmission globally (Plewes, et al. 2018). The research I have done on malaria so far has shown me how difficult it is to stop the spread of malaria completely, due to the complex life cycle of the malaria parasite. On one hand we have the complex life cycle of malaria parasite engender obstruction in further drug development. On the other hand, we have revelation of novel biochemical pathways in P. falciparum gives us new opportunities for antimalarial drug developments and discoveries. Applications of genomics-based drugs identification, novel screenings models, structural biology and efficient drug design into antimalarial drug research will expedite the road of new antimalaria drug development in the years to come (Sahil, et al. 2018).
Now that I have a fairly good understanding of the past, present, and possible future for malaria I would like to look into the difference between epidemics and endemics, specifically with malaria. From there I would like to look at some of the social factors that attribute to the spread and prevention of malaria. An epidemic is, (a disease) affecting many persons at the same time and spreading from person to person in a locality where the disease is not permanently prevalent (Epidemic n.d.). An endemic differs from an epidemic because it is, regularly found among particular people or in a certain area (Boskey 2018). With that said, an epidemic of malaria may occur in endemic areas for various reasons. This can happen due to an influx of healthy hosts, or partially infected individuals going into an area where malaria is widespread. An epidemic of malaria can also arise if people who have already contracted the parasite move into an area where malaria was not present before but due to the conditions of the area the disease is able to thrive and initiate an epidemic. I have also found in my research that partial eradication of these mosquitos or incomplete regional treatment programs can cause an epidemic to reoccur (Honor Society of Nursing n.d.). I think this reinforces our class discussion regarding the importance of following through with plans in these situations, and why it is so important to use your time wisely. If the proper steps are not followed thoroughly and you miss a golden opportunity it could allow for your progress to fall apart. In the case of the spread of diseases this should be something that is taken seriously because it could cause major implications and high rates of mortality.
During the brainstorming stage of this assignment I couldnt help but wonder how climate change would impact the spread of malaria and many of my assumptions about it were pretty accurate. My findings show that climate change could lead to an increase in cases of malaria in some areas, but in other areas there may be little to no impact on the mosquito-borne disease. Some have used General Circulation Model-based scenarios of anthropogenic global climate change in a system model for making predictions for whats to come in the next century. The results of the potential impacts of global climate change on the spread of malaria suggests widespread increases of risk due to expansion of the areas that are suitable for the malaria disease to thrive. It also states that these predicted increases are most pronounced at the boarders of endemic malaria areas and at higher altitudes within malaria areas. Areas where it may increase due to climate change are in Southeast Asia, South America, and parts of Africa where the disease is less endemic (Martens, et al. n.d.). There may also be an increase of healthy lives lost in these regions if the proper interventions are not taken.
Temperature and precipitation changes due to the impacts of climate change are not the only elements that can impact malaria transmission. Other factors may include government programs to prevent transmission, population size, acquired immunity levels among populations, and how prepared people, governments, and healthcare personnel are for an outbreak (Feldscher 2017). These variables will differ from region to region, and someones cultural background may also play a role in how the disease is treated. As per our discussion in class regarding malaria, many people believed that the free drug they were receiving in treating their malaria was not as good as the more expensive drug. This caused many people to buy their drugs at the drug store or spend their whole paycheck on an injection. I use this example because it shows how interpretations differ from region to region, and country to country. The way people behave in a society impacts the spread of illness and diseases, and it is essential for these factors to be taken into consideration and to always tailor your approach accordingly to the population you are working with. Malaria, thankfully, can not be contacted from person to person so it is safe to come in contact with someone who has been contracted with the virus. So, for now I think the Cape Breton Regional Municipality is safe from a malaria epidemic. We would need some major climate changes to occur along with an influx of female Anopheles genus mosquitoes who are also infected with the plasmodium parasite. But that doesnt mean that we as individuals are not at risk. Although it is not contracted from person to person you can contract malaria from a blood transfusion or organ transplant. It can also be transmitted if you share needles with an infected person (Honor Society of Nursing n.d.). Infants, children, and pregnant women are most at risk and anyone traveling to regions where malaria is present should brief themselves on what to expect and take the proper steps to protect themselves from the disease.
In conclusion, I have learned the importance of looking at the sociological and cultural aspects when dealing with the spread of illnesses. Sometimes what seems to be the best way at preventing a disease, such as quarantine and staying indoors, is not always practical. Although the vast majority of people today have a general understanding of diseases there are still, at times, stigmas placed against individuals who are ill. This can cause feelings of embarrassment and anxiety for those who contract malaria and may attribute to a distrust in medical personnel. In the case of malaria, human impact plays a major role in the spread, prevention, and ideas regarding the disease whether it be from climate change, medical funding, individual routines, etc. I found great value in exploring past ideologies and comparing them to current ones, as well as looking at predictions for the future. Although I may not ever come in contact with malaria on a personal level I feel that this was important information to know and I am excited to learn more in the weeks to come.
References
- Arrow, Kenneth J, Claire Panosian, and Hellen Gelband. 2004. Savig Lives, Buying Time: A Brief History of Malaria. https://www.ncbi.nlm.nih.gov/books/NBK215638/.
- Boskey, Elizabeth. 2018. What It Means When a Disease Is Endemic. November 18. https://www.verywellhealth.com/what-is-an-endemic-disease-3132825.
- Cox, Francis. 2010. History of the discovery of the malaria parasites and their vectors. February 1. https://parasitesandvectors.biomedcentral.com/articles/10.1186/1756-3305-3-5. n.d. Epidemic. https://www.dictionary.com/browse/epidemic?s=t.
- Feldscher, Karen. 2017. Assessing the impact of climate change on malaria. https://www.hsph.harvard.edu/news/features/climate-change-malaria/.
- Honor Society of Nursing. n.d. What causes a malaria epidemic to occur. https://www.sharecare.com/health/malaria/what-causes-malaria-epidemic-occur. n.d. Malaria. https://www.etymonline.com/word/malaria.
- Martens, M J, L W Niessen, J Rotmans, T H Jetten, and A J McMichael. n.d. ‘Potential impact of global change on malaria risk.’ Environmental Health Perspectives.
- Neghina, Raul, and Loan Lacobiciu. 2010. ‘Malaria, a Journey in Time: In Search of the Lost Myths and Forgotten Stories.’ The American Journal of the Medical Sciences.
- Plewes, Katherine, D Phil, Stije J, Leopold, Hugh W.F Kingston, and Arjen M Dondorp. 2018. ‘Malaria: What’s New in the Management of Malaria?’ Infectious Disease Clinics of North America.
- Sahil, Kumar, T.R Bhardwaj, D.N Prasas, and Singh K Rajesh. 2018. ‘Drug targets for resistant malaria: Historic and future perspectives.’ Biomedicine and Pharmacotherapy.
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