Breaking the fatal cycle of transmission / Hiroshi Nakajima

Breaking the fatal cycle of transmission by Hiroshi Nakajima Director-General of the World Health Organization D uring the first part of this century, malaria was the most impor-tant tropical disease. Large antimalaria campaigns led to eradication in many areas, and to a controlled situation in others. But as this issue of World Health shm.vs, malaria still remains a formidable foe. Recent epidemics are telling reminders of how quickly this disease can strike and how great its devastation can be, causing untold suffering and tragedy. They also illustrate how speedily and effectively an international response can be mobilized, once the severity of the situation is recognized and appreciated 2 at the national level. But epidemics represent only the tip of the malaria iceberg. Even more serious, in terms of the day-to-day toll of illness and death, are the countless situations where malaria is constantly present, whether in vast areas of Africa or in the tropical forests of the Amer- icas. In such areas, malaria makes its presence known through the untold cases of fevers that lead to infant and child deaths, school absenteeism and much loss of working capacity among adults. Malaria can strike anyone down, but history and experience show that it affects primarily the poorest, most peripheral and most marginal areas or groups of populations. These same people have the least access to health services, can least afford personal protection and are the furthest removed from organized malaria con- trol activities; and it is they who suffer the estimated one to two million deaths per year attributed to malaria. Wherever malaria is present, it inter- feres with human progress and devel- opment; only by bringing it under control can its disrupting effect be overcome. After appropriate malaria control activities had been introduced, (Above) The face of malaria. This disease still seriously hampers socioeco- nomic development in many countries. W ORLD HEALTH, September-October 1991 they played a major role in the completion of the Panama Canal. Today, we witness increased producti- vity in the rubber plantations of South- East Asia where malaria is controlled. Communication and socioeconomic development through the building of railways and roads in many tropical countries are also made easier. Malaria problems arise when devel- opment projects and, more impor- tantly, communities and individuals try j to bring about economic improvement ta in disorganized ways which increase ~ contact between man and mosquito, o for instance during the irrigation of ~ land and the clearing of forests. .s In the fifties, the World Health f Organization started a global pro- gramme of malaria. Today, more than Where malaria is an important obstacle 20 years after we realized that eradi- to development, the capacity to con- cation was not feasible under current trol its transmission can be enhanced economic conditions, our approach by strengthening local and regional has become more pragmatic. There is epidemiological services. no "magic bullet" for malaria, and we The battle against malaria continues, must therefore fight it on many fronts. but it urgently requires reinforcement. As the articles that follow suggest, we We at WHO are convinced that a have the means to do so. determined collaborative effort Every member of the public can use between the health sector and all the personal protection whenever and other sectors concerned can succeed wherever the transmission risks are in breaking the fatal cycle of transmis- high, and can learn to recognize signs sion of malaria in many parts of the of the disease and seek prompt globe even before the present century treatment. Health services can be ends. made available to ensure timely diag- nosis and effective treatment. Epi- demic warning and control systems can be developed as part of the national epidemiological services. Without the political will and determin- ation to cany out eHective malaria programmes, we will not win the fight against the disease. WORLD HEALTH, September-October 1991 H. I Hiroshi Nakajima, M.D., Ph.D. Front cover drawn jointly by Robert Camilleri, Matthew Carlson Morris and Nicholas Harris. International School of Geneva. IX ISSN 0043-8502 World Health is the official illustrated magazine of the World Health Organization. Editor: Eilif Liisberg. M .D. Deputy Editor: Christiane Viedma Art Editor: Peter Davies News Page Editor: Philippe Stroot World Health appears six times a year in English. French, Portuguese. Russian and Spanish. and four times a year in Arabic and Farsi. The German edition is obtainable from: German Green Cross. Schuhmarkt 4. 3550 Marburg. 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Contents Breaking the fatal cycle of transmission by Hiroshi Nakajima .......... ... ..... 2 Malaria control: history shows it's possible by Jose Antonio Najera -Morrondo ...... 4 The world malaria situation ..... ... 6 Strategies for Africa ...... . .. . ..... 6 Watch for the symptoms! by Nicholas J White .................. 8 Different strategies for different situations by Peter Trigg ....................... 10 Towards better diagnosis by David Payne .................. ... 12 Partners against malaria by John Storey .... .... . .. .. ......... . 13 Malaria and the mosquito ..... 16-17 Local wisdom in Mexico by Francisco J. L6pez-Antunano ...... 18 Forms of treatment by Lateef A. Salako .................. 19 The mosquito: public enemy No. 1 by Awash Teklehaimanot & Pushpa R. J. Herath . . ........... .. 21 Ideas for action ................ . .. 22 Travellers. beware! by Penelope Phillips-Howard .......... 24 Risks during pregnancy by Bernard J. Brabin .... ...... . .. . ... 26 Economic development and malaria by Bernhard H. Liese . ... ....... ..... . 27 A game of chess by M ichel Lebras .................•... 29 News page ............. ... · ....... ' .. · .. 31 3