Resources for World Malaria Day 2013

April 25, 2013

Not a word about condemning Rachel Carson.  No plea to use DDT to try to poison Africa or Asia to health.  That’s a great start.

More:

Mother and son under a protective bednet, the most efficient method to prevent malaria.  Columbia University MVSim image

Mother and son under a protective bednet, the most efficient method to prevent malaria. Columbia University MVSim image


April 25 is World Malaria Day — right, Bill?

April 24, 2013

He’s absolutely right.

English: World Malaria Day Button (english)

English: World Malaria Day Button (english) (Photo credit: Wikipedia)

What are you doing to fight malaria today?

More:


V for Vaccine: A slightly rude film with a powerful point

January 10, 2013

A couple of kids in the Dallas area have died already from influenza — neither had been vaccinated against it.  Deaths have occurred across the nation, frequently in young, otherwise healthy people.

Nasty flu bugs going around this year, and the every-year epidemic has hit about two months early.  One part of the good news is that the vaccines this year are especially well-suited to target the viruses that cause the trouble.  The vaccines work well every year, but especially well in 2012 and 2013.

The bad news is that millions of people haven’t bothered to get vaccinated. That’s not good.

  1. Under Obamacare, there’s no copay for insurance for a flu shot.  It’s “free” if you have any kind of insurance. In addition, county health offices offer the vaccines for free to any comers.  A couple of weeks ago at the pharmacy I stood behind a woman who confessed she’d not gotten a flu shot (pharmacies are pushing vaccinations these days, to promote their mini-clinics).  “I’ve got that crappy teachers’ insurance,” she told the technician.  “It never pays for anything like that.”  The tech looked it up, and told her that her copay was zero, and her insurance paid for it — essentially a free shot, to her.  On the way into the clinic she said, “I’ve never gotten a flu shot before.”  Oy.
  2. Think Herd Immunity:  Are you usually healthy?  Great.  But if you’re pregnant, or you work around people who are or may be pregnant, or if you’re over 60, or if you have any chronic condition like diabetes, high blood pressure, chronic sinusitis, or a raft of other things, you’re at risk, and you put others in those risk categories at risk.  My grandfather worked at a hospital while my mother and my oldest brother were living with him; after a week of my grandfather’s working in the polio ward, my brother came down with the disease.  Of course we don’t know for sure, but my grandfather kicked himself for 40 years, until his death, because he thought he’d brought home the disease my brother caught.  With vaccines, those incidents become much more rare.

Risking this blog’s G rating, I’m going to post this film, “V for Vaccine.”  Found it at New Anthropocene.  Turn up your offense filter, or ignore the language — but pay attention to what this guy says, PowerM1985:

Is it worth getting your children vaccinated if it risked them becoming autistic? In this video I give a short demonstration of why I personally believe that even if there was a risk of my child becoming autistic (AND THERE IS NOT!) I would still get them vaccinated.

You should probably know that the work of the Centers for Disease Control to correctly predict which strains of the viruses will be most prevalent, and get vaccines that will fight those viruses, has been very, very good this year.

  • Influenza A (H3N2), 2009 influenza A (H1N1), and influenza B viruses have all been identified in the U.S. this season. During the week of December 23-29, 2,346 of the 2,961 influenza positive tests reported to CDC were influenza A and 615 were influenza B viruses. Of the 1,234 influenza A viruses that were subtyped, 98% were H3 viruses and 2% were 2009 H1N1 viruses.
  • Since October 1, 2012, CDC has antigenically characterized 413 influenza viruses, including 17 2009 influenza A (H1N1) viruses, 281 influenza A (H3N2) viruses and 115 influenza B viruses.
    • All 17 of the 2009 influenza A (H1N1) viruses were characterized as A/California/7/2009-like. This is the influenza A (H1N1) component of the Northern Hemisphere vaccine for the 2012-2013 season.
    • Of the 281 influenza A (H3N2) viruses, 279 (99%) were characterized as A/Victoria/361/2011-like. This is the influenza A (H3N2) component of the Northern Hemisphere influenza vaccine for the 2012-2013 season.
    • Approximately 69% of the 115 influenza B viruses belonged to the B/Yamagata lineage of viruses, and were characterized as B/Wisconsin/1/2010-like, the influenza B component for the 2012-2013 Northern Hemisphere influenza vaccine. The remaining 31% of the tested influenza B viruses belonged to the B/Victoria lineage of viruses.

What are you waiting for?  Go get a flu shot!

More:

English: This is CDC Clinic Chief Nurse Lee An...

This is CDC Clinic Chief Nurse Lee Ann Jean-Louis extracting Influenza Virus Vaccine, Fluzone® from a 5 ml. vial. (Photo credit: Wikipedia)

Graphic on influenza, 2013 - Flu.gov

Information from Flu.gov; click image to get to active Flu Vaccine Finder


World Malaria Report 2012: Malaria still declining, but more resources needed fast

January 4, 2013

Significant gains against malaria could be lost because funding for insecticide-treated bednets has dropped, and malaria parasites appear to be developing resistance to the pharmaceuticals used to clear the disease from humans, while insects that transmit the parasites develop resistance to insecticides used to hold their populations down.

Malaria room

African bedroom equipped with LLINs (insecticidal bednets) Photo: YoHandy/Flickr

UN’s World Health Organization (WHO) published its annual report on the fight against malaria last month, December 2012.  Accompanying the many page World Malaria Report 2012  were a press release and a FAQ; the fact-sheet appears unedited below.

Insecticidal bednets have proven to be a major, effective tool in reducing malaria infections.  Careful studies of several different projects produced a consensus that distributing the nets for free works best; people in malaria-infected areas simply cannot afford to pay even for life-saving devices, but they use the devices wisely when they get them.  Nets often get abbreviated in official documents to “LLINs,” an acronym for “long-lasting insecticidal nets.”

Generally, the report is good news.

Dramatic facts emerge from the report:  The “million-a-year” death toll from malaria has been whacked to fewer than 700,000, the lowest level in recorded human history.  More people may die, and soon, if aid does not come to replace worn bednets, distribute new ones, and if the drugs that cure the disease in humans, lose effectiveness.  Many nations where the disease is endemic cannot afford to wage the fight on their own.

Links in the Fact Sheet were added here, and do not come from the original report — except for the link to the WHO site itself.

Logo for World Health Organization

17 December 2012

World Malaria Report 2012

FACT SHEET

Malaria is a preventable and treatable mosquito-borne disease, whose main victims are children under five years of age in Africa.

The World Malaria Report 2012 summarizes data received from 104 malaria-endemic countries and territories for 2011. Ninety-nine of these countries had on-going malaria transmission.

According to the latest WHO estimates, there were about 219 million cases of malaria in 2010 and an estimated 660,000 deaths. Africa is the most affected continent: about 90% of all malaria deaths occur there.

Between 2000 and 2010, malaria mortality rates fell by 26% around the world. In the WHO African Region the decrease was 33%. During this period, an estimated 1.1 million malaria deaths were averted globally, primarily as a result of a scale-up of interventions.

Funding situation

International disbursements for malaria control rose steeply during the past eight years and were estimated to be US$ 1.66 billion in 2011 and US$ 1.84 billion in 2012. National government funding for malaria programmes has also been increasing in recent years, and stood at an estimated US$ 625 million in 2011.

However, the currently available funding for malaria prevention and control is far below the resources required to reach global malaria targets. An estimated US$ 5.1 billion is needed every year between 2011 and 2020 to achieve universal access to malaria interventions. In 2011, only US$ 2.3 billion was available, less than half of what is needed.

Disease burden

Malaria remains inextricably linked with poverty. The highest malaria mortality rates are being seen in countries that have the highest rates of extreme poverty (proportion of population living on less than US$1.25 per day).

International targets for reducing malaria cases and deaths will not be attained unless considerable progress can be made in the 17 most affected countries, which account for an estimated 80% of malaria cases.

  • The six highest burden countries in the WHO African region (in order of estimated number of cases) are: Nigeria, Democratic Republic of the Congo, United Republic of Tanzania, Uganda, Mozambique and Cote d’Ivoire. These six countries account for an estimated 103 million (or 47%) of malaria cases.
  • In South East Asia, the second most affected region in the world, India has the highest malaria burden (with an estimated 24 million cases per year), followed by Indonesia and Myanmar.  50 countries are on track to reduce their malaria case incidence rates by 75%, in line with World Health Assembly and Roll Back Malaria targets for 2015. These 50 countries only account for 3% (7 million) of the total estimated malaria cases.

At present, malaria surveillance systems detect only around 10% of the estimated global number of cases.  In 41 countries around the world, it is not possible to make a reliable assessment of malaria trends due to incompleteness or inconsistency of reporting over time.

This year, the World Malaria Report 2012 publishes country-based malaria case and mortality estimates (see Annex 6A). The next update on global and regional burden estimates will be issued in December 2013.

Malaria interventions

To achieve universal access to long-lasting insecticidal nets (LLINs), 780 million people at risk would need to have access to LLINs in sub-Saharan Africa, and approximately 150 million bed nets would need to be delivered each year.

The number of LLINs delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145 million in 2010 to an estimated 66 million in 2012. This will not be enough to fully replace the LLINs delivered 3 years earlier, indicating that total bed net coverage will decrease unless there is a massive scale-up in 2013. A decrease in LLIN coverage is likely to lead to major resurgences in the disease.

In 2011, 153 million people were protected by indoor residual spraying (IRS) around the world, or 5% of the total global population at risk. In the WHO African Region, 77 million people, or 11% of the population at risk were protected through IRS in 2011.

The number of rapid diagnostic tests delivered to endemic countries increased dramatically from 88 million in 2010 to 155 million in 2011. This was complemented by a significant improvement in the quality of tests over time.

In 2011, 278 million courses of artemisinin-based combination therapies (ACTs) were procured by the public and private sectors in endemic countries – up from 182 million in 2010, and just 11 million in 2005. ACTs are recommended as the first-line treatment for malaria caused by Plasmodium falciparum, the most deadly Plasmodium species that infects humans. This increase was largely driven by the scale-up of subsidized ACTs in the private sector through the AMFm initiative, managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Drug and insecticide resistance

Antimalarial drug resistance is a major concern for the global effort to control malaria. P. falciparum resistance to artemisinins has been detected in four countries in South East Asia: in Cambodia, Myanmar, Thailand and Viet Nam. There is an urgent need to expand containment efforts in affected countries. For now, ACTs remain highly effective in almost all settings, so long as the partner drug in the combination is locally effective.

Mosquito resistance to at least one insecticide used for malaria control has been identified in 64 countries around the world. In May 2012, WHO and the Roll Back Malaria Partnership released the Global Plan for Insecticide Resistance Management in malaria vectors, a five-pillar strategy for managing the threat of insecticide resistance.

www.who.int/malaria

You were perceptive.  You noted there is no call from malaria fighters for more DDT, nor for any change in DDT policy.  This is a report from medical personnel, from public health experts, the real malaria fighters.  It’s not a political screed.

More, and related articles:


More good news about Obamacare: No pre-existing conditions clause

May 31, 2012

More:


Is the anti-vaccine movement dangerous?

April 24, 2012

I get e-mail from Bob Park, the physicist curmudgeon/philosopher at the University of Maryland (I’ve added links):

Robert L. Park

Robert L. Park (Photo credit: Wikipedia)

“DEADLY CHOICES”: PAUL OFFIT EXPOSES THE ANTI-VACCINE MOVEMENT.

There was never a time before people knew that falling trees and large animals with teeth can kill.  Microbes are another matter. They had been killing us for perhaps 200,000 years before Antonie van Leeuwenhoek showed them to us. Paul Offit and two colleagues worked for 25 years to develop a vaccine for the rotavirus, a cause of gastroenteritis that kills as many as 600,000 children a year worldwide, mostly in underdeveloped countries.  The vaccine is credited with saving hundreds of lives a day.  Offit wrote “Autism’s False Prophets” in 2008 exposing British physician Andrew Wakefield for falsely claiming the MMR vaccineis linked to autism.

H. Fred Clark and Paul Offit, the inventors of...

H. Fred Clark and Paul Offit, the inventors of RotaTeq. (Photo credit: Wikipedia)

Vaccination prevents more suffering than any other branch of medicine, but is still opposed by the scientifically ignorant who accept the upside-down logic of the alternative medicine movement.  Because vaccination of schoolchildren against virulent childhood infections is ubiquitous, crackpots, scoundrels and gullible reporters get away with linking it to unrelated health problems as they did in the 1980s with the ubiquitous power lines.  We still hear echoes of the power-line scare in the cell phone/cancer panic. Paul Offit has just written “Deadly Choices: How The Anti-Vaccine Movement Threatens Us All.”  We need to do everything we can to stop it.

You don’t subscribe to Bob Park’s “What’s New?”  You should.

THE UNIVERSITY OF MARYLAND.
Opinions are the author’s and not necessarily shared by the
University of Maryland, but they should be.

Archives of What’s New can be found at http://www.bobpark.org
What’s New is moving to a different listserver and our subscription process has changed. To change your subscription status please visit this link:
http://listserv.umd.edu/cgi-bin/wa?SUBED1=bobparks-whatsnew&A=1

You’ll be smarter for reading his little missiles missives missiles.

More:

Measles cases reported in the United States be...


Good news about health care in the U.S.: The case for Obama’s health care reforms

March 7, 2012

Here’s a preview of another piece of television that many Republicans hope you will not bother to see, a piece that explains exactly how and why the health care reforms championed by President Obama will help you and millions of others:

Program: U.S. Health Care: The Good News

Episode: The Good News in American Medicine

Journalist T.R. Reid examines communities in America where top-notch medical care is available at reasonable costs and, in some instances, can be accessed by almost all residents. Included: Mesa County, Colo.; Seattle; Everest, Wash.; Hanover, N.H. In Mesa County, for instance, doctors, hospitals and insurers place an emphasis on prevention; and a program that offers pre-natal care to poor women has proved popular.

T. R. Reid’s report started airing on PBS stations in mid-February.  If you haven’t seen it, go to this site to view the entire production.

More, resources (suggested by PBS, mostly):


Fighting malaria with indoor use of insecticides, with USAID money

September 18, 2011

Short video demonstrating the Indoor Residual Spraying program in Mali, financed by funding from the U.S. Agency for International Development (USAID).  Note there is no ban on DDT, note that fighting malaria, even with poisons for mosquitoes, requires more than just spraying poison.

The video is in French.

539 views, September 18, 2011

DDT “costly for Uganda”

July 22, 2011

To aid researchers looking for news from Africa on malaria and DDT, I’ll reproduce the entire news story from Uganda’s New Vision here.  Stories from this outlet frequently trouble me, in the unquestioning way writers take quotes from people where a more probing reporter might be more skeptical.  I am not sure of the status of New Vision among Uganda’s media, but it’s one of the few available to us here on a regular basis.

So, here’s the story, on DDT usage to fight malaria.  A couple of points we need to remember:  First, it’s clear that DDT is not banned in Uganda, and that DDT usage goes on, despite the crocodile tears of Richard Tren, Roger Bate, and the Africa Fighting Malaria, Astroturf™ group; second, this story relates difficulties in using DDT, including cost.  It’s not that the stuff itself is expensive.  DDT doesn’t work on all mosquitoes anymore, and it’s dangerous to much other wildlife.  Malaria fighters must do serious work in advance to be sure the populations of mosquitoes targeted will be reduced by DDT — that is, that the bugs are not immune to DDT — and care must be taken to control the applications, to be sure it’s applied in great enough concentrations, and only indoors, where it won’t contaminate the wild.

Here’s the story from New Visions:

DDT spraying costly for Uganda

Tuesday, 5th July, 2011

By Raymond Baguma and Gerald Kawemba

INDOOR residual spraying as a strategy to control malaria in Uganda is too costly and has affected the programme countrywide.

According to Dr. Seraphine Adibaku, the head of the Malaria Control Programme, this is why other malaria control strategies such as use of insecticide-treated nets and Artemisinin-based combination therapy are considered to be ahead of indoor residual spraying.

The Government is implementing the indoor residual spraying using pyrethrum-based and carbon-based insecticides in 10 malaria-endemic districts in the northern and eastern regions.

They include Amolatar, Apac, Kitgum, Kumi and Bukedea.

“About three million people in the 10 districts have been covered. We have reached over 90% of the population,” Adibaku said.

She added that under the Presidential Malaria Initiative, the budget for indoor residual spraying is sh4.5b per district each year.

Adibaku said it would be much cheaper if the ministry distributed insecticide-treated mosquito nets.

She, however, said indoor spraying has an advantage of delivering immediate impact compared to treated nets.

Adibaku disclosed that the health ministry is re-evaluating the effectiveness of using DDT for malaria control.

Dr. Joaquim Saweka, the World Health Organisation (WHO) resident representative in Uganda, said indoor residual spraying is highly effective and has been successful in Zanzibar and Rwanda.

He, however, added that it is capital intensive and needs a lot of money for each application done twice a year.

Saweka cited his previous posting in Ghana during which a town of 300,000 inhabitants required $3m for spraying each year.

He said with the high cost of spraying and low financial resources available, Uganda needs to prioritise usage of insecticide-treated mosquito nets.

Saweka added that Uganda is on the right path to eradicating malaria with efforts in prevention, diagnosis and treatment as well as universal coverage of insecticide-treated nets.

Health minister Dr. Richard Nduhura yesterday kicked off a nationwide programme to distribute 11,000 bicycles to health volunteers who will diagnose and treat malaria in homes. The programme is supported by the Global Fund.

It is part of the Government’s home-based management of malaria, which is part of a larger national strategy to deliver treatment to children within 24 hours after diagnosis.

 


George Clooney’s malaria? DDT didn’t cure it

January 25, 2011

Not sure why, but pro-DDT sites have been harping about George Clooney’s having contracted malaria, a second time, while performing one of his humanitarian acts in southern Sudan.

George Clooney in Sudan, Time Magazine photo

George Clooney in Sudan, Time Magazine photo

True, Clooney got malaria.  His take?

“This illustrates how with proper medication, the most lethal condition in Africa can be reduced to bad ten days instead of a death sentence.”

Sometimes it may pay to remember that malaria is disease caused by a parasite who must live part of its life cycle in humans, and part of its life in mosquitoes.  Killing mosquitoes only works until the next susceptible mosquito comes along to bite an infected human.

The goal of malaria prevention and eradication campaigns generally is to cure the humans, so regardless how many mosquitoes may be in a given location and regardless how many people they may bite, there is no malaria pool for the mosquitoes to draw from, to spread to other humans.

To beat malaria, we need to prevent the spread of the disease.  At some point that requires providing quick and accurate diagnoses of which parasites cause the infection, and a complete and completed regimen of therapeutic pharmaceuticals to actuall cure the human victims.  DDT is mostly a bystander in that crucial part of the fight.

What was Clooney doing in Sudan?  According to the New York Daily News:

Clooney was in Sudan in December to work with Google and the UN on a human rights project that combines satellite imagery analysis and field reports to prevent a new war from occurring in the troubled country.

“We want to let potential perpetrators of genocide and other war crimes know that we’re watching, the world is watching,” he said in a statement at the time. “War criminals thrive in the dark. It’s a lot harder to commit mass atrocities in the glare of the media spotlight.”

Do you consider it odd that Clooney’s contracting malaria might gather more news in western outlets than his actual trip to Sudan, to call attention to the campaign against genocide?

World Blog – The race to contain drug-resistant malaria

January 23, 2011

NBC News’s World Blog carried a series on malaria and fighting it around the world.  Here’s part I:

PAILIN, Cambodia – The border crossing between Thailand and Cambodia at Pailin has a rather bleak feel about it at the best of times. In the heavy monsoon rain, the dingy checkpoints are reduced to gray smudges.

World Blog – The race to contain drug-resistant…, posted with vodpod

 

See more video information from NBC, here.


President’s Malaria Initiative: Plans for FY 2011

December 14, 2010

Barack Obama continued George W. Bush’s Africa-oriented fight against malaria.  The President’s Malaria Initiative (PMI)continues to target malaria for control and, if possible, eradication.

PMI announced today plans for work in 2011, country by country:

Malaria Operational Plans for Fiscal Year 2011

These Malaria Operational Plans have been endorsed by the U.S. Global Malaria Coordinator and reflect collaborative discussions with the national malaria control programs and partners in country. If any further changes are made to these plans, it will be reflected in revised postings.

How long before some wag complains that Obama’s program is anti-Africa because it doesn’t propose enough poisoning of the place?  “Not enough DDT!” they will complain, I wager.  And, for the record, I make this prediction not having read any of the country operational plans — in nearly complete ignorance of what the plans actually propose.  Can you find “enough” DDT in any country’s plan?

More:


Mandy Moore Talks Mosquito Nets – ABC News

December 13, 2010

Don’t ask me what work she’s done, because I couldn’t tell you.  I can tell — based on the headlines of the clipping services — that Mandy Moore is popular.

Ironically, in her brief tour of Africa and — shall we label it? — probably-shallow understanding of the issues, Ms. Moore has a deeper understanding of malaria and how to fight it than the most erudite of the DDT denialists, like Michael Crichton, or Rutledge Taylor.  Innocence wins.

For ABC News, the actress talked about charity work in Africa:

Mandy Moore Talks Mosquito Nets – ABC News, posted with vodpod

It’s a case of a celebrity doing “Do a Good Deed” duty, most likely.  In the video, Mandy Moore puts DDT denialists to shame.  In writing?  Moore doesn’t come off as well.  (Did she write that piece herself?  Maybe she should write what she talks.)


Ducking the quacks on DDT

December 9, 2010

Howard Stern may not re-up with Sirius, I hear.  That would make it easier to avoid the quackings of one of the latest and greatest cranks on DDT and malaria.

Rutledge Taylor, the erstwhile (still?) beauty-cream peddler to the stars, spoke with Stern on the telephone the day after the Pearl Harbor anniversary, apparently on the air, and demonstrated greater lunacy about DDT and malaria than in the past; the conversation was posted to YouTube.  Among other things Taylor gets dead wrong he claims:

  • Bedbugs did not develop resistance to DDT as reported in the 1950s and confirmed by recent detailed studies
  • No one studied bedbugs in the past three decades or so
  • DDT was banned to kill people, not due to any danger
  • Mosquito nets are “antiquated”
  • DDT doesn’t harm birds, doesn’t thin eggshells
  • Linus Pauling’s vitamin C studies show that DDT works
  • William Ruckelshaus completely banned DDT use everywhere, by himself, with no science to back the action

Taylor claims to have five file cabinets full of the studies on DDT, but it becomes clear that he hasn’t read any of them.  For example, he cites the erroneous claim that DDT saved 500 million lives, from a 1970 study by the National Academy of Sciences — but he’s not got the honor to tell his listeners that NAS then concluded that despite its value, DDT is too dangerous to keep using.

Stern’s newsletter said, for the December 8, 2010 program:

THE DUDE WHO DRANK DDT

Howard got Dr. Rutledge Taylor on the line to discuss his DDT advocacy: “This is the guy who believes in DDT.” Robin remembered Dr. Rutledge’s infamous YouTube video: “He drank it!” Dr. Rutledge said anti-DDT activists cited faulty–or just plain old–research: “There’s not been a study on DDT and bedbugs in 30 years…it’s the safest pesticide on the planet.” Howard asked about the common claim that DDT thins bird eggs, so Dr. Rutledge said he’d never seen proof: “Total bullshit. I’ve got every study going back to 1940.”
Howard asked if Dr. Rutledge was really dating 80s pop star Debbie Gibson, and the doc confirmed it: “She’s right here. Right now.” Debbie grabbed the phone: “I’m the crazy-supportive girlfriend up in the middle of the night making this phone call with him. Look, he’s saving the world and I wrote ‘Shake Your Love.’ It’s a match made in heaven.” Howard joked: “Does Dr. Rutledge ever bring DDT into the bedroom? Rub it on you?” The doc laughed: “It’s better than chocolate.”

Back in the olden days, broadcasters had to demonstrate that they broadcast in the public interest.  Sirius needs to make no such demonstration.  Otherwise, Stern’s Know-Nothing rants on DDT, alone, would put their license into question.

Instead of urging people to donate $10 to Nothing But Nets to save a kid from malaria, Taylor insists that people should go see his movie, “3 Billion and Counting,” instead.

Fortunately, the movie is no longer in release.  So, Dear Reader, make Howard Stern apoplectic, and save a kid’s life, by sending $10 to Nothing But Nets, and ignore Stern completely.

The facts?  You can’t get them from Stern or Taylor:


BBC News – Malaria ‘cannot be eradicated’

November 29, 2010

BBC report: Experts say control, not eradication of malaria (short advertisement precedes news video):

BBC News – Malaria ‘cannot be eradicated’, posted with vodpod

More, and resources:

Lancet map, showing nations where  malaria eradication may be possible, and those where control may be the best solution

Map from The Lancet, accompanying article: "Malaria is caused by five species of a parasite that can be carried from human to human by mosquitoes. Over the last 150 years, the portion of the world where malaria is still endemic has shrunk, but the disease is still endemic in 99 countries. However 32 of these countries, most of them on the edges of the endemic zone, are attempting to eradicate the disease, while the rest are trying to reduce infections and deaths though control measures."


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