A malaria survivor reflects on World Malaria Day

Wednesday the 25th April 2012 was World Malaria Day and as I joined others on that day in reflecting on the disease I could not fail to appreciate how much the malady has impacted on my life. It is particularly sad to read the statistic in the World Malaria Report 2011 thatin 2010 an estimated 655,000 people died from malaria–most of them African children”. And although the same Report states that malaria mortality rates have fallen by33% in the WHO African Region, in Africa one child still dies every minute from the disease, accounting for around 90% of all malaria mortality worldwide.

Image Source, K4Health’s POPLINE Database

I am a malaria survivor, I suppose many times over, but I particularly remember my experiences as a little boy growing up during the Second World War in a place called Itoloni in today’s Mwingi South Constituency. Ndetema (as we called Fever) was very common, and it was treated at first with quinine- that horribly bitter stuff from the cinchona tree. We had our noses squeezed which forced our mouths to open for the colourless liquid to be poured down our throats, three times a day. Then I was told my spleen was large (wasyungu) and was not improving with the quinine alone, so my grandmother was brought in. I can never forget the experience. Although I was particularly very fond of my grandmother, I always anticipated her visits to our home with a lot of apprehension. All the same it seems she successfully treated my splenomegaly with her nasty herbal concoctions accompanied by hot massages over the organ using leaves of the aloe vera plant.

When the Japanese occupied Indonesian islands where the cinchona tree grew they cut off supply of quinine to the British (who were ruling us those days), and it took a few years before quinine was replaced with mepacrine. The latter is a greenish yellow dye discovered at Bayer, Germany way back in 1931. Mepacrine-hydrochloride (also known as Quinacrine and Atabrine) was one of the first synthetic substitutes for quinine although later superseded by chloroquine. I remember being taken to the Native Civil Dispensary  in Nairobi, (it stood next to Kingsway Police Station- today’s Central Police Station), for weekly supply of mepacrine which was dispensed in large topped-up mugs. It was horrible! Among the side effects of the drug were toxic psychosis and ringing ears. Incidentally, Quinacrine has been used for non- surgical sterilization for women, and several peer reviewed studies suggested the procedure was potentially safer than surgical sterilization. Nevertheless, in 1998 the Supreme Court of India banned the import or use of the drug, based on reports that it could cause cancer or ectopic pregnancies.

Chloroquine, discovered at the same Bayer laboratories in 1934, was not introduced into clinical practice for the treatment of malaria until 1947. The drug would then hold supreme until the 1990s when emergence of widespread resistance to chloroquine led to its withdrawal from use in most countries in Africa, being systematically replaced by Artemisinin. It is thus with trepidation that we receive news that the most deadly species of malaria parasites, Plasmodium falciparum, is becoming resistant to artemisinin.

Another encounter with malaria was in the early 1960s, while a student at the Makerere College Medical School in Kampala, Uganda, where I came across a disease called Big Spleen Disease, a syndrome diagnosed in men and women characterised by evidence of recent malaria, anaemia and splenomegaly. Later, during 1967 and 1968, when I was practicing medicine at the Kenyatta National Hospital I conducted a study on anaemia in pregnancy[i], the findings of which revealed that among the very severely anaemic pregnant women splenomegaly was commonly found, and most of the women had evidence of recent malaria infection.

In areas endemic for malaria pregnancy is associated with a reduction in already acquired immunity, with consequent increase in clinical attacks of severe malaria (including cerebral malaria) and other complications such as haemolytic anaemia. Malaria-induced haemolytic anaemia is particularly common among women with their first pregnancy and tends to cause more severe anaemia with rapidly dropping haemoglobin in a woman who only a few days earlier had normal level of haemoglobin. These attacks can be prevented through intermittent preventive treatment with an effective antimalarial, for all pregnant women living in endemic areas, also use of insecticide-treated mosquito nets, and indoor residual spraying..

Let me end by mentioning an indirect involvement with malaria; this time concerning my father who in the late 1940s and early 1950s was a member of the Nairobi Municipality crew that eradicated malaria transmission in Nairobi. They used DDT before its name became an anathema. Yet to date there has not been any equally effective ‘safer’ substitute. Shall we continue watching our children die of malaria in order that we protect those of the future from little understood risks?

[i]Mati JKG, Hatimy A, and Gebbie DAM (1971) The importance of anaemia of pregnancy in Nairobi and the role of malaria in the aetiology of megaloblastic anaemia. Journal of Tropical Medicine and Hygiene, 74:1
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