Malaria threatens 40% of the world’s population and kills about 2.5 million people every year. Most are children under five or pregnant women. In sub-Saharan Africa an estimated 70 million pre-school age children are at risk of dying of malaria. In addition, malaria among adults affects their ability to do productive work. All this means malaria is one of the biggest public health problems in many developing countries. Like the other diseases that we look at in this issue, malaria is transmitted by insects. Often people despair of their ability to do anything in the battle against malaria, especially as health budgets may be reduced or essential drugs become unavailable. In this issue we try to look at positive steps which can be taken ‘on our own doorstep’ without access to large resources – just as Dr Molyneux encourages. Much of the issue looks at malaria control, partly because this is such a widespread and serious disease, but also because the same control measures will help against other diseases such as yellow fever and filariasis.

Once you have finished reading this issue, you may like to encourage discussion of these matters with others in the community. Here are some ideas for role plays which may help get people thinking…

  • A wife is sick with malaria but her husband tells her she is being lazy and trying to stop work. He will not pay for treatment. She takes some leftover chloroquine from her son’s last treatment and herbal teas. Her condition becomes worse. In the end she is so sick she has to be carried by stretcher and admitted to hospital. Her life is saved but her husband has to pay a very large bill.
  • Local people blame the mango for malaria, as outbreaks always occur just as the fruit are ready to eat (a month after the rains begin). Although the fruit are one of the village children’s main sources of vitamins, villagers want to cut down all the mango trees near their village.
  • The daughter of a local family has lived for many years in the highlands where there is no malaria. Now she is returning to her family in the lowlands, pregnant and with two young children. What would your advice as a health worker be to her parents?

Isabel Carter