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Doctors Seek to Help Malaria's Most Vulnerable Victims - 2003-08-21

One of man's oldest and most determined enemies, the ancient scourge of malaria infects half a billion people a year and kills well over a million. Most of those deaths occur among children under five. Expectant mothers are also especially vulnerable. In this second in a series of articles for VOA, reporter Mike Osborne looks at efforts to protect malaria's most vulnerable victims.

Richard Morse practiced medicine for three decades at the Tenwick Mission Hospital in Kenya. He came to dread the arrival of Africa's rainy season. Rain meant mosquitoes, and mosquitoes meant yet another outbreak of malaria.

"We had 57 beds in the hospital and I remember at the time one of our peak days we had 119 children in those 57 beds. It was just a nightmare."

One case in particular stands out in Dr. Morse's memory. A small girl arrived with an advanced case of malaria. She went into coma almost immediately and the staff struggled to keep her alive. Then, the child lost circulation in her extremities, leaving her hands and feet cold and black.

"Even though the child did regain consciousness, went on to develop gangrene of the hands and the feet," recalled Dr. Morse. "We ended up amputating the hands and the feet just to get rid of the dead tissue."

Among the many researchers trying to prevent such childhood tragedies, is Thomas Wellems, who studies malaria at the National Institutes of Health in Bethesda, Maryland. His fieldwork involves children in a remote region of Mali, in West Africa.

"Children are very susceptible up through about age five to deadly effects from malaria," he said. "Their immune systems are eventually able to develop a degree of control over the most severe disease processes. It seems to result from multiple infections through many years."

But he stresses these children pay a heavy price for this partial immunity. They may be incapacitated by high fever and body tremors for weeks on end.

"During the malaria seasons, the wet season, children have three, four, five, six episodes of malaria each year," he said. "I mean imagine that! We think of the common cold among nursery age children here in the United States. That incidence of viral illnesses in the children here is probably less than the incidences of malaria in the children in these villages. It's tremendous in its effect."

In one village alone, Dr. Wellems noted the deaths of 30 children on average each month during the rainy season. Ironically, the deadly disease may cause a second problem that's just as devastating, overpopulation.

"Part of the reason that there are so many children per couple in places like Africa is the tremendous and daunting infant mortality, which is due to diseases like malaria," said Wes Van Voorhis, a professor at the University of Washington's School of Medicine who specializes in the study of infectious diseases. "Sociologists have shown that if parents have their kids die at very, very young ages, they have lots and lots more kids than they actually need to try and make up for the gap."

But even here, in the birth of a child, malaria exacts a terrible toll. Next to children under five, expectant mothers and their unborn babies are most vulnerable to the disease.

"We basically estimate that every year 75,000 to 200,000 infant deaths are associated with malaria in pregnancy," said Monica Parise who studies malaria at the Centers for Disease Control in Atlanta, Georgia.

"Basically, through mechanisms of either contributing to maternal anemia, or by infecting the placenta, the infection of the parasites in the placenta can cause adverse affects in the baby in terms of causing low birth weight, which is a factor for neonatal and infant mortality," she explains.

Dr. Parise notes that most of these deaths are easily preventable. Insecticide-treated bed netting has proven to be especially helpful in this regard and anti-malarial medications costing less than $1 per patient significantly reduce infant deaths.

In the next report in our continuing series on malaria, we'll look at the growing problem of drug resistance. There are now strains of the disease resistant, if not immune, to every know cure.