by Dr L. J. Bruce-Chwatt

The most striking feature of malaria in Tropical Africa is its high endemicity with hardly any seasonal or annual changes. The climatic conditions favour an intense transmission of Plasmodium falciparum - the prevailing malaria parasite - through mosquito vectors of which the notorious and ubiquitous Anopheles gambiae is the most important because of its wide distribution, catholic breeding habits, large numbers and relative preference for human blood. The ensuing degree of semi-permanent transmission is so high that in an unprotected African community few if any members escape the infection: one might speak of a population saturated with malaria. The consequence of such a situation is a degree of adaptation of the human group to the prevailing conditions. The individual is infected at an early age, and throughout his life will be subjected to repeated infections. Many children will die, some directly from malaria, others from a combination of various diseases with the debilitating influence of malaria parasites present in the blood. Those who survive gradually develop an increasing immunity. Thus the toll of African malaria falls mainly on the very young age-groups.

The effects on the community of such a ruthless selection have never been reliably estimated in Africa. It is probable that in West Africa no fewer than 10 per cent of deaths of children below five years of age are due to direct effects of malaria. Taking into account the commonly found infant mortality rates in rural areas of 300-400 per 1,000, it has been estimated that between 200,000 and 500,000 infants and young children in Tropical Africa die every year from the direct effects of malaria; the indirect effects of the disease on the mortality rate are impossible to assess.

It is now plain that nobody can perform the miracle of malaria eradication in Africa simply by saying "Let us spray!" The guarantee of technical perfection cannot solve those problems of health promotion which depend on the concerted effort of the community. Malaria eradication can not be imposed from without by a benevolent and generous international agency, but must be carried out by a country with all the energy, purposefulness and dedication required for this task.

(from New Scientist, 28th June, 1962)