You are advised to spend about 20 minutes on Questions 29-40 which are based on Reading Passage 3.
World Health Organization Report: MALARIA
Malaria is by far the world's most important tropical parasitic disease, and kills more people than any other communicable disease except tuberculosis. In many developing countries, and in Africa especially, malaria exacts an enormous toll in lives, despite the fact that malaria is a curable disease if promptly diagnosed and adequately treated. The geographical area affected by malaria has shrunk considerably over the past 50 years, but the control is becoming more difficult and gains are being eroded. Increased risk of the disease is linked with changes in land use linked to activities like road building, mining, logging and agricultural and irrigation projects, particularly in "frontier" areas like the Amazon and in S.E Asia. Other causes of its spread include global climatic change, disintegration of health services, armed conflicts and mass movements of refugees.
The emergence of multi-drug resistant strains of parasites is also exacerbating the situation. Malaria is re-emerging in areas where it was previously under control or eradicated. Malaria is a public health problem today in more than 90 countries, inhabited by a total of some 2, 400 million people—40% of the world 's population. Worldwide prevalence of the disease is estimated to be in the order of 300-500 million clinical cases each year. More than 90% of all malaria cases are in sub-Saharan Africa. Mortality due to malaria is estimated to be over 1million deaths each year. The vast majority of deaths occur among young children in Africa, especially in remote rural areas with poor access to health services. Other high-risk groups are women during pregnancy, and non-immune travellers, refugees, displaced persons and labourers entering endemic areas.
Malaria epidemics relate to political upheavals, economic difficulties, and en vironmental problems. Transmission of malaria is affected by climate and geography, and often coincides with the rainy season. More than any other disease, malaria hits the poor. Costs to countries include costs for control and lost workdays—estimated to be 1-5% of GPD in Africa. For the individual, costs include the price of treatment and prevention, and lost income. Rural communities are part icularly affected. The rainy season is often a time of intense agricultural activity, when poor families earn most of their annual income. Malaria can make these families even poorer. In absolute numbers, malaria kills 3,000 children per day under five years of age. It is a death toll that far exceeds the mortality rat e from AIDS. African children under five years of age are chronic victims of mal aria, and fatally afflicted children often die less than 72 hours after developing symptoms. In those children who survive, malaria also drains vital nutrients from children, impairing their physical and intellectual development. Yet protection of children can often be easy. Randomised control trials show that about 3 0 per cent of child deaths could be avoided if children slept under bed nets regularly treated with recommended insecticides such as pyrethroids. Unlike early insecticides such as DDT, pyrethroids are derived from a naturally occurring substance, PYRETHRUM, found in chrysanthemums and will remain effective for 6 to 12months.
The estimated costs of malaria, in terms of strains on the health systemsand economic activity lost, are enormous. In affected countries, as many as 3 in 10 hospital beds are occupied by victims of malaria. In Africa, where malariareaches a peak at harvest time and hits young adults especially hard, a single bout o f the disease costs an estimated equivalent of 10 working days. Research indicates that affected families clear only 40 per cent of land for crops compared with healthy families. The direct and indirect costs of malaria in sub-Saharan Africa exceed $2 billion, according to 1997 estimates. According to UNICEF, the average cost for each nation in Africa to implement malaria control programmes is estimated to be at least $300,000 a year. This amounts to about six US cents ($0.06) per person for a country of 5 million people.
In malaria-endemic parts of the world, a change in the risk of malaria can be the unintended result of economic activity or agricultural policy that changes the use of land (e.g. creation of dams, irrigation schemes, commercial tree cropping and deforestation).
"Global warming" and other climatic phenomena such as "El Nio" also play their role in increasing the risk of the disease. The disease has now spread to highland areas of Africa, for example, while El Nio has an impact on malaria because the associated weather disturbances influence vector breeding sites, and hencetransmission of the disease. Many areas have experienced dramatic increases in the incidence of malaria during extreme weather events correlated to El Nio. More over, outbreaks may not only be larger, but more severe, as the populations affected may not have high levels of immunity. Quantitative leaps in malaria incidence coincident with ENSO (El Ni/Southern Oscillation) events have been recorded around the world.
Prevention of malaria encompasses a variety of measures that may protect against infection or against the development of the disease in infected individuals. Measures that protect against infection are directed against the mosquito vector. These can be personal (individual or household) protection measures e.g., protective clothing, repellents, bed nets, or community/population protection measures e.g., use of insecticides or environmental management to control transmission . Measures that protect against the disease but not against infection include chemoprophylaxis.
In spite of drug resistance, malaria is a curable disease, not an inevitable burden. Although there are only a limited number of drugs, if these are used properly and targeted to those at greatest risk, malaria disease and deaths can be reduced, as has been shown in many countries. Disease management through early diagnosis and prompt treatment is fundamental to malaria control. It is a basic right of affected populations and needs to be available wherever malaria occurs. Children and pregnant women, on whom malaria has its greatest impact in most parts of the world, are especially important.
Malaria control is everybody's business and everybody should contribute to it, including community members and people working in education, environment, water supply, sanitation and community development. It must be an integral part of national health development and community action, for control must be sustained and supported by intersectoral collaboration at all levels and by monitoring, training and evaluation, as well as by operational and basic research.
Questions 29-33
Classify the following descriptions as referring to
Sub-Saharan Africa SA
Malaria epidemics ME
Malaria fatalities MF
Rural communities RC
Cost of malaria CM
Disease management DM
The Amazon AZ
Write the appropriate letters in boxes 29-33 on your answer sheet.
NB: you may use any answer more than once.
29. An area that is the worst for malaria.
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