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Lecture 4

Lecture 4 Malaria.docx

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Lecture 4 Malaria & Other Health Effects of Climate Change Tropical Environments - Hot (20-28ºC), stable day-to-day - Humid (85-95% RH) - Annual precipitation >1400 mm - Rainfall: short duration, high intensity, patchy distribution - Soil missing at least one nutrient (promotes biodiversity; bad for growing single crop, “monoculture”, cash crops) - Selection for microorganisms that can decompose organic material (ex. fungus) - High species diversity: Reptiles, birds, mammals, amphibians, insects, microorganisms - Soil promotes diversity but not good for agriculture - Dead animals disappear very quickly (decomposition) - Soil shallow (high leaching, erosion) - No traditional “seasons” … rainy vs. wet - No dormant winter period (no rejuvenation of soil nutrients, no killing off of disease vectors, multiple generations of vectors within one year) - Insect vectors exist in tropic areas but not in places like Canada (less disease here) - Temperate regions (where there are lots of different temperatures throughout the year.. Europe, north America) - Biodiversity = a good thing. - Note that Tropical countries (in Africa, Southeast Asia, South America) also tend to be the poorest. - The Wet Season tends to have more disease … WHY? - Vectors (mosquitos, flies) more abundant - Intestinal Parasites common (exposure to contaminated water/soil) - People spend more time indoors (respiratory infections) - Nutritional levels vary seasonally (influences susceptibility) - Abundant– more life, population increases after rainfall, burst to life, plants get fed on - Vector-borne diseases a more serious problem in the tropics … WHY? - Vectors breed year-round - Human population: dense, poor, high level of endemic diseases (recall: syndemic potential), lack of infrastructure, political instability - Population rapidly increasing (encroachment on forest, puts us into contact with zoonoses) - Zoonotic diseases: diseases affecting humans but the primary host is an animal other than human - Lots of poor people living very close to one another (tropics) - Started off in animals, then made transfer into humans, the more you cut down their environments, the worse it gets - The diseases above in the picture started off in animals and now in humans Malaria - Comes from Italian for “mala aria”, bad air (miasma has similar origins) - Has affected humans for a long time (so long humans developed protective genetic adaptations such as Sickle Cell anemia, thalassemia) - Is caused by a parasite from the Plasmodium family. Plasmodium falciparum = most lethal strain (also: P. vivax, P. malariae, P. ovale) - The parasite is spread by the female Anopheles mosquito (the vector) - Thought swamps were unhealthy because they were smelly, back then people thought it was air that caused disease - But they were bad because of the mosquito breeding around aka malaria - If person has malaria and mosquito bites him, it gets the parasite then goes bites someone else, that parasite is not transferred to the other person - No effective vaccine - Treatment/Prevention: o chloroquinine (issues of resistance) o artemisinin-based combination therapy (ACT) (expensive, black market, poor avoid treatment) o Bed nets o Spraying (DDT) - Symptoms: o Headache o Shivering o Joint pain o Vomiting o Jaundice o NOTE: these are non-specific - DDT: discovered as pesticide in 1939 - Used extensively after WWII (fear that troops returning home would re-introduce malaria) - By 1960’s clear that DDT wasn’t eradicating malaria in worst regions: high cost, logistic complexity, no follow-up infrastructure - Then Rachel Carson’s Silent Spring (1962) alerted us to side effects (there are many) - Today WHO balances side effects with effectiveness as pesticide - Developed countries encouraged to research alternatives … issues of funding, desire. - TWO BILLION more people at risk of malaria today than before eradication campaigns. WHY? - Population increase - Demographics and migration - Land and Water-Use Patterns - (clear-cutting, dams, irrigation ….) - Drug Resistance - Inadequate Control Efforts - Climate Change - Poverty and Poor Infrastructure - Demographic- more children are more at risk. People introduce for new regions, living disease is with them - Clear cutting– soil erodes, pool of standing water when mosqutios breed - Irrigation- - malaria accounts for 25% of deaths in children under 5 in endemic areas - Largest risk factor for malaria is POVERTY (poverty is both a cause and an effect) Malaria: A “Tropical” Problem? - Malaria existed in Europe and USA in 1800s … not any more though - Region hasn’t cooled (if anything it’s warmer) - Anopheles still present - It turns out that economic improvements (not environmental changes) have gone a long way toward reducing malaria in developed countries - Developed countries = better infrastructure, surveillance, draining swamps, managing surface water, overall population health better … no malaria. What does this say about reducing malarial impact in developing areas? - Was in north at some point, but isn’t here anymore - The mosquito still exists but we are not poor, that eradicates it Mosquito-Human Interactions - Humans locate settlements on higher ground away from breeding sites - “Inverse Transhumance” (you don’t need to know this term): permanent settlements in highland, flocks taken to lowland areas for winter - Cultural rules may limit mobility of females outside of their settlements - Folk beliefs in power of “good air” - Living in houses with no walls/temporary roofs - Movement in/out of houses during peak biting times Mosquito-Human Interactions - Illegal activities (bootlegging) at night - Unequal control methods because of political boundaries - Shift to crops (such as rice) that require extensive irrigation - Wearing heavy clothing that protects the body - Domestic animals kept close to living quarters - Draining swamps/standing water - Folk insecticides (chrysanthemum) - Houses on stilts - Bed net preference given to adults - High cost of bed nets, uncomfortable, smelly, concern of chemicals (infertility) - Perception of low mosquito threat in dry season - Changing sleeping patterns: visitors, bedwetting - Mosquitos seen as nuisance only, not associated with fatal disease - Tendency for self-treatment (traditional/black market) - Misunderstood causation of malaria (cold, rain, food, etc) Malaria: Structural Adjustment Programs (SAPs) - The International Monetary Fund and World Bank lend money conditionally to poor countries to reduce economic inefficiency and stimulate long-term growth - The problem: They tell the countries how to use the money. - In the 1980’s SAP reforms led to transfer from spending on health and education to more “productive” areas • Caused devolution of health sector • More individual responsibility for disease • Increase in self-medication • Rising income disparity • Increase in health-care costs from malaria • Uneven allocation of resources at household level • Currency devalution, inflation, loss of purchasing power - Give money to poor countries but with strings attached - Telling them how to spend their money, what to use it on - Said to spend it less on education and health, more on business to make a profit - Medical Poverty Trap = Long-term impoverishment that both brings about and is sustained through household medical debt. • Take children out of school and into workforce • Take out high-interest loans • Liquidation of assets • Multi-generational effects - 10/90 Gap = only 10% of health research and development is spent on 90% of world’s problems • No incentive to research drugs for poor countries unless there is threat to developed nations (TB) Climate Change th The Intergovernmental Panel on Climate Change (IPCC) concluded in their 4 assessment re
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