This issue of JAMA is devoted to malaria, a disease which was banished from Europe and North America in the 1930s and would have been banished from the whole world in the 1950s and 60s had the superpowers not found better things to do, like stockpiling thermonuclear weapons and flying to the moon. Now, according to the editorial, we may have the opportunity once again, thanks (yes, thanks) to George W Bush and the US President’s Global Malaria Initiative. This has increased funding to combat malaria ten-fold in less than ten years, and the main obstacle may now be poor local training and management in endemic areas. If GWB could be persuaded to part with another 1% of his military budget (i.e. $4.5 billion annually) the job could be finished.
Those of you with an interest in the treatment of malaria in Afghanistan, Pakistan, Uganda, Zambia and Kenya
will want to read the individual papers. To this list of countries with limited access to the most effective treatments there is one bizarre addition – the United States of America, where “artemisinins are not yet available”, and clinicians treating malaria have to follow arcane and complex treatment algorithms outlined in a systematic review.
To a general practitioner sitting in the UK the malaria workload is generated entirely by travellers – 99% being advice on prophylaxis and 1% being the testing of patients returning from endemic areas with febrile illnesses. Fortunately, our nurses can handle the prophylaxis part by using a book, chart or website; it’s not for us to meddle in these things, because, as this review concludes “prevention of malaria in travellers requires detailed knowledge of malaria epidemiology and host-vector interactions”. So if you can’t be certain of where to mark Chad or Gabon on a blank map of Africa, and are liable to confuse your sporozoite with your schizont, stick to the charts and the websites, even if they are all subtly at odds with each other.