Keith Wong

ENT 153 Scott

Malaria: Economic Result or Economic Problem?

Abstract

64% of the world lives in a malaria endemic region. (2) Of these areas, there is a huge overlap

with regions that are tropical and impoverished. The classic explanation of this is that poverty is

the driving force of malaria. Recent studies though, have elucidated a deeper story. Evidence

suggests that poverty isn’t just causing malaria, but is also caused by it. When these conditions

are combined, an incredibly efficient synergy is formed, tightening malaria’s foothold where it is

present.

Coaction of Malaria and Poverty

Each year, an estimated $3.8 to $4.5 billion is poured into malaria control, globally. This

includes malaria control research and development as well as implementation. (1) In 2013, there

was an estimated 198 million cases of malaria worldwide with an estimated 584,000 deaths. (2)

Most of these deaths occurred among children in Africa where annual income is relatively low.

(2) The tropical areas that have relatively low GDP are statistically the same places malaria is

endemic. (3) Poverty and malaria are intrinsically connected, each exacerbating one another’s

burden on poor communities.

Poverty escalates risk of malarial contraction. This is a well-accepted fact as

impoverished living conditions have historically always been closely associated with disease.

With just a bit of understanding on the epidemiology of malaria, this notion is easily elucidated,

as impoverished communities often have overcrowded households, lack adequate water

treatment, and utilize makeshift housing. Poor communities with overcrowded houses draw

mosquitoes like moth to a flame as they are attracted to the heightened CO2 levels. (4) Inadequate

water treatment in impoverished communities may lead to pools of stagnant water which are the

primary breeding grounds for Anopheles mosquitoes (malaria’s primary vectors). Additionally,

makeshift housing structures are often inadequate in protecting the residents from mosquitoes,

lacking window screens and doors, allowing for more vector-host interactions. These are the

most common reasons linking destitute communities with an increased risk of malaria.

In addition to directly increasing risk of contraction by creating conditions favorable for

the disease, poverty also pushes individuals to make poor decisions that could indirectly increase

the risks. Within malaria endemic regions, governments and organizations often provide bug nets

free of charge in hopes of decreasing vector host interactions. In very poor communities,

however, it is often used instead as fishing nets. (5) For these hyper-impoverish communities

where survival itself is a struggle, protection from malaria gets under prioritized. Within these

conditions, spread of malaria goes relatively unchecked as bug nets are shown to reduce malaria

up to 70%. (6) Because of the intensification of malaria in these hyper-impoverished regions,

malaria will continue to remain a problem in these tropical destitute communities.

Poverty is incredibly proficient at exacerbating risk of malarial contraction.

Overcrowding, poor water treatment, makeshift housing, and improper use of bug nets elucidate

this. In addition though, malaria also promotes poverty and limits rate of economic growth. This

creates a vicious cycle of poverty causing malaria and malaria going back to depress economic

growth. This is illuminated in malaria’s selection for Sickle Cell Anemia and its tendency to

preferentially affecting children.

The effects of malaria on stunted economic growth and subsequently, poverty, is

illustrated in the cruel balance of Sickle Cell Anemia that malaria enables. Sickle cell anemia

(SCA) when heterozygous can cause a myriad of problems including shortness of breath,

dizziness, and headaches, and in more severe cases, stroke, acute chest syndrome, and splenic

failure. (7) When homozygous for SCA, however, the fetus never survives. (2) Despite this

strong deselective pressure against SCA in the human gene pool, within malaria endemic regions

of the world, SCA occurs in high frequency. This is because SCA has been shown to provide at

least partial immunity from fatal malaria. (8) The strong prevalence of SCA in malaria endemic

region suggests that the selective pressure by malaria on SCA is stronger than the deselective

pressure of reduced fitness in SCA positive individuals. The high prevalence of SCA that malaria

selects for has far reaching economic implications as it not only inflates frequencies of

miscarriage, but also increases the number of anemic individuals. Miscarriages from an

economic standpoint can be hard to quantify as it can only be modeled as lost unknown

opportunity cost. An increased frequency of anemic individuals, however, more obviously shows

a stunt in economic growth. These anemic individuals are unable to provide the same level of

manual labor a healthy individual can provide, as the level of oxygenation in their blood is much

deteriorated. This in turn means the work force as a whole is less productive. Through the

mechanism of selecting for SCA, malaria indirectly impedes economic growth and promotes in

these malaria endemic regions.

In addition to the strong selection for SCA, malaria also provokes poverty by mainly

affecting children whose antigen repertoires have not yet fully developed. Age and immunity to

malaria is directly proportional as malaria resistance is a learned immune response. With each

exposure of individual by plasmodium, the host’s immune system learns to combat malaria.

Because of this, children that haven’t had the same sheer number of exposures to malaria as

adults have are much more susceptible to the disease. When children contract the disease, the

symptoms that arise are usually quite severe, resulting in a bed ridden recovery. These extended

periods of time spent recovering means the child isn’t at school and because the child has to stay

at home from school, malaria directly reduces cognitive development of children which

depresses the already slow economic growth of malaria endemic areas. (9) This accumulation of

hours lost in school implicates a depression of possible production of academic individuals in the

endemic region. The depression in the production of academic individuals further bolsters

continued poverty and stunted economic growth for the area.

There is an almost near perfect synergy between malaria and poverty, elucidated by

improper use of bug nets, overcrowded conditions, make shift housing structures, inadequate

water treatment, selection for sickle cell anemia, and severe symptoms arising in children. That

isn’t to say however that malaria can be fixed by just fixing the economy. Even if by some

motion of higher power the economy is fixed in those endemic regions, the fact remains that the

tropical climate serves as a perfect foothold for the Anopheles mosquitoes. Rather than focusing

on the economic implications of the disease, resources should be spent eliminating it. To

eradicate the disease is to eradicate its insect vectors. Only when malaria risk wanes will these

endemic regions see the end of poverty.

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