Malaria's Last Stand is an expository look at the ongoing burden of one of humanity's oldest diseases. Staff writer Kaleigh Rogers travelled to Tanzania to capture the scope of malaria's impact on the road to elimination. Read more here.
Historically, malaria has been an equal opportunity killer. If you lived somewhere with enough malaria transmission, it didn't matter if you were the president, everyone was at risk. But as malaria-plagued countries have started to develop, the wealthier populations are able to avoid malaria more easily, by living in better housing, driving in cars, and working indoors. Now, these groups are facing a new threat: non-communicable diseases, like heart disease and diabetes.
"From what I've seen over the last five years or so, it's going to be the next epidemic," said Dr. Mohamed Alweani, the medical director at the Ithna-Asheri Charitable Hospital in Arusha, Tanzania.
I met Alweani at his office in the clinic, which is one of a handful in the city that offer free treatment to those who cannot afford it. Though I was there to learn about the impact of malaria, Alweani said the number of malaria cases the clinic sees has plummeted in recent years. A staff member had to go hunting for a box of malaria medication for me to see; the doctor's desk was littered with packages of children's cough medicine. Instead of malaria warnings, the walls were tacked with posters about the risks of hypertension and diabetes.
Arusha has a slightly cooler climate that's not as hospitable to malaria-carrying mosquitoes, so it never saw the peak rates of malaria that some other parts of Tanzania did. Over the last decade, foreign aid and NGOs have increased efforts to eliminate the disease in east Africa. Alweani told me between these two factors, malaria is not as big of a concern locally as it once was. His clinic sees only two or three cases of malaria each month. Though malaria and HIV are still top killers in the country, non-communicable diseases are gradually sneaking up to eclipse them.
It's a familiar narrative for a lot of developing nations. More education leads to sedentary jobs. More wealth leads to more cars. Better housing makes staying indoors more comfortable. Meanwhile, globalization means processed foods and drinks are more readily available.
"In the past, the local population was mainly eating a lot of vegetables and doing a lot of physical activity," Alweani said. "Now, we are going to a more modern food: a lot of meat and so on, and sedentary lifestyles. Before, people wouldn't get heavy, weight-wise. Now we are seeing quite a bit of overweight people, even obese people, and even in children."
It's not just anecdotal: studies have shown overweight and obesity rates are on the rise across the developing world. In Tanzania, 22 percent of women in 2010 were either overweight or obese, according to a study published in the journal BMC Public Health. That's compared to about 10 percent in the 1990s. And the same study showed that women who lived in cities, were wealthier, and more educated had a higher likelihood of being overweight or obese.
Though the fight against diseases like malaria and HIV attract more headlines, non-communicable diseases are on the global health community's radar. In 2011, more than 190 countries signed an agreement with the World Health Organization to combat non-communicable diseases, with a focus on education and regulating industries like tobacco and alcohol. Last year, all the signees set goals, and in 2018 they'll meet to review their progress towards curbing this emerging threat.
For now, doctors on the ground like Alweani are hoping to spread awareness in their communities, as one threat starts to fade away and another comes sharply into view.
"Non-communicable disease is coming up," he said. "Now we have to focus on it."
Travel expenses while reporting this series were funded through a fellowship provided by the International Center for Journalists and Malaria No More.