Malaria and poverty are intimately connected. As T. H. Weller, a Nobel laureate in medicine, noted, ‘‘It has long been recognized that a malarious community is an impoverished community.’’1 Weller could have said the same for malarious countries. Malaria is most intractable for countries in the poorest continent, Africa. The only parts of Africa free of malaria are the northern and southern extremes, which have the richest countries on the continent. India, the country with the greatest number of poor people in the world, has a serious malaria problem. Haiti has the worst malaria in the Western Hemisphere, and it is the poorest country in the hemisphere.
Malaria risk has always been geographically specific, as shown in Figure 1. Intensive malaria is confined to the tropical and subtropical zone. Poverty is also geographically specific. As shown in Figure 2, poor countries predominate in the same regions as malaria. Almost all of the rich countries are outside the bounds of intensive malaria.
A basic problem when studying the macroeconomic impact of malaria is the lack of high-quality data on malaria incidence or prevalence in the most severely affected countries. This study uses an index of malaria prevalence derived from historical maps of the geographical extent of high malaria risk shown in Figure 1 (digitized from maps by Pampana and Russell2 and the World Health Organization3,4 [WHO]). Combined with detailed data on the world population distribution, one can estimate the fraction of the population in high malaria risk areas in each country.5 Because most malaria mortality and severe morbidity is due to one of the 4 malaria species, the malignant Plasmodium falciparum, the index of malaria intensity used in this article is the fraction of the population at risk of malaria multiplied by the fraction of cases of malaria that are falciparum malaria (from WHO data6). (A second index of malaria derived from completely different data is described and used below.) For the comparative statistics in this section, severe malaria is defined as having a malaria index of 0.5.
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After the first draft of this article was completed, McCarthy and others (unpublished data) have estimated the impact of malaria on economic growth by use of recently released estimates of malaria morbidity from the WHO.7 By use of a similar
Malaria and poverty are intimately connected. As T. H. Weller, a Nobel laureate in medicine, noted, ‘‘It has long been recognized that a malarious community is an impoverished community.’’1 Weller could have said the same for malarious countries. Malaria is most intractable for countries in the poorest continent, Africa. The only parts of Africa free of malaria are the northern and southern extremes, which have the richest countries on the continent. India, the country with the greatest number of poor people in the world, has a serious malaria problem. Haiti has the worst malaria in the Western Hemisphere, and it is the poorest country in the hemisphere.Malaria risk has always been geographically specific, as shown in Figure 1. Intensive malaria is confined to the tropical and subtropical zone. Poverty is also geographically specific. As shown in Figure 2, poor countries predominate in the same regions as malaria. Almost all of the rich countries are outside the bounds of intensive malaria.A basic problem when studying the macroeconomic impact of malaria is the lack of high-quality data on malaria incidence or prevalence in the most severely affected countries. This study uses an index of malaria prevalence derived from historical maps of the geographical extent of high malaria risk shown in Figure 1 (digitized from maps by Pampana and Russell2 and the World Health Organization3,4 [WHO]). Combined with detailed data on the world population distribution, one can estimate the fraction of the population in high malaria risk areas in each country.5 Because most malaria mortality and severe morbidity is due to one of the 4 malaria species, the malignant Plasmodium falciparum, the index of malaria intensity used in this article is the fraction of the population at risk of malaria multiplied by the fraction of cases of malaria that are falciparum malaria (from WHO data6). (A second index of malaria derived from completely different data is described and used below.) For the comparative statistics in this section, severe malaria is defined as having a malaria index of 0.5.85After the first draft of this article was completed, McCarthy and others (unpublished data) have estimated the impact of malaria on economic growth by use of recently released estimates of malaria morbidity from the WHO.7 By use of a similar
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