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February 16, 2019

Why people in malaria-prone areas behave badly

“Health comes before wealth”. Data by the World Bank shows that for the East Asian tigers, countries we seek to emulate for their rapid economic growth, economic take off only happened after their health and nutritional status had improved. Kenya is still a very unhealthy country.

Maternal and child mortality remains high and infectious diseases like malaria affect the majority of the population. In the counties that were the former Nyanza and Coast provinces malaria is so common that it is classified as being holo-endemic. That means malaria infection in those areas begins early in life, affecting almost all children, with the adults suffering too, leading to the disease being in equilibrium with the population. So many babies and children contract, suffer and die from malaria, adults less so.

One reason for this is the number of times that the population gets bitten. Scientists estimate that every person living in a holo-endemic area gets bitten by a mosquito at least once every three days — 120 times a year, throughout their lives. That is a lot of mosquito bites to scratch. Malaria is so common both for those who suffer it and those who only hear about it that we can sometimes underestimate how deadly the disease is.

Falciparum, the parasite that causes malaria, has been associated with humans for millennia. The agricultural revolution 10,000 years ago that led to an explosion in human population also heralded the spread of malaria around the world until the 19th and 20th century when mainly environmental control measures coupled with improved housing led to control of malaria in developed countries. Countries like Taiwan had a universal malaria eradication campaign in the early 20th century. However, in developing countries malaria remains a major problem. Malaria kills mainly young children, but pregnant women and their unborn babies are also very vulnerable to malaria.

Worldwide, about 10,000 women and 200,000 babies die annually because of malaria in pregnancy. Apart from death, malaria also causes miscarriages, preterm births, and low-birth-weight births. In Kenya at least 30 per cent of all outpatient visits are for malaria. Because the natural pathway of malaria infection is so short, a person is bitten by an infected mosquito, 7-10 days later there are symptoms of fever, malaise, joint pains, headache, in the case of children vomiting, nausea and loss of appetite, followed by some treatment or not; most people imagine that it is an acute illness with no long term effects. In fact malaria behaves more like a chronic illness, there with you as long as you live.

One of the complications of malaria is cerebral malaria, when the parasites enter in the brain cavity. Untreated victims of cerebral malaria die. Treated in the average hospital in Kenya, one out of every three will still die. Of those that survive about one in seven will have some brain impairment. These range from mild learning difficulties to severe cognitive impairment.

Deficits in language, attention and behaviour are common with such people having a reduced ability to initiate, plan, and carry out tasks, that is show initiative. These deficits can increase especially when there are repeated episodes of malaria; remember the average child in Nyanza and Coast is bitten 120 times a year so chances of suffering malaria are high. These repeated episodes of malaria cause anaemia and malnutrition, which adds insult to the brain and body injury already happening.

So a nine-month-old child that learns to drop things develops at 18 months to start throwing things. At that point children do not really have strong impulse control and parents complain of terrible twos. However as the child grows, parental discipline begins to channel a child’s sense of self discovery in ways that conform to what society expects of individuals. The assumption is that the child has the capacity to absorb these lessons and practice what is right.

Malaria robs many of these children of the capacity to reason properly. It should come as no surprise that young adult men in malaria holo-endemic areas behave badly unable to exercise any impulse control. Unfortunately for them, without shoes, jiggers and schistosomiasis infection will rise. The throwing of shoes at the President should not be treated as a political statement but as a sign that there is a serious problem with our health system.

Previous governments did less than the minimum investment for health. County governments have little excuse today and now have many examples of the consequences, some irreversible, of underinvesting in health. Alternatively we could analyse things through shallow political lens, let the police handle the matter, and end up doing nothing to solve the underlying problem but remember, “Health comes before wealth”.

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