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For this assignment, I have opted to focus on malaria due to my limited familiarity with the disease. I perceive this as an opportunity to acquire a comprehensive understanding of the subject, and I commenced by compiling a concise list of areas and topics that warrant further exploration. My aim is to acquaint myself with the historical, current, and potential future aspects of malaria, as I believe it will establish a strong foundation for my research. Additionally, I'm intrigued to examine how the disease is managed differently as an epidemic versus an endemic, as it will significantly enhance my comprehension of these scenarios. Being a sociology student, I'm also interested in exploring the sociological factors that contribute to the spread and prevention of the disease, including the impact of the economy and climate change on its transmission.
Malaria: historical aspects
Due to historical documentation challenges, finding an accurate timeline of malaria's evolution since its inception is quite difficult. Nevertheless, with patience and after reviewing numerous peer-reviewed scholarly articles and non-academic sources, I have managed to gain insights into the extensive history of malaria. This disease has afflicted individuals throughout the ages, ranging from Neolithic dwellers and early Chinese and Greeks to princes and paupers.
Ancient writings and artifacts provide compelling evidence of malaria's enduring presence. Clay tablets with cuneiform scripts from Mesopotamia describe deadly fevers that suggest malaria. Recent discoveries include malaria antigen detected in Egyptian remains dating from 3200 and 1304 BC. The spread of malaria into Rome during the first century AD marked a turning point in European history. It is highly likely that the disease traveled from the African rainforest down the Nile to the Mediterranean, then expanded east to the Fertile Crescent and north to Greece (Arrow, Panosian, and Gelband 2004). Given the limited knowledge of diseases during those times, it is reasonable to assume that many regarded malaria as something else, such as witchcraft or other illnesses. Myths attributing fevers to evil spirits further contributed to stigmatizing those afflicted with malaria and other diseases until the true nature of malaria was finally revealed (Neghina and Iacobiciu 2010).
In the mid-18th century, the term "malaria" was defined, derived from the Italian word "mal'aria," meaning "bad air." Originally, it denoted the unwholesome atmosphere emanating from marshes, to which the disease was formerly attributed (Malaria n.d.). This linguistic evolution demonstrates the gradual advancement in understanding the disease. Today, we know that malaria is caused by protozoan parasites of the genus Plasmodium transmitted by female Anopheles mosquitoes. This knowledge stems from Alphonse Laveran's discovery of parasites in the blood of malaria patients in 1880, and William MacCallum's identification of sexual stages in the blood of birds infected with Haemoproteus columbae in 1897. Ronald Ross, in the same year, elucidated the transmission cycle in culicine mosquitoes and birds infected with Plasmodium relictum. Eminent malariologists Giovanni Battista Grasso, Amico Bignami, Giuseppe Bastianelli, Angelo Celli, Camillo Golgi, and Ettore Marchiafava further demonstrated that human malaria is transmitted by mosquitoes (Cox 2010).
Henry Shortt and Cyrill Garnham made groundbreaking discoveries in 1948 regarding malaria parasites developing in the liver before entering the blood. In 1982, Wojciech Krotoski unveiled the dormant stages of the parasite in the liver (Cox 2010). As a result of these findings and ongoing research, the management of malaria has undergone significant changes, particularly in the past 15 years, both on individual and population levels. The implementation of Artemisinin-based combination therapies (ACT) and widespread distribution of insecticide-treated bed nets played crucial roles in significantly reducing malaria transmission worldwide (Plewes et al. 2018).
Through my research on malaria, I have come to understand the complexity of completely eradicating its spread due to the intricate life cycle of the malaria parasite. On one hand, the parasite's life cycle presents obstacles to drug development. However, the revelation of novel biochemical pathways in P. falciparum opens new avenues for antimalarial drug development. Incorporating genomics-based drug identification, novel screening models, structural biology, and efficient drug design into antimalarial research promises rapid progress in the development of new drugs to combat malaria (Sahil et al. 2018).
Malaria: Social factors
Now that I have gained a solid understanding of malaria's past, present, and potential future, I am keen on exploring the distinctions between epidemics and endemics, specifically concerning malaria. Subsequently, I wish to delve into the social factors influencing the spread and prevention of malaria. An epidemic is defined as a disease affecting many people simultaneously and spreading from person to person in a region where the disease is not continuously prevalent (Epidemic n.d.). In contrast, an endemic refers to a disease regularly found among specific people or in certain areas (Boskey 2018). It is worth noting that an epidemic of malaria can occur in endemic areas for various reasons, such as an influx of healthy hosts or partially infected individuals entering a malaria-prone region. Furthermore, an epidemic may arise if infected individuals relocate to an area previously free from malaria, where the conditions favor the disease's spread, thus initiating an epidemic. My research also indicates that partial eradication of mosquitoes or incomplete regional treatment programs can trigger reoccurrences of epidemics (Honor Society of Nursing n.d.). This highlights the importance of thorough planning and timely execution to prevent such outbreaks and their dire consequences.
During the brainstorming phase of this assignment, I couldn't help but ponder the potential impact of climate change on malaria transmission. My assumptions were substantiated by my findings, which revealed that climate change could lead to an increase in malaria cases in some regions, while having little to no impact in others. General Circulation Model-based scenarios of anthropogenic global climate change predict widespread increases in the risk of malaria due to the expansion of areas conducive to the disease's proliferation. These predicted increases are particularly prominent at the borders of endemic malaria areas and at higher altitudes within those regions. Southeast Asia, South America, and parts of Africa, where malaria is less endemic, are projected to be among the areas that may experience an increase in malaria cases due to climate change (Martens et al. n.d.). Failure to take appropriate interventions could lead to a rise in fatalities in these regions.
Apart from temperature and precipitation changes resulting from climate change, other factors, such as government prevention programs, population size, acquired immunity levels, and preparedness of healthcare personnel, can also influence malaria transmission (Feldscher 2017). These variables vary across regions, and cultural backgrounds also play a role in disease treatment and management. For instance, my class discussions on malaria revealed differing perceptions of the efficacy of free versus more expensive drugs. Such variations in interpretation underscore the importance of tailoring approaches according to the population being served. Although malaria is not transmitted directly from person to person, precautions are necessary since the disease can be contracted through blood transfusions, organ transplants, or sharing needles with an infected person (Honor Society of Nursing n.d.). Infants, children, and pregnant women are particularly vulnerable, and travelers to malaria-endemic regions must be informed and take necessary precautions to safeguard themselves from the disease.
In conclusion, my research on malaria has emphasized the significance of considering sociological and cultural factors when dealing with the spread of diseases. What may seem like the most effective preventive measures, such as quarantine and isolation, may not always be practical due to various social and cultural factors. Stigmatization of the afflicted can also hamper disease management efforts. Climate change, human actions, and medical funding all impact the spread and prevention of malaria. By examining past ideologies and comparing them to present ones, and by predicting future scenarios, we gain valuable insights that aid in crafting effective strategies for disease management. While I may never encounter malaria on a personal level, I believe this knowledge is vital, and I eagerly anticipate further learning in the coming weeks.
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