Malaria

Counting Bites

The number of malaria cases
is down sharply,for reason good and bad.

AT FIRST blush, the change seems like staggeringly good news. The World Health Organisation (WHO) has just issued a new report on malaria. The agency’s experts estimate that each year there are some 250m cases of malaria globally. That is a huge fall from the previous 350m-500m figure in a 2005 report.
A happy confluence of funding, political will and practical tools is indeed making a difference. Drug treatment that combines artemisinin, a powerful anti-malaria treatment, with other medicines, and the use of insecticide-embedded bed nets, are particularly effective.

Thanks to that, 20-plus countries outside Africa have seen their malaria burden decline in recent years. And even within Africa, which accounts for most of the world’s 880,000 or so malaria deaths each year, a handful of countries have made excellent progress. The number of new malaria cases in Eritrea fell by more than a half between 2001 and 2006. Rwanda and São Tomé and Príncipe made big gains too.
Sadly, the bigger reason for the seeming drop in the total number of malaria cases is the way the WHO counts them, a tricky task in countries with weak health-care systems. Previous reports relied on estimates dating back to the 1950s and 1960s in some countries outside sub-Saharan Africa. The new methodology takes the actual number of malaria cases reported by local health authorities as a starting point. Nearly half the fall comes thanks to counting cases in India by the new method.
The report comes on the eve of a United Nations malaria summit in New York on September 25th. Governments, philanthropic outfits (notably the Gates foundation), activists and celebrities will launch a new global strategy and collect hefty pledges in its support. Campaigners say that malaria’s moment has finally arrived.
If so, the assembled worthies may pay attention to a point made by Amir Attaran of the University of Ottawa. He argues that malaria and similar diseases need to be monitored like the weather, with what he calls “sentinel surveillance networks” throughout the developing world. This is essential both to measure malaria incidence more accurately and to assess the success or failure of various policies.
With enough time and effort, big reductions in malaria caseloads reported in future WHO studies could even be cause for celebration rather than embarrassment.

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Children's Health

Worries in a Bottle

Are commonly used plastics
and medicines harming human health?

IT IS a family nightmare. New parents try to eliminate potential hazards from their children’s lives, but what if hidden dangers lurk in the use of everyday objects and familiar substances, like plastics or medicines? Just imagine if baby-feeding bottles harmed infants’ health, or if a painkiller widely administered to children ended up doing more harm than good.
Activists have long raised concerns about the poorly understood links between the environment and health. Some worry about toxins in the air and the overuse of plastics, while others fret that children are overmedicated. Regulators and industry officials have pooh-poohed such talk, but several studies released this week may lead them to reconsider.

A frequent cause for concern has been bisphenol-A (BPA), a commonly used plastic. The Work Group for Safe Markets, a coalition of American charities and lobbying groups, earlier this year issued a report called “Baby’s Toxic Bottle” that suggested BPA leaches into milk when bottles are heated. Others worry that adults have been harmed by this plastic too, since it is often used to line the inside of drink cans.
Such worries were easily dismissed because they were not backed by scientific evidence—at least until now. A study published this week in the Journal of the American Medical Association analyses the most comprehensive set of data that tracks both a variety of health indicators and concentrations of BPA in urine. The latter matters because when this plastic is absorbed, it quickly passes through the body.
The researchers, led by Iain Lang of Peninsula Medical School at Exeter in south-west England, found that higher urinary concentrations of BPA were associated with heart problems, diabetes and liver complications. They did not find such a correlation with other diseases. Although the study did not include infants, parents using BPA bottles are unlikely to be reassured by these findings.
A separate study in the Lancet will also come as little comfort. A team led by Richard Beasley of the Medical Research Institute of New Zealand studied the link between the use of paracetamol, a painkiller frequently used for young children, and asthma. After scrutinising the health data for children aged six and seven participating in the International Study of Asthma and Allergies in Childhood, they draw a sobering conclusion: use of this drug to tame fevers in children under the age of one is associated with an increased risk of their having asthma when they are six.
So, is this all doom and gloom for parents? Not necessarily. For one thing, these studies are not the final word on a very complex subject. The authors of the paper on paracetamol, for example, admit that “causality cannot be established” from a statistical study such as theirs; to determine whether the link is coincidence or causation, they recommend randomised control trials that look carefully into the long-term effects of paracetamol use. The BPA paper also acknowledges that independent replication and follow-up studies are needed. Another complication is that even a link between asthma and paracetamol needs to be put into the proper context. Any demonstrable harm caused by the use of plastics and painkillers has to be weighed against the benefits they bring, such as reliability and efficacy. They also need to be weighed against the costs and benefits of alternatives.
Simply abandoning two familiar tools of parenthood in a panic might make matters worse: suppose, say, BPA were replaced with new materials that eventually turned out to have even more worrying properties. This week’s studies, although not definitive, do provide enough reason for researchers to redouble their efforts to understand the complex links between a child’s early life and its later health.

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