Evolutionary and historical aspects of the burden of malaria

Abstract

Malaria is among the oldest of diseases. In one form or another, it has infected and affected our ancestors since long before the origin of the human line. During our recent evolution, its influence has probably been greater than that of any other infectious agent. Here we attempt to trace the forms and impacts of malaria from a distant past through historical times to the present. In the last sections, we review the current burdens of malaria across the world and discuss present-day approaches to its management. Only by following, or attempting to follow, malaria throughout its evolution and history can we understand its character and so be better prepared for our future management of this ancient ill.

FIG. 1.

Phylogeny of the malaria parasites of humans and of some other related malaria parasite species. See the text for sources on which this reconstruction is based.

FIG. 2.

Malaria mortality in the 20th century. The graph shows the total number of deaths due to malaria per year in Europe and North America (⧫—⧫); the Caribbean and Central and South America (▪——▪); sub-Saharan Africa (•——•); China and Northeast Asia (X—X); the Middle East, South Asia, and the Western Pacific (▴——▴); and worldwide (⧫---⧫) (see Appendix and Table 3).

FIG. 3.

Malaria mortality in the 20th century. The graph shows the number of malaria deaths per 10,000 population per year in Europe and North America (⧫—⧫); the Caribbean and Central and South America (▪——▪); sub-Saharan Africa (•——•); China and Northeast Asia (X—X); the Middle East, South Asia, and the Western Pacific (▴——▴); and worldwide (⧫—⧫) (see Appendix and Table 3).

FIG. 4.

Malaria mortality in the 20th century. The graph shows the total number of deaths due to malaria per year worldwide minus sub-Saharan Africa (◊--◊) and in sub-Saharan Africa (•——•) (see Appendix and Table 3).

FIG. 5.

Malaria mortality in the 20th century. The graph shows the number of malaria deaths per 10,000 population per year worldwide minus sub-Saharan Africa (◊--◊) and sub-Saharan Africa (•——•) (see Appendix and Table 3).