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Every 12 seconds, a child dies of malaria. New initiatives to prevent and treat malaria could save the lives of one-fourth of these children by the turn of the century.

When Americans think of childhood diseases, we rarely think of malaria. Yet it is a leading cause of death among the world’s children. More than 2.5 million die of malaria each year, most of them in Africa. And those who survive chronic infection suffer a combination of anemia and immune suppression that leaves them vulnerable to other fatal illnesses.

Among adults living in areas of high transmission, malaria is best thought of as a chronic, debilitating illness that robs its victims of years of productivity. A single mosquito bite can transmit one of the four parasites that cause malaria, setting in motion bouts of fever, chills, and nausea that can recur for weeks. And in some areas, people receive as many as 300 infective bites per year. According to a 1993 World Bank report, malaria represents a global public health burden second only to tuberculosis among infectious diseases. In sub-Saharan Africa, where most cases of malaria and nearly all malaria-related deaths occur, more years of life are lost to malaria than to any other disease.

Despite massive efforts to eradicate the disease in the 1950s and early 1960s, there is more human malaria in the world today than at any other time in history. More than 500 million people are infected with malaria worldwide; one fourth of the world’s population is at risk for infection. And the risk is rising as environmental changes and large-scale migration bring people and mosquitoes together and as parasites develop resistance to successive generations of drugs.

Malaria has confounded some of the best minds of this century. A hundred years after the discovery that mosquitoes transmit malaria, we still do not know enough about the disease to defeat it permanently. But we do have the tools to limit its spread and dramatically reduce the rate at which children are dying. Our goals should be to reduce childhood mortality from malaria by at least one fourth before the turn of the century, by half in its first decade, and by more than 90 percent in its second decade. By reexamining both the successes and the failures of the past, we can develop a more effective, comprehensive public health strategy to contain and control this lethal opponent.

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