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May 15, 1996

Malaria: Submerged Awareness

Author Affiliations

Westfield, NY

JAMA. 1996;275(19):1482. doi:10.1001/jama.1996.03530430026032

To the Editor.  —Having worked between 1988 and 1995 in rural Tanzania, I appreciated seeing an article in JAMA regarding the ongoing problems of malaria. However, I would raise some questions regarding the observations made by Dr Olliaro and colleagues.1First, has malaria ever "submerged"? Have morbidity and mortality on a worldwide basis really improved since the introduction of chloroquine, or since the World Health Organization Malaria Eradication Campaign of 1957? I would suggest not. Rather, our consciousness of malaria has submerged due to (1) the heretofore ease of treatment and (2) the acquired immunodefiency syndrome epidemic superseding interest and funding in areas previously known for malaria research and control. Further, the 1993 tally of 805 300 deaths attributed to malaria2 (mostly children) can in no way begin to measure the morbidity—particularly in holoendemic regions—of nearly constant exposure to the parasites. Many deaths due to pneumonia and diarrheal