Malaria in Malawi
Karl Seydel MD, PhD
Blantyre Malaria Project and MSU
International Medicine
College of Osteopathic Medicine
Where is Malawi?
landlocked country in SE Africa, size of Pennsylvania
very tropical, mountainous
population of 14 million (compared to 311 million in the USA)
life expectancy: 39 (compared to 77 in the US) mostly because of HIV
HIV prevalence: 14%, 0.6% here
Population less than 5 years old: 17.2%, 7% here
Infant Mortality: 113, 6 here (out of 1000 live births)
Per Capita Income: $190, compared to $40,100
Physicians: 230, compared to 500,000
Poverty and malaria are intimately linked: malaria causes a huge amount of poverty
Why Malaria?
- killed more people than any other disease in the history of mankind
- caused by five species of parasites
- transmitted by mosquitos and infects erythrocytes
- initially travels to the liver and infects RBCs, which bind to inside of blood vessels
- causes decreased blood flow to brain, coma, seizures, death
- cause of anemia
- many healthy people are parasitemic: completely unknown as to why people die from
malaria
- people who are parasitemic exhibit a wide spectrum of disease
- differences in parasites or differences in hosts?
City of Blantyre, Queen Elizabeth Central Hospital
run by the government, all care is free
understaffed and overcrowded
medical students and unpaid interns, nurses, mothers have lots of care responsibility
2 kids/bed in rainy season, 250 kids/2 nurses
MSU Research Ward at Queen Elizabeth, serves as ICU for the hospital
15 beds/5 nurses
Cerebral Malaria - Pathogenesis
What are the relative roles of host and parasite heterogeneity on disease severity?
host only, parasite only, or mixture of host and parasite?
DNA sequencing, RNA analysis, and small molecule analysis of host and
parasite from a variety of disease severities
Another mystery: Why such a rapid recovery?
20% of kids die, but if they are going to recovery it will happen within 36 hours
Malawi MRI donated from GE
- rapid recovery due to rapid decrease in brain swelling
- brain matter is pushed down into spinal cord at admission due to swelling
- respiratory center is affected, causing a herniation and breathing to stop
- so why does the brain swell?
Ongoing studies
- further scanning modalities to determine etiology of edema
- autopsy studies on those that die
- planned clinical trial to reduce edema even faster
How to Combat Malaria
- bed nets and pesticide spraying reduces disease ~50%
- prompt treatment of the most severe form of malaria with IV Artesunate reduces
mortality ~90%
- the search for a vaccine has been a goal for over 40 years
- no vaccine is going to be 100% effective
- a multifaceted approach is going to be necessary for disease eradication
Why you should go abroad
1. It will definitely change your life outlook -- Malawians are poor but NOT miserable
2. You will experience things NEVER found in the US
3. It will challenge you and expand your boundaries
most beautiful, most ugly, most exhilirating, most depresssed, most tired, most
fatigued, most overwhelmed, most hopeful, most painful
Dr. Seydel
bio major, enjoyed research
took a year off to work in the lab, do clinical rotations
MD/PhD
clinical internship
research for 6 years on Malaria at the NIH
now spends 50% on the ward, 50% researching