* DRUG-RESISTANT MALARIA CARRIED BY MOSQUITOES STAGES DEADLY COMEBACK
BY  * NICHOLAS D. KRISTOF - New York Times


 Age-Old Killers Stalk The World

LP      Her face was calm and soothing, but Mariam Karega's eyes
     brimmed with fear as she cradled little Hussein and nursed him,
     trying to pump life into him along with her milk.
        "I'm losing hope," Karega said, her aching eyes radiating the
     terror of any parent holding a dying child. "He's tiny, and he's
     stopped growing. And although he'd started to walk, now he can't
     anymore. I don't think he'll make it."
TD      It was a sweltering afternoon, and a dozen other villagers sat
     solemnly around Karega and her 15-month-old son, a knowing sympathy
     hanging in the air along with the flies. In this village of
     thatched mud huts in rural Tanzania, in East Africa, the trauma of
     losing a child is almost as common as a scraped knee.
        The children are dying not from something monstrous, such as
     the crocodiles lurking in the nearby Ruvu River. These children are
     dying of mosquito bites.
        In 1996, between 1 million and 3 million people died of
   * malaria, the mosquito-borne disease that has struck Hussein and
   * other children in the village. Most alarming, malaria, far from
     coming under control, is becoming resistant to medications and is
     expanding into new areas. The disease is killing many more people
     than it did a few decades ago.
        For these reasons, the World Health Organization recently
     declared the mosquito "public health enemy No. 1."
        Americans might think of medical care as incalculably complex,
     a world of angioplasty and echocardiograms and other technologies
     that to many people are as incomprehensible as they are
     unpronounceable. But for most people in the world, the challenges
     of health care are simpler: When mothers such as Karega hold dying
     children, it usually is because of something as simple as dirty
     water or a mosquito bite.
        While medical care has made tremendous strides in recent
     decades, some of the most formidable challenges remain the most
     basic: providing people with toilets and clean water, and
     protecting them from deadly mosquitoes. The extraordinary thing
     about the mosquitoes is that in this battle against the best minds
     of 20th-century science and medicine, the mosquitoes might be
     winning.
   *    In the 1950s, experts were optimistic that malaria could be
     wiped out. For a time, DDT and other insecticides led to a sharp
     reduction of mosquitoes and of the disease. But the use of DDT and
     similar chemicals was sharply curtailed because of their harmful
   * environmental effects. Partly as a result, malaria began a long
     upswing around the world in the 1960s and '70s.
   *    In the past decade, malaria has killed about 10 times as many
     children as all wars combined in that period.
   *    Doctors say there is no reason children have to die of malaria.
     They usually can be saved if they get prompt treatment from a good
     doctor. But that often is impossible in the Third World, where
     well-trained doctors are scarce.
   *    Normally, drugs are used to treat malaria, although
     drug-resistant strains are becoming a problem all over the world
     and especially in Southeast Asia. In addition, mosquitoes are
     emerging that are resistant to ordinary insecticides, and,
     together, they make a ferocious combination: super mosquitoes armed
   * with drug-resistant super malaria.
        But the situation is not hopeless. Experts cite a slew of
     technical reasons to argue that with time and money, a successful
     vaccine probably can be developed.
        Until an effective vaccine is developed, experts say, the best
     approach is to keep mosquitoes from biting people. The anopheles
     mosquito tends to bite after dark, and several recent studies have
     suggested that sleeping inside a mosquito net impregnated with
   * insecticide can reduce malaria sharply.
        But many people in Third World countries can't afford mosquito
     nets, or not enough for everyone in the family.
        Nhem Yen, a Cambodian villager, has one small mosquito net --
     and that is the source of her anguish. The 40-year-old woman has
     five children and two grandchildren in her little hut. Every
     evening, she must figure out which children will sleep under the
     net -- and which will sleep outside the net and risk death.
        "It's very hard to choose," she said softly, her children
     clustered around her. "But we have no money to buy another mosquito
     net. We have no choice."