MALARIA IN THE AFRICAN HIGHLANDS - PAST, PRESENT AND FUTURE

Many of the first European settlers in Africa sought refuge from the h eat and diseases of the plains by moving to the cool and salubrious hi ghlands. Although many of the highlands were originally malaria free, there has been a progressive rise in the incidence of the disease over the last 50 years, largely as a consequence of agroforestry developme nt, and it has been exacerbated by scarce health resources. In these a reas of fringe transmission where the malaria pattern is unstable, epi demics may be precipitated by relatively subtle climatic changes. Sinc e there is little immunity against the disease in these communities, o utbreaks can be devastating, resulting in a substantial increase in mo rbidity and death among both children and adults. We present here the results obtained using a mathematical model designed to identify these epidemic-prone regions in the African highlands and the differences e xpected to occur as a result of projected global climate change. These highlands should be recognized as an area of special concern. We furt her recommend that a regional modelling approach should be adopted to assess the extent and severity of this problem and help improve diseas e surveillance and the quality of health care delivered in this unstab le ecosystem.