Ervin Dyer, Post-Gazette Young mothers and fathers stand in line at the Arumeru hospital in Arusha, Tanzania, to have their children checked by a doctor, including an exam for malaria. In Tanzania, there is roughly one physician for every 32,000 people. In the Arumeru district, a popular tourist destination near Mount Kilimanjaro, they are lucky -- there's one doctor per 16,000. Click photo for larger image. Online graphic See a graphic that shows how malaria is transmitted and where the disease is most prevalent in the world today. (Note to readers: This is a large graphic, approximately 170k)

ARUSHA, Tanzania -- Around noon, a warm breeze starts plowing through this lush region and pushes into the airy hospital room that Anna Patris shares with a dozen other mothers.

They are in a malaria ward, one of the few in Arumeru, a busy tourist district that sits at the foot of Mount Kilimanjaro.

Mrs. Patris holds her son, Alexander, 2, on her lap.

Under the cover of a moth-splattered white mosquito net, she tenderly whispers sweet nothings while patting him on the back.

Speaking through an interpreter, she says they've been in the ward for two weeks.

Each time Alexander coughs, Mrs. Patris prays that he doesn't die from malaria -- the scourge of Tanzania -- the same disease that took the life of two of her other young children.

In a way, Alexander is fortunate. He's been diagnosed with pneumonia and is recovering, but his mother is right to fear malaria.

She lives at ground zero for the disease: Tanzania. This place has the highest rates of death from malaria in all of sub-Saharan Africa and every 5 minutes here someone dies of the disease.

Malaria stalks the land of the Serengeti, killing 270 people every day and causing more death and sickness than HIV/AIDS as it ravages pregnant woman and children under 5, say health officials. The crisis roils both urban areas and rural villages where, of the 33.4 million people who live here, an estimated 18 million contract malaria each year. Of that figure, 100,000 will die; 80 percent of them children 5 or younger.

"If there is a terrorist," said Dr. Andrew Kitua, director of the National Institute for Medical Research in Dar es Salaam, "our terrorist is malaria."

'Forgotten disease'

Malaria, or the ailment the Italians called "bad air," is the "forgotten disease," said Dr. David Sullivan, an infectious disease specialist at Johns Hopkins University. Centuries old, it is practically eradicated in developed nations and the masses in Africa usually dismiss it as nothing more than a nasty, pesty "sickness" to suffer through. But its severity can't be so easily swatted away.

"It is a dream stealer," said Dr. Sullivan. Malaria haunts young mothers and every 30 seconds kills a child in Africa whose immune system -- many weakened by poor nutrition -- is just no match for the severe anemia and other complications that come with the disease.

It rips through sub-Saharan Africa because the region is plagued by a mosquito population that prefers to bite humans, as opposed to cows or other animals. Tanzania, especially, is bedeviled by Plasmodium falciparum, the most virulent malaria parasite, which accounts for 90 percent of all the recorded cases in the country.

The great majority survive the strain and their bodies go on to develop an immunity to the disease. They don't die, but they do remain forever prone to debilitating attacks. In Tanzania, most know someone who has died from the "sickness" and most take it in stride. That's because for generations their fathers, mothers, brothers, and sisters have been gripped by malaria, some as many as three or four times a year. It leaves them vulnerable, but able to get past the disease's energy-sucking anemia and body aches. Millions of others are not so lucky.

Malaria, unlike HIV/AIDS or cancer, is a silent epidemic. There are few globally recognized advocates screaming about its ugly reality. Yet it is a disease that infects at least 300 million people a year, causing up to 2.7 million deaths around the globe. More than HIV/AIDS. More than cancer. More than tuberculosis.

Sub-Saharan Africa suffers the greatest burden.

Its tropical climate, persistent poverty, and patterns of transmission become a lethal combination that make this region responsible for 80 percent of all malaria deaths.

Enough is enough, cried some 44 African leaders six years ago in Nigeria when they launched "Roll Back Malaria," a strategy aimed at alleviating the death and sickness among women and children, the most vulnerable populations.

There has been some success.

In Kenya, Tanzania's neighbor to the north, hospital rates of malaria mortality have decreased from 22 percent to 7.5 percent.

That's largely because of improvements in a larger clinical staff and the ability to weed out tainted blood when transfusions are needed, said Dr. Douglas Jay Perkins, a parasitic disease specialist from the University of Pittsburgh Medical Center who spends several months a year in rural Kenya, not far from Nairobi.

Kenyans are very cognizant of malaria and the suffering it causes, said Dr. Perkins, because it affects up to 30 percent of their children.

For instance, when the University of Pittsburgh field office in Kenya has a treatment study, parents line up for blocks to enroll their children because the mothers want them to see the physician and avoid the misery of malaria, he said.

	Ervin Dyer, Post-Gazette Children stand in front of their mud and straw home in Usa River village, an area not far from the Arumeru hospital. Underdeveloped infrastructure is a major obstacle to the nation's fight against malaria. Click photo for larger image.

"I think Africa wants the world to be aware of malaria and see it as a moral imperative -- especially with pediatric malaria -- to make gains against this disease," said Dr. Perkins.

Mounting its own battle to break the back of malaria is the goal in Tanzania, which spends 13 percent of its government budget on public health. The nation offers subsidized, insecticide-treated bed nets to families desperate for relief, has authorized limited home-based spraying of insecticide, has signed off on new drug therapies and has launched a public awareness campaign to encourage early treatment.

Funding makes difference

There is evidence that when attention and funding are directed toward malaria, it can make a huge difference.

Three years ago, Zanzibar, an island of 1 million people that's a semi-autonomous part of Tanzania, began receiving $9 million in international grants. With it, the island treated more than 170,000 children, distributed 100,000 nets and improved malaria treatments in all health care centers. They effectively shut down the disease on the island.

Jambiani, a village of 5,000 on the northern coast of Zanzibar, is a sparkling example. It has not had a case of malaria in seven months. Even the schoolchildren know the symptoms and quickly sing "Malaria bye-bye" to reinforce their pride in beating the disease.

Internationally, $600 million is spent on the war against malaria -- 80 percent of which comes from the independent world charity, the Global Fund to Fight AIDS, Tuberculosis and Malaria. The rest comes from bilateral donors like USAID, The World Bank and humanitarian billionaire Bill Gates, who pledged $100 million to fight malaria five years ago. The money does not include malaria research.

A few months ago, medical journals complained that World Bank funding was slow to respond to the suffering in Africa and had misspent funds on ineffective medicines.

Every year, at least $3 billion is needed to battle malaria, said Louis da Gama, an energetic Brit with Global Health Advocates, an international organization that monitors disease control and prevention in Africa.

To get that amount means effectively adding $2.4 billion to the current spending of $600 million.

With the additional funding, said Mr. da Gama, global donors could make sure the resources are there -- new combination drug treatments and some of the badly needed insecticide-treated nets -- to save African youth.

But, he said, "Nobody cares about poor black babies in Africa."

"I'm tired," he said, "of going to rural clinics where moms give me their children and I give them back knowing the babies are going to die."

Economic impact, too

Just as it does with humans, malaria wracks the Tanzanian economy as well.

Crops wither, goods go unsold and children go hungry as farmers and family members miss harvest and time from work. Add in the costs of care, which can be staggering, and missed economic opportunities and malaria robs Tanzania of about $119 million in productivity each year.

Malaria, say health officials, churns the vicious cycle of poverty.

No doubt. While malaria is preventable, treatable and curable, it is exacerbated by a grossly underdeveloped infrastructure.

In Tanzania, there is one physician for every 32,000 people. So, just getting treatment is a monstrous task -- even if families could afford it.

Most cannot. The average income in Tanzania is $1 a day.

Chloroquine, which was safe, cost pennies a day and was widely available, is being phased out as new strains of malaria have grown resistant to it. A new course of remedies, offering a combination of medicines, is $2.50 or less a treatment, but the price remains out of reach for too many. And, millions don't even know the new treatment is available.

Insecticide-treated nets, effective against preventing mosquito bites at night, when the bugs are most active, can cost $2 even when subsidized by the government. The price is prohibitive for families worried about where their next meal is coming from.

Malaria, a parasite carried by a female mosquito, thrives in warm, wet climates. One way to beat it: Get rid of the mosquitoes.

But, without massive spraying of insecticides, that is not likely to happen, and even if it wanted to, Tanzania cannot afford it.

So the poor roads in Tanzania, with their ubiquitous potholes of dirty, stagnant water, become breeding ground for mosquitoes. So do the hollow discarded coconut shells. In Tanzania, rice fields become killing fields because the sloshy wet grounds needed to sustain the crop become havens for mosquito larvae. Still many families grow the rice to feed their families because it sells well at market.

Helping themselves

Slowly, Tanzanians are being educated to save themselves.

More want the nets. In the past, they were too hot to sleep under and many shunned them, preferring to catch a cool breeze.

For those who can, they are seeking better treatment options.

The messages have seeped into rural Arusha, where Mrs. Patris and her husband, Kevin, learned their lessons through tragedy: their children, Kevin, 8, and Nbette, 3 months old, developed "dege dege," a fever indicating an advanced stage of malaria. Shortly after, they both died.

So, when little Alexander got sick and feverish, the family, which raises crops to sell at market, knew it was time to go to the hospital.

"I do what I can now," said Mrs. Patris. "Malaria is not forgotten."