Controversies and Questions Regarding the Three Great Killers in Africa
Main Article Content
Abstract
Introduction: If we speak of the three great killers in the first world (those countries with stable governments and relative affluence in comparison to the developing world), cancer, heart disease, and respiratory diseases (particularly if we include lung cancer) come to mind. In the developing world (third world), the three great killers are infectious diseases. The differentiation between first and third world have been obscured in many nations, where there is a mixture of mixture of problems, both the diseases of the affluent societies and those that have less developed medical systems. This review will focus on the three great killers afflicting sub-Saharan Africa: HIV, TB, and malaria.
Methodology: This manuscript is primarily a literature review of HIV, TB, and malaria using publicly available sources such as Google Search, PubMed and NIH reviews. When using personal experience, it is limited to East Africa, particularly Sudan and South Sudan, where the authors have their primary experience with these diseases.
Article Details
How to Cite
MCINTOSH, J. Clarke; KUOT, China Mayol.
Controversies and Questions Regarding the Three Great Killers in Africa.
Medical Research Archives, [S.l.], v. 13, n. 5, may 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6538>. Date accessed: 21 june 2025.
doi: https://doi.org/10.18103/mra.v13i5.6538.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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23. Sinclair D, Donegan S, Isba R, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD005967. doi: 10.1002/14651858. CD005967.pub4. PMID: 22696354; PMCID: PMC6532684.
24. Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, Bojang K, Olaosebikan R, Anunobi N, Maitland K, Kivaya E, Agbenyega T, Nguah SB, Evans J, Gesase S, Kahabuka C, Mtove G, Nadjm B, Deen J, Mwanga-Amumpaire J, Nansumba M, Karema C, Umulisa N, Uwimana A, Mokuolu OA, Adedoyin OT, Johnson WB, Tshefu AK, Onyamboko MA, Sakulthaew T, Ngum WP, Silamut K, Stepniewska K, Woodrow CJ, Bethell D, Wills B, Oneko M, Peto TE, von Seidlein L, Day NP, White NJ; AQUAMAT group. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010 Nov 13;376(9753):1647-57. doi: 10.1016/S0140-6736(10)61924-1. Epub 2010 Nov 7. Erratum in: Lancet. 2011 Jan 8;377(9760):126. PMID: 21062666; PMCID: PMC3033534.
25. Mathiba RM, Mathivha LR, Nethathe GD. Artesunate compared with quinine for the treatment of severe malaria in adult patients managed in an intensive care unit: a retrospective observational study. S Afr J Crit Care 2019: 35 (1): 13-18.
26. Samal KK, Sahu CS. Malaria and Widal reaction. J Assoc Physicians India. 1991;10:745–747.
27. Tyagi RK, Gleeson PJ, Arnold L, Tahar R, Prieur E, Decosterd L, Pérignon JL, Olliaro P, Druilhe P. High-level artemisinin-resistance with quinine co-resistance emerges in P. falciparum malaria under in vivo artesunate pressure. BMC Med. 2018 Oct 1;16(1):181. doi: 10.1186/s12916-018-1156-x. PMID: 30269689; PMCID: PMC6166299.
28. Lesi AFE, Meremikwu MM. High dose Quinine regime for treating severe malaria. Cochrane Database of Systemic Reviews 2004 (3) Art No: Cd003341. Doi:10:1002/14651858. SD003341.pub2
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30. McIntosh JC Letter to the Editor: Concerns about malaria in South Sudan South Sudan Med J; 2023; 16: 79
31. The Mosquito: A Human History of Our Deadliest Predator. Timothy C. Winegard. Dutton, Penguin Random House, New York, NY, USA, 2019. ISBN (hardcover): 9781524743413; ISBN (ebook): 9781524743437; ISBN (export): 9781524745608
2. Vithalani J, Herreros-Villanueva M. HIV Epidemiology in Uganda: survey based on age, gender, number of sexual partners and frequency of testing. Afr Health Sci. 2018 Sep;18(3):523-530. doi: 10.4314/ahs.v18i3.8. PMID: 30602983; PMCID: PMC6307011.
3. Setiabudiawan TP, Reurink RK, Hill PC, Netea MG, van Crevel R, Koeken VACM, Protection against tuberculosis by Bacillus Calmette-Guérin (BCG) vaccination: A historical perspective, Med, Volume 3, Issue 1, 2022, Pages 6-24, ISSN 2666-6340, https://doi.org/10.1016/j.medj.2021.11.006.
4. WHO bulletin on Tuberculosis March 2025.
5. Snider GL. Tuberculosis then and now: a personal perspective on the last 50 years. Ann Intern Med. 1997 Feb 1;126(3):237-43. doi: 10.7326/0003-4819-126-3-199702010-00011. PMID: 9027277.
6. Apiu GK, Sala L, Iannetti R, McIntosh JC. One year’s experience of extra-pulmonary TB in a county/regional hospital in South Sudan. South Sudan Medical Journal 2022;15(1):12-15
7. Daryoush Samim, Guy Muula, Nicolas Banholzer, Douglas Chibomba, Sihle Xulu, Carolyn Bolton, Denise Evans, Lisa Perrig, Stefano De Marchi, Gunar Günther, Matthias Egger, Thomas Pilgrim, Lukas Fenner, Cardiovascular Involvement in Tuberculosis Patients Treated in Southern Africa, JACC: Advances, Volume 4, Issue 1, 2025, 101427, ISSN 2772-963X, https://doi.org/10.1016/j.jacadv.2024.101427.
8. Barnett TC, Bowen AC, Carapetis JR. The fall and rise of Group A Streptococcus diseases. Epidemiol Infect. 2018 Aug 15;147:e4. doi: 10.1017/S0950268818002285. PMID: 30109840; PMCID: PMC6518539.
9. Kaplan EL, Markowitz M. The fall and rise of rheumatic fever in the United States: a commentary. Internat J Cardio. 1988; 21 (1): 3-10 ISSN 0167-5273
10. Liang Y, Yu D, Lu Q, Zheng Y, Yang Y. The rise and fall of acute rheumatic fever and rheumatic heart disease: a mini review. Front Cardiovasc Med. 2023 May 23;10:1183606. doi: 10.3389/fcvm.2023.1183606. PMID: 37288267; PMCID: PMC10242100.
11. de Loizaga SR, et al. Rheumatic Heart Disease in the US: Forgotten but not Gone. Results of a 10 Year Multicenter Study. Am J Heart Assoc. 2021 17 (10): 1-12.
12. The Decline of Tuberculosis Mortality in the United States and the Influence of the Influenza Epidemic of 1918. American Review of Tuberculosis, 1925; 13(4), pp. 385–391
13. Tuberculosis (TB) Disease in the United States 1993–2023 (CDC slide set, July 2024) Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention National Tuberculosis Surveillance System
14. Tuberculosis Treatment Shortening, Singh V Drug Discovery Today, 2024: 29 (5) 1-8.
15. Treatment of Tuberculosis Guidelines for National Programmes, WHO 2003.
16. Malaria vaccines (RTS,S and R21) WHO bulletin 8 April 2025
17. Mawazo A, Bwire GM, Matee MIN. Performance of Widal test and stool culture in the diagnosis of typhoid fever among suspected patients in Dar es Salaam, Tanzania. BMC Res Notes. 2019 Jun 5;12(1):316. doi: 10.1186/s13104-019-4340-y. PMID: 31167646; PMCID: PMC6551910.
18. Goswami D, Patel H, Betz W, Armstrong J, Camargo N, Patil A, Chakravarty S, Murphy SC, Sim BKL, Vaughan AM, Hoffman SL, Kappe SH. A replication competent Plasmodium falciparum parasite completely attenuated by dual gene deletion. EMBO Mol Med. 2024 Apr;16(4):723-754. doi: 10.1038/s44321-024-00057-7. Epub 2024 Mar 21. PMID: 38514791; PMCID: PMC11018819.
19. Berry, A.A., Richie, T.L., Church, L.W.P. et al. Safety, tolerability and immunogenicity of a condensed, multi-dose prime regimen of PfSPZ Vaccine for the prevention of Plasmodium falciparum malaria infection. Malar J 24, 88 (2025). https://doi.org/10.1186/s12936-025-05299-5
20. Malaria in South Sudan—Past, Present, and Future, WHO bulletin March 2025.
21. Obonyoh K, James A, McIntosh JC. A review of one year malaria blood film data from a hospital in Yei, South Sudan, South Sudan Medical Journal, 2024;17(4):198-1201 © 2024 The Author (s) License: This is an open access article under CC BY-NC Doi: https://dx.doi.org/10.4314/ssmj.v17i4.9
22. Feleke, S.M., Reichert, E.N., Mohammed, H. et al. Plasmodium falciparum is evolving to escape malaria rapid diagnostic tests in Ethiopia. Nat Microbiol 6, 1289–1299 (2021). https://doi.org/10.1038/s41564-021-00962-4
23. Sinclair D, Donegan S, Isba R, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD005967. doi: 10.1002/14651858. CD005967.pub4. PMID: 22696354; PMCID: PMC6532684.
24. Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, Bojang K, Olaosebikan R, Anunobi N, Maitland K, Kivaya E, Agbenyega T, Nguah SB, Evans J, Gesase S, Kahabuka C, Mtove G, Nadjm B, Deen J, Mwanga-Amumpaire J, Nansumba M, Karema C, Umulisa N, Uwimana A, Mokuolu OA, Adedoyin OT, Johnson WB, Tshefu AK, Onyamboko MA, Sakulthaew T, Ngum WP, Silamut K, Stepniewska K, Woodrow CJ, Bethell D, Wills B, Oneko M, Peto TE, von Seidlein L, Day NP, White NJ; AQUAMAT group. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010 Nov 13;376(9753):1647-57. doi: 10.1016/S0140-6736(10)61924-1. Epub 2010 Nov 7. Erratum in: Lancet. 2011 Jan 8;377(9760):126. PMID: 21062666; PMCID: PMC3033534.
25. Mathiba RM, Mathivha LR, Nethathe GD. Artesunate compared with quinine for the treatment of severe malaria in adult patients managed in an intensive care unit: a retrospective observational study. S Afr J Crit Care 2019: 35 (1): 13-18.
26. Samal KK, Sahu CS. Malaria and Widal reaction. J Assoc Physicians India. 1991;10:745–747.
27. Tyagi RK, Gleeson PJ, Arnold L, Tahar R, Prieur E, Decosterd L, Pérignon JL, Olliaro P, Druilhe P. High-level artemisinin-resistance with quinine co-resistance emerges in P. falciparum malaria under in vivo artesunate pressure. BMC Med. 2018 Oct 1;16(1):181. doi: 10.1186/s12916-018-1156-x. PMID: 30269689; PMCID: PMC6166299.
28. Lesi AFE, Meremikwu MM. High dose Quinine regime for treating severe malaria. Cochrane Database of Systemic Reviews 2004 (3) Art No: Cd003341. Doi:10:1002/14651858. SD003341.pub2
29. Mansouri, A., Cregut, M., Abbes, C. et al. The Environmental Issues of DDT Pollution and Bioremediation: a Multidisciplinary Review. Appl Biochem Biotechnol 181,309–339 (2017). https://doi.org/10.1007/s12010-016-2214-5
30. McIntosh JC Letter to the Editor: Concerns about malaria in South Sudan South Sudan Med J; 2023; 16: 79
31. The Mosquito: A Human History of Our Deadliest Predator. Timothy C. Winegard. Dutton, Penguin Random House, New York, NY, USA, 2019. ISBN (hardcover): 9781524743413; ISBN (ebook): 9781524743437; ISBN (export): 9781524745608