The human host as active agent in malaria epidemiology

The literature on malaria epidemiology tends to view the human host as a passive or constant factor. However, for at least 2000 years people have been an active factor, causing vast changes in epidemiological patterns. They have cut forest and increased the breeding area of An. gambiae, or changed salinity in rice swamps causing a different change in the dominant vector. Human activity not only increases risk, but influences control by killing mosquito larvae, killing adult mosquitos or preventing mosquitos from feeding. For example, people prefer chloroquine or other anti-malarials to traditional herbal remedies that do not kill parasites, and in some areas introduce larvivorous fish into swamp rice fields and cattle ponds. Bed nets impregnated with residual insecticide simultaneously prevent mosquitos from feeding on people and kill adult mosquitos. Preferences and practices in bed net use in the Gambia are described.