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      How malaria was ‘weaponised’ by the British Army during World War I

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      MalariaWorld Journal
      Dutch Malaria Foundation

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          Abstract

          During the first World War (1914-1918), the British Army found itself confronting enemy armies in several countries in which malaria potentially hampered its ability to engage with the enemy. This article contrasts how it dealt with malaria on two of these fronts, the Macedonia front and the Palestine front. One front resulted in a failure of the Army to protect itself against the disease, with the other front resulting in successful protection of its troops, enabling those troops to create a decisive victory. The paper briefly explains the major differences between the two fronts, including the different attempts to deal with the disease, and draws lessons for contemporary malaria elimination efforts.

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          Most cited references9

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          Anti-mosquito measures in Palestine during the campaigns of 1917–1918.

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            Malaria’s contribution to World War One – the unexpected adversary

            Malaria in the First World War was an unexpected adversary. In 1914, the scientific community had access to new knowledge on transmission of malaria parasites and their control, but the military were unprepared, and underestimated the nature, magnitude and dispersion of this enemy. In summarizing available information for allied and axis military forces, this review contextualizes the challenge posed by malaria, because although data exist across historical, medical and military documents, descriptions are fragmented, often addressing context specific issues. Military malaria surveillance statistics have, therefore, been summarized for all theatres of the War, where available. These indicated that at least 1.5 million solders were infected, with case fatality ranging from 0.2 -5.0%. As more countries became engaged in the War, the problem grew in size, leading to major epidemics in Macedonia, Palestine, Mesopotamia and Italy. Trans-continental passages of parasites and human reservoirs of infection created ideal circumstances for parasite evolution. Details of these epidemics are reviewed, including major epidemics in England and Italy, which developed following home troop evacuations, and disruption of malaria control activities in Italy. Elsewhere, in sub-Saharan Africa many casualties resulted from high malaria exposure combined with minimal control efforts for soldiers considered semi-immune. Prevention activities eventually started but were initially poorly organized and dependent on local enthusiasm and initiative. Nets had to be designed for field use and were fundamental for personal protection. Multiple prevention approaches adopted in different settings and their relative utility are described. Clinical treatment primarily depended on quinine, although efficacy was poor as relapsing Plasmodium vivax and recrudescent Plasmodium falciparum infections were not distinguished and managed appropriately. Reasons for this are discussed and the clinical trial data summarized, as are controversies that arose from attempts at quinine prophylaxis (quininization). In essence, the First World War was a vast experiment in political, demographic, and medical practice which exposed large gaps in knowledge of tropical medicine and unfortunately, of malaria. Research efforts eventually commenced late in the War to address important clinical questions which established a platform for more effective strategies, but in 1918 this relentless foe had outwitted and weakened both allied and axis powers.
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              The epidemiology and control of malaria in Palestine.

              IJ Kligler (1930)
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                Author and article information

                Journal
                Malariaworld J
                Malariaworld J
                MWJ
                MalariaWorld Journal
                Dutch Malaria Foundation
                2214-4374
                1 August 2023
                2023
                : 14
                : 2
                Affiliations
                [1 ]BC Business Centrum, Elscot House, Arcadia Avenue, London N3 2JU, United Kingdom.
                Author notes
                Article
                10.5281/zenodo.8203655
                10395414
                f575f4dc-a7ce-40bb-88dc-0985e9a49c0a
                Copyright © 2023 Alexander

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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                Opinion Article

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