Hispaniola is the only malaria endemic island in the Caribbean, with Haiti attributed most of the malaria cases. Tamar Carter has analyzed the genetics of both the human host and the parasite of malaria, specifically Plasmodium falciparum, in order to determine the impacts of malaria on Haitian population health. She has studied the genetic adaptations to malaria found in Haiti, two possible add-on techniques for RBCD screening, and the impacts of human intervention. Carter has determined poverty to be the main culprit for endemic disease; health infrastructure is limited and surveillance and preventative resources are lacking. The 2010 earthquake has increased the recorded cases of malaria, but the cause of this can be due to the increase in attention to Haiti and, therefore, the increase in malaria testing and monitoring or due to the natural disaster itself. Most likely it is due to a combination of the two.
There is a high frequency of red blood cell disorders, including sickle cell disease and G6PD deficiency, with 14.4% and 18.7% of the Haitian population, respectively, carrying these disorders. Only one HbSS individual was identified, an infant, suggesting that HbSS infants are not surviving into adulthood, and that there is a need for broader sickle cell screening. There is a need to inform potential parents of their sickle cell status in order for them to plan and prepare for the health of their child. Carter’s research showed that among the traditional screening methods, spectrophotometry (spec), and insoluble hemoglobin separation (insol), the spec had the highest accuracy of 100%. Interestingly, this was not the recommended method; the insol method was recommended due to its economic feasibility, unlike the more accurate but awfully more expensive spec. Although, it may seem like another case of cost-effectiveness taking precedence over treatment/prevention effectiveness, insol had an accuracy rate of 99.3%, which can increase with wait time for separation.
Remarkably, the Haitian population lacks the Duffy antigen. The majority of the Haitian population, approximately 9.7 million strong, are descendants from West Africa where almost 100% of individuals lack this protein, and Duffy negative is a modification found in West Africa to confer resistance to the P. vivax form of malaria. Very few to no P. vivax malarial infections have been reported in Haiti, and this may be attributed to this mutation.
The primary malaria treatment policy in Haiti is the use of the antimalarial drug primaquine. As Wiley noted in Chapter 8, G6PDd can be dangerous in conjunction with consumption of...