Talk:Malaria/GA2

GA Review

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Reviewer: Biosthmors (talk · contribs) 18:48, 21 May 2012 (UTC)

I'll do this. Biosthmors (talk) 18:48, 21 May 2012 (UTC)

Some addressed comments

Lead comments

In the lead, change "The disease results from the multiplication of Plasmodium parasites" --> "The protists act as parasites"? Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• Better, changed. Sasata (talk) 04:50, 23 May 2012 (UTC)

::*Maybe also specify that they "The protists first infect the liver, then act as parasites..." to summarize #Pathogenesis

• Done. Sasata (talk) 16:08, 6 June 2012 (UTC)

Specify if disease from P. knowlesi infection also mild? Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• Done. Sasata (talk) 04:50, 23 May 2012 (UTC)

The fourth paragraph of the lead seems like it should be swapped with the third. That way "Despite a clear need" is much more clear. Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• I've reorganized the lead. Sasata (talk) 04:50, 23 May 2012 (UTC)

The four significant figures in the estimate aren't necessary. Consider reducing all estimates to two sig figs. In general, I think there is undue recentism on comparing WHO numbers to The Lancet numbers. Also, I think readers would be better informed by recent historical averages and trends. Something more like "Over 200 million cases of malaria are estimated to occur annually, with around a million deaths per year attributed. In the 2000s, a trend of X (or not) was observed with ..." Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• I agree completely and have reduced the details. Need to read some more about trends, as I've seen different conclusions from different sources. Sasata (talk) 04:50, 23 May 2012 (UTC)

Signs and symptoms comments

Link hemolytic anemia instead Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• Ok. Sasata (talk) 05:51, 23 May 2012 (UTC)

"has been found to" --> can Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• This phrase has been removed. Sasata (talk) 05:51, 23 May 2012 (UTC)

Start a prognosis section (per this) with the info about neurologic damage and the sentences that start at "Severe malaria can progress extremely rapidly..." Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• Good idea, done. Sasata (talk) 05:51, 23 May 2012 (UTC)

Per that guideline also consider a classification section to introduce important malarial variants such as severe, cerebral, etc. Biosthmors (talk) 20:16, 21 May 2012 (UTC)

• Will ponder about the best way to present this and get back to you. Sasata (talk) 05:51, 23 May 2012 (UTC)

• Severe is defined now in the diagnosis section. I think we're good for now but maybe a FA-level article should include this type of section. Biosthmors (talk) 19:21, 26 June 2012 (UTC)

Cause comments

The material that starts with "Malaria parasites contain..." seems like it belongs in the Research section Biosthmors (talk) 20:16, 21 May 2012 (UTC)

Perhaps reword a sentence to "The primary hosts for malaria parasites are female mosquitoes of the Anopheles genus, who act as transmission vectors to humans and other vertebrates, the secondary hosts." And make one link in the sentence as double linking occurs with secondary hosts and definitive hosts both going to host (biology). Biosthmors (talk) 19:50, 22 May 2012 (UTC)

"and the infected Anopheles mosquitoes carry" --> "and the infected Anopheles mosquitoes eventually carry" as the following sentences detail the steps after initial infection. Biosthmors (talk) 19:50, 22 May 2012 (UTC)

In "Life cycle" change the instances that only refer to an "infected human" to an "infected vertebrate". Biosthmors (talk) 19:50, 22 May 2012 (UTC)

"This type of transmission is occasionally referred to as anterior station transfer. The sporozoites are injected into the skin, alongside saliva, when the mosquito takes a subsequent blood meal." Might the order of these sentences be reversed? Biosthmors (talk) 19:50, 22 May 2012 (UTC)

"(i.e., relapses begin the year after the mosquito bite)" --> "with relapses beginning the year after the mosquito bite"? Biosthmors (talk) 19:50, 22 May 2012 (UTC)

• Have implemented all the suggestions/fixes above. Sasata (talk) 05:51, 23 May 2012 (UTC)

"Parasitic Plasmodium species also infect birds, reptiles, monkeys, chimpanzees and rodents.[13] There have been documented human infections with several simian species of malaria; however, with the exception of P. knowlesi—a zoonotic species that causes malaria in macaques[10]—these are mostly of limited public health importance.[14]" could go into a new "In other animals" section. Biosthmors (talk) 20:23, 23 May 2012 (UTC)

Pathogenesis comments

"Malaria develops via two phases: an exoerythrocytic and an erythrocytic phase. The exoerythrocytic phase involves infection of the hepatic system, or liver, whereas the erythrocytic phase involves infection of the erythrocytes, or red blood cells." --> "Malaria infection develops in two phases: one which involves the liver, or hepatic system (exoerythrocytic), and one which involves red blood cells, or erythrocytes (erythrocytic)."? Biosthmors (talk) 20:23, 23 May 2012 (UTC)

• Better, changed. Sasata (talk) 17:53, 25 May 2012 (UTC)

"High endothelial venules (the smallest branches of the circulatory system) can be blocked by the attachment of masses of these infected red blood cells. The blockage of these vessels..." is followed by a source but I didn't see the word HEVs mentioned in the source. That HEVs are the smallest branches of the circulatory system comes off as an extraordinary claim needing a citation. Biosthmors (talk) 20:23, 23 May 2012 (UTC)

• I couldn't verify the statement using other sources either, so I've removed it. Sasata (talk) 17:53, 25 May 2012 (UTC)

"Fertilization and sexual recombination of the parasite occurs in the mosquito's gut. (Because sexual reproduction of the parasite defines the definitive host, the mosquito is the definitive host, whereas humans are the intermediate host.)" I'm not sure the sentence in parenthesis is there for a good reason. It seems to be there just to teach readers the definitions of "intermediate host" and "definitive host". Maybe that's necessary but I think that should occur up in the Cause#Life cycle sentence "The definitive hosts for malaria parasites are female mosquitoes of the Anopheles genus, which act as transmission vectors to humans and other vertebrates, the secondary hosts." if helpful. Biosthmors (talk) 20:23, 23 May 2012 (UTC)

• Changed as suggested. Sasata (talk) 05:56, 28 May 2012 (UTC)

Also under #Genetic resistance the first sentence "Malaria is thought to have been the greatest selective pressure on the human genome in recent history" might be beefed up in certainty as the lead of the main article says "Malaria has placed the strongest known selective pressure on the human genome since the origination of agriculture within the past 10,000 years.^[2][3]" Biosthmors (talk) 20:23, 23 May 2012 (UTC)

• Done, and added another recent review to corroborate this strong statement. Sasata (talk) 05:56, 28 May 2012 (UTC)

The sentence that starts with "To be clear..." in #Malarial hepatopathy could specify that "malarial hepatitis" is not used in hepatitis+ cases (if this is accurate) and that inflammation is key to hepatitis. Maybe something like, "Hepatitis, which is characterized by inflammation of the liver, is not actually present in what is called 'malarial hepatitis'; the term invokes the reduced liver function associated with severe malaria." Biosthmors (talk) 20:23, 23 May 2012 (UTC)

• I like that wording, now changed. Sasata (talk) 06:28, 28 May 2012 (UTC)

Diagnosis comments

"discovered" --> "developed"? Biosthmors (talk) 19:16, 30 May 2012 (UTC)

• Done. Sasata (talk) 17:43, 4 June 2012 (UTC)

Prevention comments

I'm not sure why "used to prevent the spread of disease, or to protect individuals in areas where malaria is endemic" couldn't be shortened to "to prevent malaria". Biosthmors (talk) 20:54, 23 May 2012 (UTC)

• Done. Sasata (talk) 18:18, 26 May 2012 (UTC)

"continued existence" --> "presence". Biosthmors (talk) 20:54, 23 May 2012 (UTC)

• Done. Sasata (talk) 18:18, 26 May 2012 (UTC)

The phrase "can be controlled" regarding the economist's estimate is vague. Maybe it has a specific definition which should be included, if there is one. Biosthmors (talk) 20:54, 23 May 2012 (UTC)

• I've removed this estimate after reading the original paper the news reports cites. Sachs doesn't really give a clear definition of what he considers "comprehensively controlled", and papers (e.g. PMID 20649972) have been published concerning the exact meaning of terms like "control" and "elimination"; further, his estimate was for a specific time frame (2007–2010) and limited to Africa. Sasata (talk) 06:32, 6 June 2012 (UTC)

I recommend removing "conducive country conditions, a targeted technical approach using a package of effective tools" as they sound like vague PR speak and a fancy sounding summary of the following factors, which individually make more sense. Biosthmors (talk) 20:54, 23 May 2012 (UTC)

• Done. Sasata (talk) 18:18, 26 May 2012 (UTC)

The paragraphs that start with "A 2008 study..." and "Brazil, Eritrea, India, and Vietnam..." both cite primary studies, so I am not sure how giving this much weight to these two primary studies is in line with the guideline for sourcing standards (WP:MEDRS). Trim/use secondary sources? But I wouldn't want us to lose content that puts the global picture in context either. Biosthmors (talk) 20:54, 23 May 2012 (UTC)

• I removed the info cited to these studies and replaced with some analysis sourced to a 2010 review. There's a lot more that could be said, so let me know if you think more discussion is warranted. Sasata (talk) 06:32, 6 June 2012 (UTC)

In the picture caption remove "very"? Biosthmors (talk) 19:16, 30 May 2012 (UTC)

• Done. Sasata (talk) 17:24, 4 June 2012 (UTC)

Under #Medications I think "and proguanil hydrochloride (Malarone)" should be "or proguanil hydrochloride (Malarone)," with a comma at the end. Or maybe a pair of em dashes could segregate the three medications. Biosthmors (talk) 19:16, 30 May 2012 (UTC)

• Malarone is a combination of atovaquone and proguanil, so the word is needed there, but perhaps you meant the previous "and" (", and the combination of"), which I've now switched to the correct "or". Used emdashes as suggested. Sasata (talk) 17:24, 4 June 2012 (UTC)

"Quinine was used historically; however, the development of more effective alternatives such as quinacrine, chloroquine, and primaquine in the 20th century reduced its use." This seems like it should be incorporated into the history section per the MEDMOS guideline. Biosthmors (talk) 19:16, 30 May 2012 (UTC)

• Done. Sasata (talk) 07:04, 6 June 2012 (UTC)

Under #Vector control there is "In 2002, there were 1,059 cases of malaria reported in the US, including eight deaths, but in only five of those cases was the disease contracted in the United States." It should be sourced and in the epidemiology section, but it is a bit random so maybe exclude or expand to include multiple years. Biosthmors (talk) 19:16, 30 May 2012 (UTC)

• In retrospect it does seem a bit random, so I've removed it for now. Sasata (talk) 16:04, 6 June 2012 (UTC)

The part that says malaria was "successfully eradicated or controlled also in several tropical areas by removing or poisoning the breeding grounds of the mosquitoes or the aquatic habitats of the larva stages, for example by filling or applying diesel oil to places with standing water" seems to imply diesel oil was successful. I didn't see that verified so I suggest changing diesel oil to Paris Green as that is what the Lancet source appears to credit in Brazil and Egypt. As Paris Green is an outdated technique due to its toxicity, maybe it should go in the history section too. Biosthmors (talk) 19:16, 30 May 2012 (UTC)

• Changed to Paris Green per sources, but am not convinced that every mention of a historical technique should be transferred to the history section... will ponder higher-level organization some more. Sasata (talk) 16:04, 6 June 2012 (UTC)

In #Vector control the paragraphs that start with "Sterile insect technique..." and "Another way to..." completely cite primary studies or news pieces, not the standard WP:MEDRS. One review I spotted from 2011 that has been cited 6 times is doi:10.1007/s00436-010-2232-0. Biosthmors (talk) 20:03, 6 June 2012 (UTC)

• Combined and rewrote the two offending paragraphs (they both fall into the category of "genetic manipulation"), removed the less-than-ideal sources, and sourced to suggested review. Sasata (talk) 05:45, 12 June 2012 (UTC)

In #Mosquito nets and bedclothes "help keep mosquitoes away from people and greatly reduce the infection and transmission of malaria" --> "provide a barrier to significantly reduce the transmission of malaria"? It sounds like the sentence is also saying "reduce the infection of malaria" which is awkward. Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Tweaked prose. Sasata (talk) 18:07, 12 June 2012 (UTC)

"only 13%" --> "only about 13%" or "little more than 10%" or "a minority"? It seems odd to confidently put a precise number on it. Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Changed to "about 13%". Sasata (talk) 18:07, 12 June 2012 (UTC)

"center of a bed such that it drapes down and covers the bed completely" --> "center of a bed to drape over it completely"? Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Done. Sasata (talk) 18:07, 12 June 2012 (UTC)

There's nothing about bedclothes. Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Trimmed subheader. Sasata (talk) 18:07, 12 June 2012 (UTC)

In #Other methods "Education in recognizing the symptoms of malaria has reduced the number of cases in some areas of the developing world by as much as 20%" needs a cite. Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Couldn't source this figure specifically, so made the text more general, and added citations. Sasata (talk) 19:49, 12 June 2012 (UTC)

"a killer" --> "fatal" Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Done. Sasata (talk) 19:49, 12 June 2012 (UTC)

The mosquito laser sounds cool but I think we need some medical sources instead of physics ones here so that content might need removing. Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Agree, removed. Sasata (talk) 06:20, 12 June 2012 (UTC)

Other comments

In signs and symptoms, link "severe malaria" down to the classification section in diagnosis? Biosthmors (talk) 19:21, 26 June 2012 (UTC)

• Done. Sasata (talk) 16:05, 29 June 2012 (UTC)

In Prevention#Medications can we move it down towards the bottom of the section and specify it is for travelers at the beginning? I think the section should start off with how to prevent malaria in people who live in endemic areas. Biosthmors (talk) 19:38, 27 June 2012 (UTC)

• Done x 2. Sasata (talk) 16:05, 29 June 2012 (UTC)

I think the DDT content in Prevention#Indoor residual spraying might over-imply the idea that "backlash against DDT was too severe and it should be used more for this purpose." The article says:"Since the use of DDT has been limited or banned for agricultural use for some time, DDT may now be more effective as a method of disease-control" while the absract of the source it cites says:"There are signs that more malaria vectors are becoming resistant to the toxic action of DDT, and that resistance is spreading to new countries." Many things may be true, but I think the prevention section in general highlights potential or plausible things too much. Biosthmors (talk) 19:48, 27 June 2012 (UTC)

• I've removed this sentence; see also below. Sasata (talk) 07:11, 4 July 2012 (UTC)

In #IRS see the sentence "Although DDT has never been banned for use in malaria control and there are several other insecticides suitable for IRS, some advocates have claimed that bans are responsible for tens of millions of deaths in tropical countries where DDT had once been effective in controlling malaria" is followed by the editorial comment of "these claims seem less and less notable". Can we get a MEDRS for this content or remove it? Seems a bit ORish. I doubt this sentence is sourced to the French language reference. Biosthmors (talk) 20:03, 6 June 2012 (UTC)

• I'm reluctant to outright remove this, for fear of sweeping a valid opinion under the rug (WP:NPOV and all). Instead, I've attributed the statement to Robert Gwadz of the NIH and cited the paragraph more accurately. Sasata (talk) 17:17, 12 June 2012 (UTC)

• Link to another page number? Page 3 of 7 doesn't have Gwadz saying that as far as I can tell. Biosthmors (talk) 18:55, 26 June 2012 (UTC)

• Oops – page 4. Sasata (talk) 15:36, 29 June 2012 (UTC)

• Thanks. I also think this type of non WP:MEDRS doesn't belong in the Prevention section. And maybe we can get more and/or better estimates. And the article text currently reads "said in 2007 that bans are responsible for tens of millions of deaths" while when quoted he only said "may have killed 20 million children". The word may is imprecise; is he only 2% confident the actual number is that high, or is he 40% confident that the number is higher? Maybe something like "possibly 20 million children died due to the difficulty in accessing DDT after agricultural bans." Then that begs the question (for FA, I guess): why was it so hard to get a hold of for approved uses? Were chemical companies afraid of possible penalties from regulators? Were there no vendors with licenses to sell DDT in the African countries? Were the profit margins to set up shop selling it too small or non-existent? Biosthmors (talk) 20:15, 3 July 2012 (UTC)

• After some reflection, I understand your point better now and agree that it's best here to stick with simple explanations of what works and why. I've removed the paragraph on DDT-use apologetics; opinions on the merits of DDT in malaria prevention can be more fully elucidated in the daughter articles. Sasata (talk) 07:11, 4 July 2012 (UTC)

In Epidemiology, if the WHO estimate based off of documented cases while the Lancet estimate is not, I think that should be stated. Biosthmors (talk) 20:46, 2 July 2012 (UTC)

• Good idea, done. Sasata (talk) 07:34, 4 July 2012 (UTC)

• That looks great, maybe in the lead put the word "documented" and that estimates that include undocumented cases are higher? Biosthmors (talk) 20:01, 5 July 2012 (UTC)

• I added "documented", but think that the notion that undocumented cases are higher is perhaps too obvious to state explicitly here? Also, the disparity in documented/undocumented death stats is mentioned in the following sentence. Sasata (talk) 08:19, 21 July 2012 (UTC)

Should IRS and mosquito nets have level 4 headings under "Vector control" in Prevention? Biosthmors (talk) 20:15, 3 July 2012 (UTC)

• Makes sense, done. Sasata (talk) 07:14, 4 July 2012 (UTC)

The first sentence of the Treatment section -- "When properly treated, people with malaria can usually expect a complete recovery" -- sounds like it should start of the Prognosis section. Biosthmors (talk) 20:47, 9 July 2012 (UTC)

• Agree, moved. Sasata (talk) 08:06, 21 July 2012 (UTC)

Under Cause, the first sentence has the words "are genus". Maybe this wording is standard. If not then "are of genus" or "are from genus"? Biosthmors (talk) 20:02, 13 July 2012 (UTC)

• Fixed. Sasata (talk) 08:06, 21 July 2012 (UTC)

Is the sentence in Epidemiology, "The global endemic levels of malaria have not been mapped since the 1960s", contradicted by the 2007 publication/folowing sentence? If so it seems unnecessary. Biosthmors (talk) 20:59, 27 July 2012 (UTC)

• Removed contradictory statement and reorganized text. Sasata (talk) 20:41, 29 July 2012 (UTC)

In Treatment#Uncomplicated malaria put a year on the emergence(s) instead of saying recently? Biosthmors (talk) 22:26, 27 July 2012 (UTC)

• Done. Sasata (talk) 19:49, 29 July 2012 (UTC)

In Treatment#Severe malaria can we specify what supportive measures are? Biosthmors (talk) 22:28, 27 July 2012 (UTC)

• Gave some examples. Sasata (talk) 19:49, 29 July 2012 (UTC)

Also in #IRS "According to a study published on Mosquito Behavior and Vector Control" is unnecessary as is introducing the definitions of "endophilic" and "exophilic", it seems. Biosthmors (talk) 21:11, 6 June 2012 (UTC)

• Trimmed. Sasata (talk) 17:34, 12 June 2012 (UTC)

• "Mosquito" should be made plural, and if it has limited effectiveness due to the fact mosquitos still come indoors to feed (even if they live and rest outdoors) maybe we should mention that. The prose wasn't all that clear to me. Biosthmors (talk) 18:55, 26 June 2012 (UTC)

Should the paragraph that begins "Although coinfection with HIV..." in Epidemiology be in the Prognosis section? Biosthmors (talk) 20:55, 9 July 2012 (UTC)

• I think so. Moved. Sasata (talk) 13:43, 14 August 2012 (UTC)

In Society and culture, the content that begins "A study on the effect of malaria on IQ in a sample of Mexicans..." is inadequately sourced to a primary source. Remove or add content from a review that puts this type of study in context? Biosthmors (talk) 19:49, 1 August 2012 (UTC)

• Removed the primary source & its conclusions; added a general statement about neurological sequelae from a recent review. Sasata (talk) 19:48, 23 August 2012 (UTC)

"Cerebral malaria" should be defined as it is used several times in the article. Biosthmors (talk) 19:55, 1 August 2012 (UTC)

• I glossed a brief definition in the "Signs and symptoms" section. Sasata (talk) 13:43, 14 August 2012 (UTC)

In Epidemiology, the sentence "Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years" is sourced to a 2001 paper. Remove or update with a more current trend? Biosthmors (talk) 19:36, 1 August 2012 (UTC)

• I've removed it for now; I haven't yet found a similar, more recent prediction. Sasata (talk) 18:08, 4 September 2012 (UTC)

In Society and culture#Economic impact, the section ends with "April 25 is World Malaria Day" and this seems out of place. Put the link in a See also section? Biosthmors (talk) 18:38, 27 August 2012 (UTC)

• Done. Sasata (talk) 07:46, 1 September 2012 (UTC)

Also in Prevention#IRS, reword slightly from "will be killed" --> "can be killed" as a lethal dose has to be absorbed, and won't always be absorbed. Biosthmors (talk) 21:05, 27 August 2012 (UTC)

• Done. Sasata (talk) 07:46, 1 September 2012 (UTC)

The first paragraph in Research sounds technical and is based off of a primary study. The study as been cited by several reviews: doi:10.1002/cyto.a.20766, doi:10.1016/j.pt.2009.10.006, doi:10.1002/cbic.201000084, and doi:10.1096/fj.10-174383. I think the article probably needs a comprehensive check to see how many primary studies are still cited. Biosthmors (talk) 21:04, 9 July 2012 (UTC)

• I used the first review you listed, by one of the same authors (didn't need to change the article text!). Will sweep the article again for non-MEDRS-compliant articles now. Sasata (talk) 15:53, 10 September 2012 (UTC)

• The article has now been swept, see Talk:Malaria#Statements possibly needing better sources; let me know if you see anything I've missed. Sasata (talk) 07:09, 11 September 2012 (UTC)

In Prevention#IRS, the sentence "However, because of its legacy, many developed countries previously discouraged DDT use even in small quantities." is sourced to a news source. I say that's fine if it is the history or society and culture section, but I think it is off the mark for a prevention section. If we had a Prevention of malaria article this could be part of the history there and I think it would fit there just fine. Biosthmors (talk) 20:54, 27 August 2012 (UTC)

• Agree with your points, and the story doesn't lose anything without it -- so removed. Sasata (talk) 07:46, 1 September 2012 (UTC)

• As this was in a paragraph I am now recommending to be moved to the history section anyways, maybe it should come back. Biosthmors (talk) 19:23, 4 September 2012 (UTC)

• The history section ends off with the sentence "During the 1960s, awareness of the negative consequences of its indiscriminate use increased, ultimately leading to bans on agricultural applications of DDT in many countries in the 1970s.", which says about the same. Sasata (talk) 15:43, 10 September 2012 (UTC)

In the lead, make "The protists first infect the liver, then act as parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases progressing to coma or death." two sentences and include the fact that female mosquitos are how the protists enter the body? That fact seems important enough for the lead. Biosthmors (talk) 19:02, 4 September 2012 (UTC)

• Done, Sasata (talk) 17:21, 9 September 2012 (UTC)

In Prevention#IRS, is the sentence "The overuse of antibacterial soaps and antibiotics led to antibiotic resistance in bacteria, similar to how overspraying of DDT on crops led to DDT resistance in Anopheles mosquitoes." necessary? It seems readers could click on antibiotic resistance if necessary in the previous sentence. Biosthmors (talk) 19:05, 4 September 2012 (UTC)

• Done. Sasata (talk) 17:21, 9 September 2012 (UTC)

In Prevention#IRS, put the paragraph that begins with "The first pesticide used for IRS was DDT" into the history section? Biosthmors (talk) 19:15, 4 September 2012 (UTC)

• Moved. Sasata (talk) 17:21, 9 September 2012 (UTC)

In Prevention#IRS, change "currently" to "as of 2006" on the WHO recommendations and see if one can find a more updated list? Six years seems old (and potentially irrelevant or outdated) for this important of a disease. Biosthmors (talk) 19:15, 4 September 2012 (UTC)

• Added the date, will try to find updated source. Sasata (talk) 19:14, 9 September 2012 (UTC)

In Prevention#IRS, make it read "Indoor residual spraying (IRS)" to abbreviate the term. Biosthmors (talk) 19:29, 4 September 2012 (UTC)

• Done. Sasata (talk) 19:14, 9 September 2012 (UTC)

• Are we near the review being wrapped up? It's been nearly four months since the review began, so ideally it should be about finished. Wizardman _{Operation Big Bear} 21:02, 9 September 2012 (UTC)

• We'll get there eventually. Sasata (talk) 15:35, 10 September 2012 (UTC)

• =) Biosthmors (talk) 06:58, 12 September 2012 (UTC)

In Prevention#Vector control should the paragraphs that start with "A more targeted..." and "Sterile insect technique..." be merged? The prose seems to be duplicated. Biosthmors (talk) 06:58, 12 September 2012 (UTC)

• Missed that ... now merged. Sasata (talk) 21:38, 12 September 2012 (UTC)

In the History section, towards the bottom, there is "now the recommended treatment for falciparum malaria". "Now" seems like it should be "as of" or another historical phrasing. And falciparium as used here definitely means P. falicparium and is not being used as a synonym for severe malaria, right? Biosthmors (talk) 07:47, 12 September 2012 (UTC)

• Changed "now" to "became" and "falciparium" to P. falicparium. Sasata (talk) 21:38, 12 September 2012 (UTC)

In Society and Culture#Economic impact add "to lower birth and death rates" after demographic transition so readers don't have to click on the link to understand the sentence? Biosthmors (talk) 19:24, 13 September 2012 (UTC)

• Done. Sasata (talk) 17:53, 16 September 2012 (UTC)

In Society and Culture#Economic impact, change "the poor" to "those in poverty"? Biosthmors (talk) 19:26, 13 September 2012 (UTC)

• Done. Sasata (talk) 17:53, 16 September 2012 (UTC)

In the lead "Infection is initiated by" --> "It begins when"? It seems like it should be made more accessible. Biosthmors (talk) 00:36, 24 September 2012 (UTC)

• Done. Sasata (talk) 16:07, 24 September 2012 (UTC)

In Signs and symptoms, the complications section should be Prognosis, I think. And link complications to Complication (medicine) on first use? Biosthmors (talk) 17:50, 19 September 2012 (UTC)

Hmmm... or maybe some of what is in prognosis should just go under complications... Biosthmors (talk) 22:48, 20 September 2012 (UTC)

• I've shuffled some of this information. Sasata (talk) 16:07, 24 September 2012 (UTC)

In Society and Culture#War, the claim "infliction of the disease as a biological warfare agent" comes off as extraordinary, so it needs an inline citation. Biosthmors (talk) 19:26, 15 September 2012 (UTC)

• Added a source. Sasata (talk) 16:07, 24 September 2012 (UTC)

In Society and Culture#War, the text that starts with " 'Malaria Site: History of Malaria During Wars' ..." is not clear prose. Consider taking out the title of the webpage, making sure the author is reliable, and pulling the information out of quotes or resourcing the content? The paragraph reads as a survey of internet sites, instead of plainly citing facts. Biosthmors (talk) 19:26, 15 September 2012 (UTC)

• I've trimmed most of this paragraph. There is still one remaining citation to here, but I think the author could be considered reliable based on this. Sasata (talk) 16:51, 24 September 2012 (UTC)

In Society and Culture#War, it is unclear to me what the paragraph/quote with italics about executive and disciplinary powers is getting at. Consider checking the source to see what might be best said in regards to war? Biosthmors (talk) 19:29, 15 September 2012 (UTC)

• I've added a more germaine quote from the Colonel. (Still not completely satisfied with this section, and I predict more changes before FAC) Sasata (talk) 17:10, 24 September 2012 (UTC)

• Much better thanks. Biosthmors (talk) 20:00, 24 September 2012 (UTC)

In History, reword "... in Algeria named Charles Louis Alphonse Laveran observed parasites for the first time, inside the red blood cells of people suffering from malaria." to "in Algeria—Charles Louis Alphonse Laveran—observed parasites in the red blood cells of infected people for the first time."? Just seemed like it use a copy edit and I wasn't sure if the comma is correct. Biosthmors (talk) 19:47, 24 September 2012 (UTC)

• Fixed the prose. Sasata (talk) 05:28, 25 September 2012 (UTC)

In Society and Culture#War, the last paragraph starts to go off-topic when it transitions into "and, during these activities, to...", in my opinion. The CDC spelled out is also Centers for Disease Control and Prevention, which could be linked. Biosthmors (talk) 19:55, 24 September 2012 (UTC)

• Agree; trimmed the rambling and linked/defined CDC. Sasata (talk) 05:28, 25 September 2012 (UTC)

In Society and Culture#Economic impact, use a source to root the paragraph about cognitive changes (which currently seems better in prognosis) to expected economic effects? Maybe some material should go in prognosis and some should stay. Biosthmors (talk) 19:30, 13 September 2012 (UTC)

• Done. Sasata (talk) 05:57, 25 September 2012 (UTC)

In Research, the section seems like it should start with the vaccine information (as that is what the lead mentions). It is currently segregated above and below a level three heading, but maybe no level 3 subheading is necessary. The technical information in the first paragraph seems like it should be at the bottom. The paragraph that starts with "Malaria vaccines have been an elusive goal of research..." seems like it should be in the history section, except for the last sentence, which sounds like it should stay but it shouldn't include the words "It has been determined", which are extraneous if this is just a fact. Biosthmors (talk) 20:21, 26 September 2012 (UTC)

• How does it look now? Sasata (talk) 05:26, 27 September 2012 (UTC)

• Much better, thanks. Biosthmors (talk) 17:01, 27 September 2012 (UTC)

In Signs and symptoms, the sentence that starts with "The presentation may include fever, shivering, arthralgia..." does not include the top left one of headache in the picture. That seems like an incongruity. Biosthmors (talk) 21:05, 26 September 2012 (UTC)

• Added. Sasata (talk) 05:43, 27 September 2012 (UTC)

In Cause#Recurrent malaria, make "Recrudescence" --> "Recurrence (recrudescence)" so readers are confident on the meaning with just the prose? Biosthmors (talk) 17:13, 27 September 2012 (UTC)

• Done. Sasata (talk) 18:00, 27 September 2012 (UTC)

I was trying to verify some symtoms and I see that the source "Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases" has the pages listed as Chapter 275. That could be right. Is it? Biosthmors (talk) 21:11, 27 September 2012 (UTC)

• Yes; I tightened up the details for that reference and gave a page range for the chapter. Sasata (talk) 21:27, 27 September 2012 (UTC)

In signs and symptoms, we are using a 2001 source to present classical symptoms. What was classical in 2001 may not be the case anymore. Can we get an updated MEDRS? Biosthmors (talk) 21:36, 27 September 2012 (UTC)

• Still classical in 2009 – updated source. Sasata (talk) 22:30, 27 September 2012 (UTC)

• Thanks. If it had been a 2002 source I think I would have let it slide but I guess one needs to draw the line somewhere. Biosthmors (talk) 17:19, 28 September 2012 (UTC)

I hate to be a pain, but we're nearing the five month mark on this review. No reason any review should take this long. Let's get it wrapped up. Wizardman 05:08, 8 October 2012 (UTC)

In signs and symptoms, it says "For reasons that are poorly understood, but that may be related to high intracranial pressure, children with malaria frequently exhibit abnormal posturing, a sign indicating severe brain damage". The source says "brainstem signs (abnormalities in posture, pupil size and reaction, ocular movements or abnormal respiratory patterns) are commonly observed". While the article does say "mechanisms of neural injury in cerebral malaria are poorly understood", I think saying "For reasons that are poorly understood" is off-topic for this section, as it isn't the pathogenesis or cause section. Remove? And rewording so we mentioning that the characteristic is general problematic signs of the brainstem with a bit more detail or putting the specific signs in a note seems better than focusing on posture, based off of this source. Biosthmors (talk) 17:27, 28 September 2012 (UTC)

• Removed the offending bits as you suggested, swapped out the source for one (open access) that more generally summarizes clinical aspects of the disease, and added some more symptoms of cerebral malaria. Sasata (talk) 20:59, 30 September 2012 (UTC)

In signs and symptoms the sentence "Non-falciparum species have however been found to be the cause of ~14% of cases of severe malaria in some groups" seems like it belongs in causes. Biosthmors (talk) 19:06, 28 September 2012 (UTC)

• Done. Sasata (talk) 21:09, 30 September 2012 (UTC)

In signs and symptoms#complications, "with P. falciparum malaria" should be "with severe P. falciparum malaria", according to the abstract. Biosthmors (talk) 19:13, 28 September 2012 (UTC)

• Done. Sasata (talk) 21:09, 30 September 2012 (UTC)

In the lead, instead of "many of whom were children under the age of five" maybe say something like "most of whom are children in Africa"? Source is first page of Taylor 2012, "Respiratory Manifestations of Malaria". Biosthmors (talk) 19:17, 28 September 2012 (UTC)

• Done. Sasata (talk) 21:09, 30 September 2012 (UTC)

In signs and symptoms, "Consequences of severe malaria include coma and death if untreated—young children and pregnant women are especially vulnerable" sounds prognosisish. Can we reword to give detail on how coma is seen as a sign? I guess death is a sign of having malaria and I'm not saying it needs to come out entirely, but it's not worded right for this section, in my opinion. Biosthmors (talk) 20:11, 28 September 2012 (UTC)

• I took this sentence out. The vulnerability of children and women is discussed elsewhere, and I mentioned coma as a possible consequence of cerebral malaria in the following paragraph. Sasata (talk) 21:52, 30 September 2012 (UTC)

In Signs and symptoms, the sentence "The causes of this problem are diverse and include respiratory compensation of metabolic acidosis, noncardiogenic pulmonary oedema, concomitant pneumonia, and severe anaemia" seems like a too close paraphrase of the abstract. Maybe reword this portion: "The causes of this problem are diverse"? Biosthmors (talk) 23:18, 28 September 2012 (UTC)

• Done. Sasata (talk) 21:56, 30 September 2012 (UTC)

In Cause#Life cycle, the second sentence of "Young mosquitoes first ingest the malaria parasite by feeding on an infected vertebrate carrier and the infected Anopheles mosquitoes eventually carry Plasmodium sporozoites in their salivary glands. A mosquito becomes infected when it takes a blood meal from an infected vertebrate." largely repeats material found in the first sentence. Make into one sentence? Biosthmors (talk) 02:00, 9 October 2012 (UTC)

• Done. Sasata (talk) 21:52, 9 October 2012 (UTC)

In Signs and symptoms, the sentence that says "Individuals with severe malaria frequently exhibit neurological symptoms that indicate brain damage, including abnormal posturing, nystagmus, strabismus, opisthotonus, seizures, or coma" has some problems. I didn't find nystagmus or strabismus in the source. I stopped checking after not finding those two. Also, the source presents symptoms of cerebral malaria as transient. Brain damage sounds permanent to me. Biosthmors (talk) 01:30, 9 October 2012 (UTC)

• In the source it's spelled "nistagmus"; the source lists "disconjugate gaze" as a symptom, I thought (perhaps incorrectly?) that this was synonymous to strabismus. Not quite sure what you want me to do with the other–even coma can be a transient symptom. Yes, brain damage can result, but this is the Signs and symptoms section, not Prognosis. Sasata (talk) 21:52, 9 October 2012 (UTC)

• I shouldn't be making unqualified assumptions about medical terminology, so I posted a query at the wp:MED talk page. Sasata (talk)

• Serves me right for making assumptions ... have changed it per the source and glossed a definition. Sasata (talk) 23:00, 9 October 2012 (UTC)
• Remove "that indicates brain damage", as the source says they are often transient? Sorry I wasn't clearer. Biosthmors (talk) 22:07, 9 October 2012 (UTC)

• Gotcha – done. Sasata (talk) 23:00, 9 October 2012 (UTC)

In the history section, remove "new" from "Some new evidence..." as it is unclear when the evidence will stop being new. Biosthmors (talk) 22:11, 9 October 2012 (UTC)

• Done. Sasata (talk) 23:06, 9 October 2012 (UTC)

In Cause#Life cycle, I don't see the value in saying "and the infected Anopheles mosquitoes eventually carry Plasmodium sporozoites in their salivary glands". Remove? The term is introduced later with context. Biosthmors (talk) 22:21, 9 October 2012 (UTC)

• Done. Sasata (talk) 23:06, 9 October 2012 (UTC)

In Cause#Life cycle, "the parasite gametocytes taken up in the blood will further differentiate into male or female gametes and then fuse in the mosquito's gut"? Biosthmors (talk) 22:27, 9 October 2012 (UTC)

• Done. Sasata (talk) 23:06, 9 October 2012 (UTC)

Use the emedicine source on the talk page to incorporate the new content temporarily until traditional MEDRS can be found? Biosthmors (talk) 17:40, 10 October 2012 (UTC)

• I'm not sure if if agree with the new additions; the statements "... they now have only a limited role in the actual clinical decision making process with regards to arriving at a diagnosis of Malaria.[7] With the easy availability of laboratory tests ..." is contradicted by sourced material in "Diagnosis": "Areas that cannot afford laboratory diagnostic tests often use only a history of subjective fever as the indication to treat for malaria.[37] Polymerase chain reaction based tests have been developed, though these are not widely implemented in malaria-endemic regions as of 2012, due to their complexity.[3]" I'll do some more reading and amend the new text tonight. Sasata (talk) 19:00, 10 October 2012 (UTC)

• That sounds good. Maybe we just need a sentence of clarification about how in some areas symptoms are diagnostic but in others when they should prompt labwork -- aka "microscopic examination of blood using blood films or using antigen-based rapid diagnostic tests". I think that was the salient point of the new contribution. Biosthmors (talk) 19:16, 10 October 2012 (UTC)

• I've shuffled the new text to the "diagnosis" section and balanced it with some text about the drawbacks of presumptive diagnosis. Sasata (talk) 06:14, 11 October 2012 (UTC)

• Can we still get a sentence in the signs and symptoms section about the relationship between symptoms and diagnosis? There is one such sentence at Deep_vein_thrombosis#Signs_and_symptoms, for example. Biosthmors (talk) 21:59, 15 October 2012 (UTC)

• Like this?. Sasata (talk) 08:47, 16 October 2012 (UTC)

• Thanks. Biosthmors (talk) 19:09, 16 October 2012 (UTC)

In the lead, "Despite a clear need, no vaccine offering a high level of protection currently exists". That implies there is one with a moderate level of protection. Is that true? It not, reword to be more accurate? Biosthmors (talk) 21:47, 15 October 2012 (UTC)

• I've reworded to "no effective vaccine currently exists" Sasata (talk) 22:29, 15 October 2012 (UTC)

There should be a sentence summarizing the diagnosis section in the lead. Mention both the technology/low technology approaches? Biosthmors (talk) 22:03, 15 October 2012 (UTC)

• Added. Sasata (talk) 22:42, 15 October 2012 (UTC)

In the lead, "Malaria is prevalent in tropical regions because the significant amounts of rainfall, consistently high temperatures and high humidity, along with stagnant waters in which mosquito larvae readily mature, provide them with the environment they need for continuous breeding." is pretty wordy. Maybe, "Malaria is prevalent in tropical regions because significant amounts of rainfall, warm temperatures, and stagnant waters provide habitat for mosquito larvae? Biosthmors (talk) 22:09, 15 October 2012 (UTC)

• Reworded along the lines of what you suggested. Sasata (talk) 06:51, 16 October 2012 (UTC)

"Despite a clear need" --> "Despite a need" in the lead? The word "clear" seems to be belaboring the point/opinionish. Biosthmors (talk) 22:10, 15 October 2012 (UTC)

• Done. Sasata (talk) 22:29, 15 October 2012 (UTC)

Same kind of POVish language in Research with "new strategies are required" because of "required". How about something like "are being developed" instead of required? Biosthmors (talk) 22:12, 15 October 2012 (UTC)

• Good idea, fixed. Sasata (talk) 06:51, 16 October 2012 (UTC)

In Research, can we get clarification on the word "irradiated"? To me, it begs questions like these: What about non-irradiated mosquitoes? What kind of irradiation? Why were the mosquitoes irradiated? Biosthmors (talk) 22:15, 15 October 2012 (UTC)

• Done. Sasata (talk) 07:12, 16 October 2012 (UTC)

• Thanks, that makes much more sense now. Biosthmors (talk) 18:55, 16 October 2012 (UTC)

We've gone back to a version of the lead where there is excessive text about the # of deaths. A recent review (doi:10.1016/S1473-3099(12)70064-6) states, "Between 655 000 and 1·2 million people die every year from Plasmodium falciparum infection.1,2". Something like that is in a much more encyclopedic format. The Lancet study is just a primary study after all and it shouldn't be given so much text to indroduce it. MEDRS asks that we respect secondary sources, so we shouldn't trumpet this one study per WP:MEDREV. Biosthmors (talk) 21:38, 15 October 2012 (UTC)

• I agree. What about do you think of this as a compromise? Sasata (talk) 22:20, 15 October 2012 (UTC)

• Better. Can we also clean the article of the unnecessary details such as "An estimate in The Lancet, based on a systematic analysis of all available mortality data combined with empirical methods for estimating causes of death..."? Using a MEDRS compliant secondary source to compare and contrast the two studies would be much better than citing journalists resource though I'm not opposed to citing reliable lay summaries. The lay summary includes the point that "about twice as many deaths than are estimated in the World Malaria Report 2011, with substantially more malaria deaths in adults in Africa and in both adults and children outside of Africa than previously recognized". This might creates a problem for the text because I'm not sure it is verifiable that most of the 1.24 million were children under 5 from Africa. That summary applied to only the 655,000 estimate. Reword? Biosthmors (talk) 22:34, 15 October 2012 (UTC)

• In the lead, I've reworded "most" to "many" and cited the 0.655–1.2 mil range to the 2012 review you mentioned. In the article, the text "The majority of cases occur in children under five years old.[72]" is sourced to a review article with an independent death rate estimate, viz.: "Most estimates suggest that malaria directly causes about 1 million deaths per year or 3000 deaths a day, and that most of these deaths occur in African children", so I don't think the article statement is incompatible with any of the preceding data presented. I've trimmed the Lancet sentence; is it too much? I prefer to leave the lay summary in there as it's accessible, and the Lancet article is behind a paywall. Sasata (talk) 07:44, 16 October 2012 (UTC)

• I think saying "A 2012 study places the number of deaths in 2010 at 1.24 million." is enough. This way we eliminate the risk of using scientific sounding words to indicate to readers they should give the study more weight. Also, systematic analysis is piped over to systematic review, but the article is not labeled as a review article. Biosthmors (talk) 19:09, 16 October 2012 (UTC)
• Or "A 2012 study estimated the number of documented and undocumented deaths in 2010 was 1.24 million." If that's what the study did. Biosthmors (talk) 19:19, 16 October 2012 (UTC)

• I think that's a good way to summarize it – changed. Sasata (talk) 07:23, 17 October 2012 (UTC)

In signs and symptoms, around or in "frequently exhibit neurological symptoms", add cerebral malaria to that sentence? The source says they are symptoms for cerebral malaria. Biosthmors (talk) 23:00, 16 October 2012 (UTC)

• Done. Sasata (talk) 06:05, 17 October 2012 (UTC)

The article "Malaria Prevention in Short-Term Travelers" is used in Prevention#Medications. Should it be cited behind the sentence that ends with "continued for seven days afterwards)." The source seems to directly support only that sentence. Biosthmors (talk) 22:48, 17 October 2012 (UTC)

• Done, and added a couple of additional reviews to source the other sentences. Sasata (talk) 16:33, 18 October 2012 (UTC)

In Cause#Recurrent malaria, I wasn't able to quickly verify the "Approximately one in five of P. vivax malaria cases" portion of that sentence. Where did the statistic about one in five come from? Is it better to say "often" or something else a bit vague? Biosthmors (talk) 23:36, 17 October 2012 (UTC)

• I couldn't find it either, replaced with "often" as you suggested. Sasata (talk) 16:51, 18 October 2012 (UTC)

In Society and culture#War, "in the fortunes" --> "in the outcomes" or something similar? I was thinking plunder as a reader. Biosthmors (talk) 23:53, 22 October 2012 (UTC)

• Changed "fortunes" to "fates", better? Sasata (talk) 16:59, 23 October 2012 (UTC)

• Yes. Thanks. Biosthmors (talk) 18:46, 23 October 2012 (UTC)

In #Mosquito nets, the sentence "Since the Anopheles mosquitoes feed at night, the preferred method is to hang a large "bed net" above the center of a bed to drape over it completely" and the source seem to conflict a bit. The source mentions dusk to dawn, and I'm not sure draping over captures the sourc either. It recommends tucking in. Also, the word "preferred" begs questions. Reword? Biosthmors (talk) 00:05, 23 October 2012 (UTC)

• Reworded this to bring it closer to the source recommendations. Sasata (talk) 17:23, 23 October 2012 (UTC)

In Epidemiology, "associated with an estimated 200,000" --> "associated with up to 200,000"? The source contains the important qualifier "up to". Biosthmors (talk) 00:15, 23 October 2012 (UTC)

• Done. Sasata (talk) 17:25, 23 October 2012 (UTC)

In #Economic impact, the term "acute" is used twice. Replace with "severe" for consistent prose, if that is accurate? Biosthmors (talk) 19:29, 23 October 2012 (UTC)

• Done. Sasata (talk) 04:10, 24 October 2012 (UTC)

In the lead, could the sentence "Resistance has developed to several antimalarial drugs, most notably chloroquine and artemisinin." mention the geographical dependence? That seems to be a main point from the article. Biosthmors (talk) 20:36, 23 October 2012 (UTC)

• Like so? Sasata (talk) 04:10, 24 October 2012 (UTC)

• Great, thanks. I think that helps readers get oriented to the topic. Biosthmors (talk) 02:15, 25 October 2012 (UTC)

In Epidemiology, "This mortality rate is equivalent to roughly 2000 deaths every day" shouldn't link to mortality rate. Mortality rate has a specific definition. Maybe, "Deaths due to malaria occur at a rate of approximately 2000 a day according to this estimate"? Or save it until later in the section when we can get to ~2000 to 3000? Biosthmors (talk) 21:01, 23 October 2012 (UTC)

• Good point! I've removed the link. Sasata (talk) 04:15, 24 October 2012 (UTC)

In #Uncomplicated malaria, the article says "This is done to reduce the risk of resistance against artemisinin" but the source says "The less effective single-drug treatments increase the chance of parasites evolving and becoming resistant to the treatment; combining anti-malarial drugs with independent modes of action can impede the development of resistance to each individual component of the combination." Reword to mirror the source's emphasis that it helps prevent drug resistance in general, and not just against artemisinin? Biosthmors (talk) 00:04, 24 October 2012 (UTC)

• Done. Sasata (talk) 04:33, 24 October 2012 (UTC)

In #Economic impact, the article says "Malaria is not just a disease commonly associated with poverty but also a cause of poverty and a major hindrance to economic development." But the source says "The causality of this relationship is complicated, however. Does malaria cause poverty? Or does poverty cause malaria? Both channels of causation seem reasonable. It is also possible, as noted by Sachs and Malaney (2002), that the correlation could be spurious, caused perhaps by some other direct connection between climate and geography with growth rates or income levels. Resolving these causality issues has been difficult for researchers trying to assess the economic impact of malaria. In spite of the difficulties involved, two widely publicized papers have found that malaria appears to slow economic growth in poor countries" in the review, and "it is entirely possible for an economy to arrive at a 'malaria trap,' in which sickness begets poverty and poverty makes disease prevention unaffordable" in the conclusions. It seems this paper is being cited as a primary source for its conclusions. Weaken the language somewhat or source to a secondary source? Biosthmors (talk) 00:41, 24 October 2012 (UTC)

• Did both. Sasata (talk) 04:54, 24 October 2012 (UTC)

• "Some evidence suggests" --> "evidence suggests"? "Some evidence suggests" is weak, so it might be a tad too watered down, but I haven't looked at Worrall 2005 to really gauge this. Biosthmors (talk) 02:15, 25 October 2012 (UTC)

• It's intended to be weak: "We found mixed evidence on malaria incidence, with a number of studies identifying no relationship between socio-economic status and incidence, although a larger number of studies do find a link." Sasata (talk) 16:20, 25 October 2012 (UTC)

In Research, clarify what "channeled into the parasite" means? Biosthmors (talk) 21:25, 26 October 2012 (UTC)

• Done. Sasata (talk) 07:32, 27 October 2012 (UTC)

In Eradication efforts, "According to director Inder Singh, the U.S.-based Clinton Foundation has significantly reduced the cost of drugs to treat malaria, and is working to further reduce the spread of the disease" is not true to the source, in my opinion. That wasn't attributed to Singh. A more accurate summary might say "the CF has worked to manage demand and stabilize prices in the artemisin market". Biosthmors (talk) 22:13, 26 October 2012 (UTC)

• I agree and like your summary, thanks. Sasata (talk) 07:47, 27 October 2012 (UTC)

In Eradication efforts, I think the paragraph that starts with "Malaria has been successfully eradicated in certain areas" is undue, by giving so much text/detail to that one source. Trim? Or perhaps remove/replace? Also, the tense is off: "DDT is used in moderate amounts", though the source is from 2004. The text also might border on the promotional: "These actions have produced positive results. The program has cut infection and death rates tremendously, and is cost effective". Biosthmors (talk) 23:19, 26 October 2012 (UTC)

• I've rewritten and re-sourced this paragraph. Sasata (talk) 09:02, 27 October 2012 (UTC)

Remove the mention of mass drug administrations in Prevention#Other methods per [1], which says, "this approach is not currently recommended". Prevention/treatment/diagnosis sections are designed to only contain what works/is recommended. Consider incorporating into the historical section instead? Biosthmors (talk) 23:37, 26 October 2012 (UTC)

• Removed. I might include it in the history section later, or perhaps in a daughter article. Sasata (talk) 09:25, 27 October 2012 (UTC)

In War, the article says "cinchona bark and quinine proved to be inadequate to supply military personnel" while the source says "inability to procure or maintain adequate stocks of quinine". Perhaps supplies were adequate, just with low-inventory levels. Weaken to "inconsistent supplies of cinchona bark and quinine to military personnel" or something similar? Biosthmors (talk) 19:26, 28 October 2012 (UTC)

• Done. Sasata (talk) 21:05, 28 October 2012 (UTC)

In History, the source "Early Origin and Recent Expansion of Plasmodium falciparum" could use updating to make sure the content is accurate. Biosthmors (talk) 23:03, 28 October 2012 (UTC)

• Resourced to a 2011 review, with text amended. Sasata (talk) 17:30, 29 October 2012 (UTC)

In Epidemiology, the article says "Malaria is more common in rural areas than in cities; this is in contrast to dengue fever where urban areas present the greater risk" but the only spot the source mentions malaria is "Although A. aegypti was common in the Mediterranean region prior to World War II [19], it also disappeared from southern Europe and North Africa following this period. The reason for this is unclear, although it is probably attributable to malaria eradication efforts and widespread use of DDT [16]." I don't know why comparing/contrasting the epidemiology of malaria with dengue fever is necessary for even a FA. Remove? Biosthmors (talk) 23:19, 28 October 2012 (UTC)

• Removed. Sasata (talk) 18:12, 29 October 2012 (UTC)

In Pathogenesis, the article says "The parasite switches between a broad repertoire of PfEMP1 surface proteins, thus staying one step ahead of the pursuing immune system". The closest thing I saw in the source was "The helices are decorated with a number of polymorphic flexible loops that are likely to be involved in ligand binding and immune evasion". The phrase "one step" is awkward, I think, because it implies one biochemical reaction. Resource? Biosthmors (talk) 23:32, 28 October 2012 (UTC)

• Rewrote to "The parasite switches between a broad repertoire of PfEMP1 surface proteins, thereby avoiding detection by protective antibodies." and re-sourced the paragraph to a more appropriate review. Sasata (talk) 18:56, 29 October 2012 (UTC)

The sentence "Despite efforts to reduce transmission and increase treatment, there has been little change in which areas are at risk of this disease since 1992" should have a more recent source than 2004. Remove for now and maybe resource for FA? Covering overall death trends seem more pertinent than getting into the geography of it, though. Biosthmors (talk) 17:33, 29 October 2012 (UTC)

• Removed. I'll add more recent epidemiology data before FAC. Sasata (talk) 19:28, 29 October 2012 (UTC)

In War, the newspaper cited for the biological warfare portion attributes this particular view to one historian. It is possible this is not a consensus view of history, so I think it is insufficient to verify the claim of its use in biological warfare as fact. Biosthmors (talk) 02:32, 29 October 2012 (UTC)

• True that; I had difficulty finding corroborating opinions on this. Removed. Sasata (talk) 19:33, 29 October 2012 (UTC)

In Epidemiology, portions of a sentence -- "The Wellcome Trust, UK, has funded ... a more contemporary and robust means" -- are promotional in my opinion. We should cite facts from the article if they are relevant. Remove funding details? Source "a more contemporary and robust means" to a secondary source or remove? Extract relevant data from the source? Biosthmors (talk) 16:41, 29 October 2012 (UTC)

• I kept the source but removed the promotional tone. Sasata (talk) 19:57, 29 October 2012 (UTC)

In Economic impact, "In some countries with a heavy malaria burden, the disease may account for as much as 40% of public health expenditure, 30–50% of admissions to hospital, and up to 50% of outpatient visits" is verified. But the wording and the sentence structure are very similar. Adapt/reorder/reword some more? Biosthmors (talk) 17:45, 31 October 2012 (UTC)

• Reworded to "The disease has a heavy burden in some malaria-endemic countries, where it is responsible for up to 50% of outpatient visits, 30–50% of hospital admissions, and up to 40% of public health spending." Sasata (talk) 19:26, 31 October 2012 (UTC)

The portion in Vector control that begins with "A more targeted and ecologically friendly vector control strategy" and ends with "technological problems have hindered its effective deployment" doesn't appear to belong. If it doesn't work, or isn't recommended, reduce to a sentence and put in Research? Biosthmors (talk) 17:10, 29 October 2012 (UTC)

• Trimmed a bit and moved to Research.

In Genetic resistance, the article should link to sickle cell trait at least once, and it should clarify the role between the trait (heterozygous form) and the disease (homozygous form). Biosthmors (talk) 22:12, 28 October 2012 (UTC)

• Done. Sasata (talk) 22:35, 28 October 2012 (UTC)

• The Hedrick source says, "The sickle-cell allele is widely known as a variant that causes red blood cells to be deformed into a sickle shape when deoxygenated in AS heterozygotes, in which A indicates the non-mutant form of the β-globin gene, and also provides resistance to malaria in AS heterozygotes. In SS homozygotes, S causes the severe disease sickle-cell anemia. It is generally assumed that individuals with genotype SS had very low or zero fitness when, or if, there was no modern medical care." The article currently says "The impact of sickle cell anemia on malaria immunity is of particular interest." But I don't think that is where the interest is. Sickle cell anemia is a redirect to sickle-cell disease (aka SS), whereas the protective sickle cell trait is AS. Change instances of sickle cell disease or anemia to sickle cell trait, where appropriate? Cite Hedrick instead of Barnes? Biosthmors (talk) 01:43, 29 October 2012 (UTC)

• I've think I've fixed the errors with disease/allele/trait (also per Axl on the talk page), and replaced Barnes with Hedrick. Sasata (talk) 21:51, 31 October 2012 (UTC)

In Pathogenesis, the section ends with "Pregnant women are especially attractive to the mosquitoes, and malaria in pregnant women is an important cause of stillbirths, infant mortality and low birth weight,[28] particularly in P. falciparum infection, but also in other species infection, such as P. vivax.[29]" Move to complications section?

• Done, and trimmed some duplicative life cycle info. Sasata (talk) 16:00, 30 October 2012 (UTC)

In the lead, "prevalent in tropical regions because significant amounts of rainfall" --> "prevalent in sub-tropical and tropical regions because rainfall" to generalize and make it more accurate? The body of the article could probably use adjusting too. Biosthmors (talk) 18:58, 30 October 2012 (UTC)

• Done. Sasata (talk) 07:42, 31 October 2012 (UTC)

In Economic impact, "The slow demographic transition to lower birth and death rates in Africa may be partly attributed to malaria" is a pretty weak statement. After all, the source says neonatal disorders, diarrhea, and pneumonia kill more children. But I don't think that means this idea should be included in all of those articles. And the two places where malaria are mentioned in the discussion do not sound important for this article. "Total fertility rates were best explained by child mortality, as measured indirectly by infant mortality, in a 2007 study" sounds off-topic. Remove these two sentences due to weakness/questionable relevance? Biosthmors (talk) 20:02, 30 October 2012 (UTC)

• Agree, done. Sasata (talk) 07:50, 31 October 2012 (UTC)

Chen Q, Schlichtherle M, Wahlgren M (2000). "Molecular aspects of severe malaria". should be replaced with a more recent source. Biosthmors (talk) 20:31, 30 October 2012 (UTC)

• Replaced with a 2011 review, PMID 21458590. Sasata (talk) 07:19, 31 October 2012 (UTC)

In Other methods, Mehlhorn H, Armstrong PM (2001). Encyclopedic Reference of Parasitology: Diseases, Treatment, Therapy. should be updated. Biosthmors (talk) 20:33, 30 October 2012 (UTC)

• I've updated this to the 3rd edition (2008), which essentially says the same as the 2nd. Sasata (talk) 00:51, 1 November 2012 (UTC)

• Great, thanks. Biosthmors (talk) 22:45, 1 November 2012 (UTC)

In Diagnosis, I couldn't verify "Rapid diagnostic tests that detect P. vivax are not as effective as those targeting P. falciparum" to the cited source. The source is mainly about pregnancy/placental malaria, and the article could mention that while peripheral blood is what is generally used, RDT and PCR are possibilties and placental histology is the gold standard. Biosthmors (talk) 22:48, 29 October 2012 (UTC)

• I'm glad you're checking these so carefully! I've expanded the paragraph and re-sourced to a 2012 review. I decided not to mention any differences in diagnostics of placental malaria (there's so many details one could include, but I think it's better in most cases to leave details to the daughter article–feel free to disagree). Sasata (talk) 16:59, 30 October 2012 (UTC)

• No problem. I figure with this important of a topic it deserves the attention. Biosthmors (talk) 23:02, 1 November 2012 (UTC)

In Economic impact, there is the more certain "Poverty is both a cause and effect of malaria", which is in contrast to what preceeds it. Weaken? Biosthmors (talk) 22:52, 1 November 2012 (UTC)

• Now "Poverty can increase the risk of malaria, ..." Sasata (talk) 19:10, 6 November 2012 (UTC)

In Genetic resistance, sickle cell is introduced as possibly providing protection, then definitely providing protection. Reword for consistency? Perhaps "may provide resistance" --> "provide or may provide resistance"? Biosthmors (talk) 22:56, 1 November 2012 (UTC)

• I just removed the waffling "may"; the sentence is stronger (and correct) without it. Sasata (talk) 18:32, 6 November 2012 (UTC)

In History, "The indigenous peoples of Peru made a tincture of cinchona to control malaria. The Jesuits noted the efficacy of the practice and introduced the treatment to Europe during the 1640s, where it was rapidly accepted" is problematic. The source describes its established use for fever control and attributes its antimalarial application to a serendipitous discovery. Also, it says "around 1640" which could mean before. The source also says the medication generated significant controversy and it wasn't until 1681 that it was universally accepted. Biosthmors (talk) 23:33, 29 October 2012 (UTC)

• Now aligned more closely with the source. Sasata (talk) 16:00, 30 October 2012 (UTC)

• Thanks. How about "malaria. The Jesuits introduced the treatment" --> "fever. Its effectiveness against malaria was found and the Jesuits introduced". I don't think we can definitely conclude American natives used it for malaria at that time. Biosthmors (talk) 23:02, 1 November 2012 (UTC)

• Sounds good, done. Sasata (talk) 19:13, 6 November 2012 (UTC)

The first two paragraphs of text in Vector control are based on giving a historical overview, instead of focusing on what is recommended today. Put in History? Trim? Update? Biosthmors (talk) 17:26, 29 October 2012 (UTC)

• I've trimmed some, moved some to History, and some to Eradication efforts. Sasata (talk) 06:40, 31 October 2012 (UTC)

Remove "Generally, these drugs are taken daily or weekly, at a lower dose than is used for treatment of a person who contracts the disease" per Wikipedia:MEDMOS#Drugs.2C_medications_and_devices, which says "Do not include dose, titration or pricing information except when they are extensively discussed by secondary sources, or necessary for the discussion in the article"? Biosthmors (talk) 17:30, 10 November 2012 (UTC)

• Done. Sasata (talk) 18:50, 14 November 2012 (UTC)

In Genetic resistance, should the text say something like "thalassaemia traits" instead of "thalassemia" per Hedrick? This looks like it could be a similar case of what was happening with sickle cell anemia/trait earlier. Hedrick says, "detrimental genetic diseases, such as sickle-cell anemia, thalassemia" and "On the other hand, there are multiple variants that alter expression levels and provide protection within each of the categories known as α-thalassemia, β-thalassemia ..." Biosthmors (talk) 19:04, 10 November 2012 (UTC)

• Agree, done. Sasata (talk) 18:50, 14 November 2012 (UTC)

In Signs and symptoms, rearrange "Severe malaria is usually caused by P. falciparum" to introduce the malaria type as P. falciparium malaria, per the source? Biosthmors (talk) 14:58, 31 October 2012 (UTC)

• Also, this source is from 2003. It should be replaced. With such an important topic, I don't think it is best to be so far away from WP:MEDDATE. Biosthmors (talk) 17:13, 31 October 2012 (UTC)

• I've replaced two of the four uses of this source with a 2012 review (will take a bit more digging to find sources to replace the other two instances). Is this what you had in mind to introduce the malaria type? Sasata (talk) 20:00, 31 October 2012 (UTC)

• Sorry, I should have made that clearer. The source characterizes the time frame as specific to falciparium malaria. It doesn't have to be severe to manifest within this timeframe. Also, another parasite species that may cause severe malaria could present in different time frames, right? Biosthmors (talk) 23:24, 1 November 2012 (UTC)

• I made these changes to clarify the time range as associated with falciparium malaria. I didn't want readers thinking severe vivax malaria exhibits the same time frame, becuase that's not what the source says/said. Any comments or concerns? Biosthmors (talk) 21:29, 5 November 2012 (UTC)

• I've removed the word "typically" before 9–30 days, as the source says it's most commonly 9–14 days. Maybe this latter time frame should be included as well? Sasata (talk) 18:23, 6 November 2012 (UTC)

Comments

In Epidemiology, "global spatial limits of the disease and to assess disease burden" --> "global range of the disease" or "its global range"? Disease burden links to a page with a definition that is beyond the scope of the source, it appears. Biosthmors (talk) 21:46, 5 November 2012 (UTC)

• Assessing disease burden is an important aspect of the malaria mapping initiative, so I've added another source to the sentence that should emphasize this association. Sasata (talk) 18:23, 6 November 2012 (UTC)

"Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa", used in Signs and symptoms#Complications, is a primary source but the sentence itself is cited to a recent review. However, might there be a bit of OR through linking the two? Also "an effect which from" is unclear prose. Biosthmors (talk) 23:59, 22 October 2012 (UTC)

• That article (PMID 16229771) is marked as a review for me. Have reworded the prose and included the word "may" to match the uncertainty in the conclusions of the cited review. Sasata (talk) 16:59, 23 October 2012 (UTC)

• I'm trying to find a sentence in here that says something along the lines of "an increased viral HIV viral load during malaria infection may cause death". That's what I'm trying to verify. Is that what you're trying to say? Biosthmors (talk) 22:47, 15 November 2012 (UTC)

• Ok, understood. Yeah, in retrospect I connected the two in an unacceptable OR-y fashion. How about I just trim the sentence to just "Coinfection with HIV and malaria increases mortality." and leave the possible reasons out? Sasata (talk) 18:59, 16 November 2012 (UTC)

• Sounds good, thanks. Biosthmors (talk) 19:01, 16 November 2012 (UTC)

• Done. 19:25, 16 November 2012 (UTC)

In Cause#Life cycle, the sentences "A sporozoite travels in blood vessels to liver cells, where it reproduces asexually. Some offspring (called merozoites) enter red blood cells and liver cells, where they divide asexually." start introducing a level of complexity that needs more verification, in my opinion. Do some sporozoites leave liver cells as merozoites to enter other liver cells as merozoites? It's a bit unclear what we're supposed to think as readers. Biosthmors (talk) 18:47, 26 October 2012 (UTC)

• I've worked on this paragraph, hopefully it flows better. I still need to figure out how to optimize/trim the repeating information in "Life cycle", the image caption, and "Pathogenesis". Sasata (talk) 07:32, 27 October 2012 (UTC)

In Prevention#Medications, the article seems to understate the source a bit. Right now the article says "mefloquine is associated with higher rates of neurological and psychiatric symptoms". But the abstract of the source says "we also found 22 published case reports of deaths, including five suicides, associated with mefloquine use at normal dosages. No other currently used drugs were reported as causing death, at normal dosages". Rephrase to convey the seriousness of these reported adverse events? Biosthmors (talk) 18:04, 31 October 2012 (UTC)

• I changed the relative "higher" to the absolute "high"; do you think this will suffice? Sasata (talk) 20:41, 31 October 2012 (UTC)

• How about "mefloquine is associated with death, suicide, and higher rates of neurological and psychiatric symptoms"? Biosthmors (talk) 22:34, 15 November 2012 (UTC)

• Done. Sasata (talk) 19:25, 16 November 2012 (UTC)

If you happen to have a copy of Gay 2012 could you email it to me? PMID 22386676. Thanks. Biosthmors (talk) 22:19, 15 November 2012 (UTC)

• Switched out the Gay citations to an open-access review to make it easier to verify. Sasata (talk) 16:58, 16 November 2012 (UTC)

Can we round up "and up to 29% of pregnant women" to 30% in complications? It just seems odd to see all the other stats in the paragraph ending in 0 or 5 then that one. Biosthmors (talk) 22:42, 15 November 2012 (UTC)

• Hmmm, this one I'd prefer leave as is; I don't think it's a good idea to change stats from the source just so they don't offend our sense of aesthetics ;-) Sasata (talk) 19:31, 16 November 2012 (UTC)

• Fine by me! Silly I am. I thought the slightest annoyance deserved attention at a good article nomination. Thanks for your patience. =) Biosthmors (talk) 19:35, 16 November 2012 (UTC)

In Prevention, maybe we should remove the sentence that says "Many countries are seeing an increasing number of imported malaria cases owing to extensive travel and migration". It's a 2006 source and the 2012 Lancet study gave decreasing statistics globally. It might not be considered a factual statement according to the recent literature. Biosthmors (talk) 23:26, 15 November 2012 (UTC)

• Good call – according to PMID 21908138, this trend has been reversing in recent years. Deleted. Sasata (talk) 20:01, 16 November 2012 (UTC)

"The longest incubation period reported for a P. vivax infection is 30 years" is sourced to a 2003 paper. Update? It might be inaccurate now. Biosthmors (talk) 17:22, 16 November 2012 (UTC)

I've removed it; the most recent review on the subject (PMC 3228849) doesn't make any such extraordinary claims, instead restricting themselves to saying "Sometimes the latency could be as long as one year, and there were well documented, but apparently unusual, cases reported of latencies greater than two years." Sasata (talk) 20:25, 16 November 2012 (UTC)

In vector control, the source for "As of 2006, the World Health Organization advises the use of 12 insecticides in IRS operations, including DDT as well as alternative insecticides (such as the pyrethroids permethrin and deltamethrin)" didn't mention permethrin. Cyfluthrin was listed. I'm not sure why the phrase "alternative insecticides" is necessary. Reword to replace permethrin and remove "alternative insecticides"? Biosthmors (talk) 17:48, 16 November 2012 (UTC)

• Done. Sasata (talk) 20:33, 16 November 2012 (UTC)

Okay, seriously. Reviews are not supposed to take over two weeks. This is hitting the six month mark. Pass or fail it, please, before someone else has to. --Rschen7754 03:21, 17 November 2012 (UTC)

As you can see from this series of edits[2], we are still actively going through the article to ensure it meets the good article criteria. Two dedicated people are happily improving the content of this important global disease to make sure it meets the good article criteria, for whatever that's worth! Biosthmors (talk) 15:55, 17 November 2012 (UTC)

No, this is more like a FA review, to be honest. See WT:GAN. --Rschen7754 19:17, 17 November 2012 (UTC)

Thanks. I commented there. Biosthmors (talk) 20:15, 17 November 2012 (UTC)

I am passing the article. Please see WP:GAN: "The review process itself should take, at most, two weeks." Please also see WP:GAN/R where you are the outlier by far. GAN is supposed to be a lightweight review, not a six month-long drawn out thing. --Rschen7754 20:17, 17 November 2012 (UTC)

I've reverted your actions. If if matters so much to you, I'll withdraw this GA review, work on it and resubmit later. Sasata (talk) 20:39, 17 November 2012 (UTC)

This review has far exceeded the GA standards. The consensus at WT:GAN is to promote it, because the reviewer has failed to do so in a reasonable amount of time. --Rschen7754 20:46, 17 November 2012 (UTC)

Then I withdraw this review. Sasata (talk) 20:47, 17 November 2012 (UTC)

This is completely unnecessary. The article is at GA standards already. --Rschen7754 20:48, 17 November 2012 (UTC)

Ideas for FA

I've removed the word "typically" before 9–30 days, as the source says it's most commonly 9–14 days. Maybe this latter time frame should be included as well? Sasata (talk) 18:23, 6 November 2012 (UTC)

Something to think about. Biosthmors (talk) 22:30, 15 November 2012 (UTC)

Kajfasz P (2009). "Malaria prevention". International Maritime Health 60 (1–2): 67–70. PMID 20205131 mentions DEET as being preffered with picaridin-based repellents also effective. Incorporate into Vector control? Biosthmors (talk) 17:08, 10 November 2012 (UTC)

It seems we should get at least a paragraph of detail in Prevention#Medications (with perhaps an adjacent map) of what areas/drugs are recommended/disadvised. This source makes a big point of making these distinctions. Biosthmors (talk) 17:15, 10 November 2012 (UTC)

This source also says there are "numerous mistakes with prophylaxis" in the conclusion, which could be incorporated into a future clinical practice section. Biosthmors (talk) 17:18, 10 November 2012 (UTC)

And that about 900 in Europe died in a span of recent years. Epi-worthy. Biosthmors (talk) 17:23, 10 November 2012 (UTC)

Some numbers on this: "Approximately 110 countries endemic for malaria are visited by 125 million international travellers every year, and more than 30,000 of them contract malaria [1]." could be in Epi. Biosthmors (talk) 17:27, 10 November 2012 (UTC)

I can't access this source; might you be able to email it to me? Sasata (talk) 19:45, 14 November 2012 (UTC)

Sure, when I get it. Maybe we're having the same issue. The url from PubMed doesn't pull up the PDF like it did before. Biosthmors (talk) 03:51, 15 November 2012 (UTC)

In History, I think "The malarial parasite was called Plasmodium by the Italian scientists Ettore Marchiafava and Angelo Celli." is verified. All that the source says is something like "Plasmodium, Marchiafava and Celli, 1885." I guess they got to name it? Biosthmors (talk) 17:41, 31 October 2012 (UTC)

• Yes, the names given after a taxon are the authors ("authority") and tell who first named it (see binomial nomenclature). Now that you mention it, I'm thinking that this sentence is unnecessary detail for this overview article? Sasata (talk) 19:05, 31 October 2012 (UTC)

• Agreed, this seems best at History of malaria. Biosthmors (talk) 22:45, 1 November 2012 (UTC)

• Removed (this info is already in the history article). Sasata (talk)

In Vector control, it is stated that ~13% of sub-Saharan homes have nets. Are there any estimates on what % of them use them? Or reasons as to why they do not? Biosthmors (talk) 19:38, 5 November 2012 (UTC)

In other methods, add that prengnant women/infants can also be targeted for intermittent preventive treatment (doi:10.1517/14656566.2012.703651). Biosthmors (talk) 18:15, 31 October 2012 (UTC)

• Added. Sasata (talk) 07:34, 1 November 2012 (UTC)

I remember seeing the WHO estimate ~107 countries had endemic malaria in 2010. If this is right then "As of 2010, 99 countries have endemic malaria" could be also cited to that and generalized to about 100. Biosthmors (talk) 20:39, 30 October 2012 (UTC)

• Done. Sasata (talk) 08:07, 31 October 2012 (UTC)

In Epidemiology, giving the context that malaria "is responsible for at least one in every five child deaths in sub-Saharan Africa"[3] (not the best source to cite) would be good. Mentioning the other causes would be good too I think. Biosthmors (talk) 19:49, 30 October 2012 (UTC)

A section such as "Clinical practice" may be worthy to document clinical practice and the reception of those practices. For example, "Although other studies from Africa have noted that access to laboratory testing is an important barrier to testing, the findings of the Ghana study are similar to those of other studies regarding the use of tests to guide treatment of patients with malaria, as well as the WHO finding of overprescription of antimalarial drugs despite widespread use of diagnostic tests." is mentioned in doi:10.1093/cid/cis228. Biosthmors (talk) 19:14, 30 October 2012 (UTC)

Along the same lines, this source concludes that "It would be a wiser use of resources to direct future efforts on improving access to these tests and how they are used to guide treatment, rather than pursuing ever-diminishing incremental improvements in diagnostic sensitivity and specificity." These types of expert opinions would be valuable to include in the article. Biosthmors (talk) 19:18, 30 October 2012 (UTC)

doi:10.1111/j.1469-0691.2011.03639.x is a 2011 review on diagnosis that could be incorporated. Biosthmors (talk) 19:04, 30 October 2012 (UTC)

Other useful images may be found at [4][5]. Biosthmors (talk) 18:33, 30 October 2012 (UTC)

"use human blood as a means to provide nourishment for their developing eggs" was mentioned in doi:10.1002/anie.200400663. While not the ideal source, perhaps, this way of presenting the parasite to readers could be useful. Biosthmors (talk) 23:08, 29 October 2012 (UTC)

That malaria was brought to the New World by Europeans is mentioned in the same source. That's a fact worth incorporating. Biosthmors (talk) 23:25, 29 October 2012 (UTC)

Draining marshes would logically cause ecological harms to some sorts of amphibians, fish, reptiles, or bird species and so it deserves a mention if it is discussed in sources. Biosthmors (talk) 17:15, 29 October 2012 (UTC)

The company Sanaria and their work might be worth a mention in research per coverage in http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146776/ Biosthmors (talk) 16:28, 29 October 2012 (UTC)

• Done. Sasata (talk) 19:44, 6 November 2012 (UTC)

Use consistent definitions for the words "eradicate" (worldwide) and "eliminate" (localized areas)? In Eradication efforts, there is "Malaria has been successfully eradicated in certain areas." Biosthmors (talk) 23:15, 26 October 2012 (UTC)

• Done (although sources don't seem to use these terms consistently). Sasata (talk) 19:30, 14 November 2012 (UTC)

In Prevention#Vector control, the cited source for the first paragraph doesn't support the entire paragraph. There is a sentence in the article that says "In some areas, the draining of wetland breeding grounds and better sanitation were adequate." Is that, or parts of the paragraph, common knowledge? Might some of this be OR? The source just says malaria was eliminated and the elimination program used X, Y, and Z. Biosthmors (talk) 23:44, 16 October 2012 (UTC)

• I've added a new source and changed the text to better align with the source. Sasata (talk) 07:14, 17 October 2012 (UTC)

• The source[6] cited for the sentence "Malaria was eliminated from most parts of the USA in the early 20th century by such methods, and the use of the pesticide DDT and other means eliminated it from the remaining pockets in the South by 1951" doesn't explicitly say DDT or other methods were responsible, does it? I want us to avoid the possibility of original research. Also, the source appears to be primary, so it could probably use replacing with a secondary source anyways. Biosthmors (talk) 22:56, 17 October 2012 (UTC)

• From the source: "The program commenced operations on July 1, 1947. It consisted primarily of DDT application to the interior surfaces of rural homes or entire premises in counties where malaria was reported to have been prevalent in recent years." The "South" is mentioned earlier: "The center was located in Atlanta (rather than Washington, DC) because the South was the area of the country with the most malaria transmission." "Other methods" is supported by this sentence: "It also included drainage, removal of mosquito breeding sites, and spraying (occasionally from aircrafts) of insecticides. Total elimination of transmission was slowly achieved." How does a CDC summary count as a primary source? Sasata (talk) 16:59, 18 October 2012 (UTC)

• Isn't it primary because it is their history? Biosthmors (talk) 17:01, 18 October 2012 (UTC)

• Ok, maybe it's secondary with COI :) I'll see if I can find something to replace this. Sasata (talk) 17:03, 18 October 2012 (UTC)

• I guess it would have made more sense had I suggested an independent source. =) Biosthmors (talk) 17:06, 18 October 2012 (UTC)

• What do you think about PMC 1253858 as a source? It's not listed as a "review" in pubmed as such, but it clearly is a review (and calls itself a "brief historical review" in the introduction). Although it's old, it covers most of the points in the sentence it would be citing (would have to change the text a bit in some places; it doesn't, for example, explicitly give 1951 as the year of elimination), and the author was associated with the WHO, not the CDC (and honestly, I don't think this material is contentious or likely to be challenged). Sasata (talk) 17:27, 18 October 2012 (UTC)

• Sure, that's fine. Biosthmors (talk) 17:38, 18 October 2012 (UTC)

• Done. Sasata (talk) 18:03, 18 October 2012 (UTC)

• I'm not going to let this affect the GA review, but on second thought, I think we need something from the 2000s. For those who look to this page to understand how malaria can be prevented should have the convenience of us citing the best possible sources, and I think that means citing something more recent. Biosthmors (talk) 23:43, 22 October 2012 (UTC)

• Will keep looking for a more recent source. Sasata (talk) 16:59, 23 October 2012 (UTC)

Switch http://en.wikipedia.org/wiki/File:Malaria.jpg with the life cycle picture in http://en.wikipedia.org/wiki/File:MalariacycleBig.jpg? Or maybe include http://en.wikipedia.org/wiki/File:Ookinete,_sporozoite,_merozoite.png somehow? It seems things should be rearranged a little bit to match the prose. Also, putting arrows on some of the microscopic pictures to identify particular aspects, like ring forms/gametocytes, could be helpful. Biosthmors (talk) 19:31, 16 October 2012 (UTC)

• I move the life cycle diagram to the proper location. Will look at more closely at image selection, layout, and other similar tweaks before FAC. Sasata (talk) 06:29, 22 October 2012 (UTC)

http://en.wikipedia.org/wiki/File:Malaria.jpg might be best suited for the top of the article. It catches my eye, at least. The caption could be worded something like this: "A Plasmodium in the form that enters humans and other vertebrates from the saliva of female mosquitoes (a sporozoite) traverses..." Biosthmors (talk) 22:42, 16 October 2012 (UTC)

Sure, we'll give it a try, swapped positions. Sasata (talk) 07:35, 17 October 2012 (UTC)

In Epidemiology, maybe a sentence on the three highest countries from the 2012 Lancet study would be appropriate at the end after "As of 2010, countries with the highest death rate per 100,000 population are Ivory Coast with 86.15, Angola (56.93) and Burkina Faso (50.66) – all in Africa". Biosthmors (talk) 19:17, 16 October 2012 (UTC)

• How's this? Sasata (talk) 08:04, 17 October 2012 (UTC)

• I'm not sure what the stats mean, exactly. The source says, "Cumulative probability of dying from malaria in the absence of all other causes from birth to age 80 years in 2010." So this isn't a mortality rate, see Mortality_rate#Statistics for comparison. I reworded this because I thought it could be misunderstood. Biosthmors (talk) 20:59, 23 October 2012 (UTC)

In Epidemiology, the systematic analysis ("Global malaria mortality between 1980 and 2010: a systematic analysis") estimates that children under 5 in Africa experienced "699 000 (415 000–1 112 000) deaths in 2010." Children under 5 outside of Africa experienced "15 000 (4300–31 000) [deaths] in 2010." If we have a recent secondary source that cites the 2012 paper and wants to say that this amounts to most deaths depsite the wide confidence intervals, then OK. The 2012 paper says "Our findings show substantially more deaths across all ages and regions than the World Malaria Report 2011²¹ assessment for 2010: 1·3 times higher for children younger than 5 years in Africa, 8·1 times higher for those aged 5 years or older in Africa, and 1·8 times higher for individuals of all ages outside of Africa." The 2012 paper suggests things can change significantly in 6 years, so I don't think we should be citing the 2005 paper in the Lancet about where most of the cases come from. Replace? Biosthmors (talk) 18:29, 16 October 2012 (UTC)

• Ok; I've replaced this stat with the 65% deaths under 15 years old from the 2012 Lancet article. Sasata (talk) 07:26, 17 October 2012 (UTC)

Trends in the global malaria burden/death count are mentioned in doi:10.1016/S0140-6736(12)61127-1 "As with HIV, overall frequency of malaria has decreased, from 233 million cases in 2000, to 216 million cases in 2010. Over the same period deaths from malaria have fallen by more than a third—from nearly 985 000 to 655 000—according to WHO.73 A more recent estimate suggests more deaths and even greater rate of reduction (from 1·8 million deaths in 2004, to 1·1 million deaths in 2010) with technology playing a key part in this progress, most notably artemisinin-based combination therapies and insecticide-treated bednets.74" This type of content would be great because it suggests which interventions are likely to produce results. Biosthmors (talk) 23:12, 15 October 2012 (UTC)

There is also more content in this source. I suggest it be incorporated into the article. Biosthmors (talk) 23:18, 15 October 2012 (UTC)

I added the epidemiological trends and some other details from this article. Anything else you think should be included? Sasata (talk) 20:45, 14 November 2012 (UTC)

The article mentions the issue of funding difficulties in less-developed regions. Is there any estimate on total governmental/NGO/charity spending on malaria prevention per year and trends? And perhaps a comparision with HIV prevention funding would be nice too. Biosthmors (talk) 22:23, 15 October 2012 (UTC)

"Global malaria mortality between 1980 and 2010: a systematic analysis" has a helpful paragraph that mentions funding the danger of the financial crisis to disturb recent improvements in malaria mortality. Biosthmors (talk) 18:22, 16 October 2012 (UTC)

In Pathogenesis#Genetic resistance, it says "it is thought to have placed the greatest selective pressure on the human genome in recent history". If sources say it has "placed the greatest selective pressure on the human genome in recent history" then we can just cite it as fact and remove "it is thought". Biosthmors (talk) 21:50, 15 October 2012 (UTC)

• Done. Sasata (talk) 08:51, 16 October 2012 (UTC)

In Cause#Life cycle, readers are presented with the information "Anopheles mosquitoes eventually carry Plasmodium sporozoites in...". My emphasis. Then there are lots more of these fancy words. Maybe we should get some explanatory prose in a summary style paragraph of how Apicomplexa lifecycle stages apply to malaria. That way readers aren't put off by all the new vocabulary. Biosthmors (talk) 01:58, 9 October 2012 (UTC)

• Rewrote the intro paragraphs of that subsection; how's this? Sasata (talk) 09:16, 16 October 2012 (UTC)

• Much clearer, thanks. Biosthmors (talk) 18:49, 16 October 2012 (UTC)

The paragraph in the Signs and symptoms#Complications portion that starts with "Coinfection with HIV and malaria does increase mortality, although this is less of a problem than with HIV/tuberculosis coinfection..." seems overly focused on comparing things to HIV/TB. I'm not sure this matters at all to readers. I'd suggest removing it and clarifying the most important facts about HIV/malaria. Biosthmors (talk) 23:22, 8 October 2012 (UTC)

• Done. Sasata (talk) 09:34, 16 October 2012 (UTC)

Taylor 2012, "Respiratory Manifestations of Malaria" gives case counts for Western Europe and the Americas, which should be in the Epidemiology section for comparison. Biosthmors (talk) 23:22, 8 October 2012 (UTC)

• Added. Sasata (talk) 08:08, 11 October 2012 (UTC)

Tertian malaria is a term that could use some classification in a new classification section perhaps (and cerebral, severe, etc.). Biosthmors (talk) 21:31, 27 September 2012 (UTC)

The phrase benign malaria seems to have been popular. Not sure how much now. As is benign tertian malaria, though the 2010 review "Current status of Plasmodium vivax vaccine" suggests P. vivax isn't so benign. Biosthmors (talk) 21:43, 27 September 2012 (UTC)

http://en.wikipedia.org/wiki/File:Symptoms_of_Malaria.png shouldn't be sourced to WebMD, ideally, it should be sourced to a traditional MEDRS. Biosthmors (talk) 21:03, 26 September 2012 (UTC)

• Done. Sasata (talk) 06:06, 27 September 2012 (UTC)

Some facts and background on "several species of Plasmodium from higher apes" and "P. knowlesi, a zoonotic species that causes malaria in macaques", could go into the in other animals section for comprehensiveness. Biosthmors (talk) 21:01, 26 September 2012 (UTC)

The WHO site has an expected timeline on a vaccine under development. As research directions is a section, we could use some more detail on what is expected in 2014 or 2015. Or another source might have a more updated timeline. Biosthmors (talk) 20:11, 26 September 2012 (UTC)

• Good idea, now added. Based on this, it looks like they will be updating this timeline in early 2013. Sasata (talk) 06:27, 27 September 2012 (UTC)

Nadjm 2012 mentions that at least 2000 die daily as a big take home summary bullet point. This method of presenting the statistics should probably be presented in the lead to make it a bit more real for readers. Biosthmors (talk) 20:52, 25 September 2012 (UTC)

• I added this, but am not sure how they get a value of "more than 2000 people every day" when the WHO 2010 source they use gives "655 000 malaria deaths in 2010"? Sasata (talk) 05:55, 27 September 2012 (UTC)

See if the paragraph sourced to Sachs J, Malaney P (2002). "The economic and social burden of malaria". Nature 415 (6872): 680–5. doi:10.1038/415680a. PMID 11832956. can be updated with a more recent (and perhaps better) source that estimates the degree of causality? Biosthmors (talk) 20:52, 25 September 2012 (UTC)

Infant mortality caused by malaria deserves a paragraph of discussion, I would think, to be comprehensive. Biosthmors (talk) 02:09, 19 September 2012 (UTC)

• Started this (more later). Sasata (talk) 06:46, 25 September 2012 (UTC)

My fault for linking you to a review by the same researchers, but the "Poisoning Pyridoxal 5-Phosphate-Dependent Enzymes: A New Strategy to Target the Malaria Parasite Plasmodium falciparum" content in the Research section shouldn't be cited to a review by the same researchers as they are not independent. Biosthmors (talk) 19:08, 15 September 2012 (UTC)

• I trimmed out some of the biochemical details, and doubled up the citation with another review. Sasata (talk) 06:58, 22 October 2012 (UTC)

In Society and Culture#Economic impact, include sources that discuss lost tourism revenue? I imagine malaria can discourage tourism. Biosthmors (talk) 20:33, 13 September 2012 (UTC)

In the prognosis section, specify how often the most severe case of the disease occurs. Readers may wonder if it is 1% or 10% of the time. Biosthmors (talk) 18:29, 27 August 2012 (UTC)

Incorporate epidemiological data for severe/uncomplicated malaria if available. Biosthmors (talk) 22:31, 27 July 2012 (UTC)

"Severe malaria is much less of a problem in adolescents than in younger children.", for example. doi:10.1016/S1473-3099(06)70655-7 Biosthmors (talk) 21:38, 30 October 2012 (UTC)

In general, I think the prevention section could be improved by focusing on what works today and I guess some detail on why it works. For example, are mosquito nets, vector control and indoor residual spraying commonly employed together? Or are some areas of the world targeted with just one of those methods for some reason? Maybe we can split out the historical details such as the DDT and malaria content to other sections of the article. Biosthmors (talk) 19:38, 27 June 2012 (UTC)

• Well run eradication efforts combine methods in a coordinated approach while adhoc methods get limited, transient results at best. doi:10.1371/journal.pmed.1000402 LeadSongDog come howl! 06:50, 28 June 2012 (UTC)

• Thanks for the comment and link. I think this type of big picture info should be described. Biosthmors (talk) 20:46, 2 July 2012 (UTC)

• Big picture discussion is good; do you think this would fit better in the subsection "Eradication efforts"? Sasata (talk) 07:11, 4 July 2012 (UTC)

• Hmmm... I was thinking prevention but if there are current eradication programs discussed in secondary sources I think their details (geography/strategy/funding/logistics) should be mentioned in the prevention section under a subheading. Biosthmors (talk) 20:01, 5 July 2012 (UTC)
• I think the section should ideally be written so that if a philanthropist or a public health worker wants to prevent malaria, they would have some more concrete ideas on what to do or where resources should be allocated (more on what works and why). Biosthmors (talk) 19:29, 1 August 2012 (UTC)

Under #Genetic resistance I would put the speculative sentence ("A number of diseases may provide some resistance to it including...") at the end. In regards to sickle cell, it goes in to detail about why the homozygotes would benefit though they do not in the end. So that seems like it should be trimmed. Biosthmors (talk) 20:23, 23 May 2012 (UTC)

This reviewdoi:10.1038/hdy.2011.16 says this reviewdoi:10.1016/j.gene.2010.07.008 is excellent on the mechanisms so it may work well to help support the section. It has sections on a variety of mechanisms besides the sickle-cell trait. Biosthmors (talk) 21:28, 27 July 2012 (UTC)

I think the section may benefit from some more explanatory text on the other mechanisms of resistance. Biosthmors (talk) 19:29, 1 August 2012 (UTC)

Lead

In "The WHO has estimated that malaria annually causes over 200 million cases of fever" We need to mention the year the data is from as these number frequently change over time.Doc James (talk · contribs · email) 13:03, 11 June 2012 (UTC)

• Done. Used 2010 data. It might be a worthwhile idea to make a graph showing number of episodes and deaths using WHO data going back however many years. Something to think about for FAC. Sasata (talk) 15:43, 14 June 2012 (UTC)

Diagnosis

• It is stated that "saliva and urine have been investigated as alternative, less invasive specimens" but what the conclusions are is not mentioned. If this is not in clinical practice than it should be moved to the section on research.

• I can't find any reviews that discuss this, so to avoid the research section becoming a dumping ground for unsubstantiated primary research, I removed it completely. There's probably a place for it in the daughter article. Sasata (talk) 16:35, 14 June 2012 (UTC)

• "Severe malaria" is mentioned a few times but never defined. It should be defined in the diagnosis section. There are WHO clinical and lab criteria. Doc James (talk · contribs · email) 12:26, 11 June 2012 (UTC)

It looks like "severe malaria" is now defined in the diagnosis section.Rytyho usa (talk) 22:08, 15 August 2012 (UTC)

Other methods

• Where is the evidence to support this?

Education in recognizing the symptoms of malaria has reduced the number of cases in some areas of the developing world by as much as 20%. Recognizing the disease in the early stages can also stop the disease from becoming a killer. Education can also inform people to cover over areas of stagnant, still water e.g. water tanks which are ideal breeding grounds for the parasite and mosquito, thus cutting down the risk of the transmission between people. This is most put in practice in urban areas where there are large centers of population in a confined space and transmission would be most likely in these areas.

• Now reworded and sourced. Sasata (talk) 19:53, 12 June 2012 (UTC)

• Per "mass drug administrations". Yes but does it work?
  • The cited source (doi:10.1371/journal.pmed.1000402} says it has, when endemic in isolated "islands", but not in contiguous areasLeadSongDog come howl! 06:35, 28 June 2012 (UTC)
  • I've added a couple of sentences discussing the efficacy of MDA and intermittent preventive therapy. Sasata (talk) 15:55, 10 September 2012 (UTC)
• Until something has secondary sources to support active use it should be in the research section e.g.

Furthering attempts to reduce transmission rates, a proposed alternative to mosquito nets is the mosquito laser, or photonic fence, which identifies female mosquitoes and shoots them using a medium-powered laser.[63] The device is currently undergoing commercial development, although instructions for a DIY version of the photonic fence have also been published.[64]

Doc James (talk · contribs · email) 12:54, 11 June 2012 (UTC)

• This has been removed. Sasata (talk) 06:20, 12 June 2012 (UTC)

References

For a major disease like this all references should be secondary sources from the last 5 years (at most 10) per WP:MEDRS.

• This is a primary source http://www.ncbi.nlm.nih.gov/pubmed/15306705 look at 290 children, one cannot conclude from this that "In endemic areas, treatment is often less satisfactory and the overall fatality rate for all cases of malaria can be as high as 10%."

• I've removed this statement and the source. Sasata (talk) 18:31, 14 June 2012 (UTC)

• Another primary source "http://www.ncbi.nlm.nih.gov/pubmed/9675468"

Doc James (talk · contribs · email) 13:07, 11 June 2012 (UTC)

• Now replaced with the Nadjm 2012 review. Sasata (talk) 18:03, 19 June 2012 (UTC)

Verifiable — criterion 2

I will be going through the article to gauge verifiability. I'll develop a list of verified facts here. Any concerns I develop I'll put above in comments. Biosthmors (talk) 20:30, 28 September 2012 (UTC)

1. "However, symptoms may occur later in those who have taken antimalarial medications as prevention" checks out because the primary source says "In 134 of these cases (44.7 percent), the illness developed more than two months after the traveler's return". Biosthmors (talk) 21:56, 27 September 2012 (UTC)
2. "In drier areas, outbreaks of malaria have been predicted with reasonable accuracy by mapping rainfall" in Epidemiology is verified. Biosthmors (talk) 00:27, 23 October 2012 (UTC)
3. "According to Joseph Patrick Byrne, "Sixty thousand American soldiers died of malaria during the African and South Pacific campaigns."" is verified. Biosthmors (talk) 20:41, 24 October 2012 (UTC)
4. Counterfeits in China is verified by "it became clear the counterfeit artesunate situation was worsening in the Greater Mekong Sub-Region of South East Asia (comprising Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, Vietnam, and Yunnan Province in the People's Republic of China)." Biosthmors (talk) 20:46, 24 October 2012 (UTC)
5. That P. knowlesi is in macaques is verified.[7] No copyright on that source ("Plasmodium knowlesi: A Malaria Parasite of Monkeys and Humans" -- U.S. government) but not openly accessible from the publisher. Biosthmors (talk) 20:53, 24 October 2012 (UTC)
6. "Malaria is typically diagnosed by the microscopic examination of blood using blood films or using antigen-based rapid diagnostic tests" is verified. Biosthmors (talk) 22:47, 28 October 2012 (UTC)
7. "This public health use of small amounts of DDT is permitted under the Stockholm Convention on Persistent Organic Pollutants (POPs), which prohibits the agricultural use of DDT" is verified. Biosthmors (talk) 23:35, 28 October 2012 (UTC)
8. "As of 2010, countries with the highest death rate per 100,000 population were Ivory Coast with 86.15, Angola (56.93) and Burkina Faso (50.66)." is verified. Biosthmors (talk) 23:40, 28 October 2012 (UTC)
9. "The drawback of this practice, however, is overdiagnosis of malaria and mismanagement of non-malarial fever, which wastes limited resources, erodes confidence in the health care system, and contributes to drug resistance" is verified. Biosthmors (talk) 23:51, 28 October 2012 (UTC)
10. "artesunate has been shown to be superior to quinine in both children and adults" is verfied. Biosthmors (talk) 02:38, 29 October 2012 (UTC)
11. "The term malaria originates from Medieval Italian: mala aria — "bad air"; the disease was formerly called ague or marsh fever due to its association with swamps and marshland" is largely verified. Biosthmors (talk) 16:23, 29 October 2012 (UTC)
12. "Malaria is not just a disease commonly associated with poverty: some evidence suggests that it is also a cause of poverty and a major hindrance to economic development" is verified. Biosthmors (talk) 23:38, 29 October 2012 (UTC)
13. "Malaria in pregnant women is an important cause of stillbirths, infant mortality and low birth weight,[12] particularly in P. falciparum infection, but also in other species infection, such as P. vivax.[13]" is verified. Biosthmors (talk) 21:22, 30 October 2012 (UTC)
14. " Initial manifestations of the disease—common to all malaria species—are similar to flu-like symptoms" is verified. Biosthmors (talk) 21:24, 30 October 2012 (UTC)
15. "although [hypnozoites] in P. ovale is uncertain" is verified. Biosthmors (talk) 21:26, 30 October 2012 (UTC)
16. " proliferation of substandard antimalarial medicines resulting from inappropriate concentration of ingredients, contamination with other drugs or toxic impurities, poor quality ingredients, poor stability and inadequate packaging" is verified. Biosthmors (talk) 18:31, 31 October 2012 (UTC)
17. "Some survivors of cerebral malaria have an increased risk of neurological and cognitive deficits, behavioural disorders, and epilepsy." is verified. Biosthmors (talk) 02:24, 10 November 2012 (UTC)
18. "In the 2000s (decade), malaria with partial resistance to artemisins emerged in Southeast Asia" is verified. Biosthmors (talk) 17:32, 16 November 2012 (UTC)
19. "This effort led to the publication of a map of P. falciparum endemicity in 2010" is verified. Biosthmors (talk) 20:44, 16 November 2012 (UTC)