Shivering and sweating feverishly, Felicia Egbuchue took the malaria medicine her doctor prescribed. Although it had cured her in years past, this time it didn't. She was rushed to the hospital, and hooked up to an intravenous drip.
"I have no inner strength. I feel like I'm dying," the 30-year-old university student said from her hospital bed.
Malaria, the ancient mosquito-borne disease that was rolled back by medical advances in the mid-20th century, is making a deadly comeback.
Strains of the disease are becoming increasingly resistant to treatment, infecting and killing more people than ever before — sickening as many as 900 million last year, according to estimates by the U.S. Agency for International Development.
More than 1 million people — and as many as 2.7 million by some estimates — of those victims died. The vast majority of the deaths were in Africa.
Only AIDS kills more people worldwide. Among children, malaria kills even more than AIDS.
After three days in a private hospital in Nigeria's commercial capital of Lagos, Egbuchue recovered from what doctors said was a strain that had become resistant to many of the standard treatments.
"Malaria is something that we thought we had conquered years ago. But more and more of our people are dying from it every day," said Patrick Dike, a malaria specialist at the Lagos hospital.
The economic cost of malaria is also high — in countries of Africa, Asia and Latin America where the disease is endemic, the World Health Organization estimates up to $12 billion are lost annually to the disease.
Americans traveling abroad also are at risk. Of the 225 Marines and Navy forces who went ashore to assist West African peacekeepers in Liberia, 51 showed symptoms — an unusually high rate, U.S. officials said.
International efforts to contain or even eradicate the disease have received a boost in recent years with major grants from the U.S. government and from the $4.7 billion five-year U.N. Global Fund for Aids, Tuberculosis and Malaria.
The Bill and Melinda Gates Foundation, which has supported malaria control efforts, is also expected to announce new funding toward malaria medicines, controls and vaccine research this weekend.
"We hope that malaria gets some additional visibility," Bill Gates, the Microsoft chairman, said in a conference call with journalists. "Of those million people who die, overwhelmingly those are children. ... This is something we should demand more action on."
Malaria campaigners complain that despite the increased focus, their efforts remain woefully underfunded. Whereas AIDS vaccine research receives $400 million a year, malaria research receives just $60 million.
While donors commit an estimated $200 million each year to treating impoverished patients and distributing mosquito nets and insecticides to prevent mosquito bites that transmit the disease, experts say they need at least $1 billion to make a dent.
"Malaria has to some extent been forgotten by the international community," said Allan Schapira, a senior official in WHO's Rollback Malaria program. "Apart from AIDS, it is the single worst child health problem that we haven't got a grip on."
A major cause of malaria's alarming resurgence is the parasite's increasing resistance to the drugs used to treat and prevent the disease — including chloroquine, the cheapest and most effective anti-malarial since the 1950s.
The number of alternatives are limited. The WHO supports use of multi-drug combinations based on artemisinin, until recently an extract from the "sweet wormwood" plant used in China for centuries but little known in the West.
Yet aid agency officials say that artemisinin is not yet produced in large enough quantities to affordably treat the large numbers of Africans who need it most.
Some governments and Western donors have been hesitant to promote the treatment widely because of a lack of funds — artemisinin is 10 times more expensive than chloroquine, or between $4.50 and $9 for a three-day treatment.
"It is definitely the future," Anne Peterson, head of global health for USAID in Washington, said of artemisinin-based drugs. "Yet it is far more expensive and harder to get out to the numbers of people who need it."
The Nobel Prize-winning international humanitarian group Medecins Sans Frontieres is urging the United States and other Western governments to support and fund artemisinin-based therapy regimens. It notes chloroquine and other drugs have become ineffective in up to 80 percent of malaria cases in some countries.
"Donors must stop wasting their money funding drugs that don't work," MSF said in a report.
Peterson, the USAID official, said that until it receives more funds, the U.S. agency will support the use of the "cheapest, most effective drugs" in countries where they still have use.
Dike, the Lagos doctor, said in the absence of affordable alternatives, he and some colleagues have in desperation begun exchanging information about what available combinations work best to treat patients.
"People don't understand why their relatives are sometimes not recovering, or why they are not being cured as quickly as they are used to being cured. How do you explain drug resistance? When they are suffering, the doctor is blamed."
By Glenn McKenzie