Malaria in Sub-Saharan Africa

Malaria is still currently a major epidemic in sub-Saharan Africa, and it is reported that a child dies in Africa from Malaria every 60 seconds. Malaria is a disease that is spread to humans from the bite of a mosquito that is infected with the malaria parasite. This disease has been around for centuries and has a very low rate in the western world, but it is an infectious disease that still plagues the continent of Africa, in particular sub-Saharan countries. This disease has a major impact not only on those who are infected, but the communities, countries, and economies that surround the affected areas are also devastated by the spread of malaria. Current statistics state that 350-500 million people in Africa are infected every year by malaria and that 700,000 to a million people die each year from the disease. Of these deaths, one in five are children, and the children living with malaria are commonly suffering from anemia, which leads to poor growth and development. The economic factors surrounding malaria are quite obvious; it is a disease that primarily affects poor people, in poor communities, in mostly poor countries. This economic factor is an unfortunate circular cycle, malaria mainly affects the poor and those who suffer from malaria are unable to provide, so they remain poor and their children are therefore locked into poverty. There are also major world politics involved with combating malaria. NGO’s like UNICEF, the World Health Organization, and organizations like the Roll Back Malaria Partnership work with the local governments and invest billions of dollars into malaria prevention and treatment. One of the major campaigns that have shown some results is the deployment of millions of bug nets. Some of these nets are treated with insecticides and they are widely promoted for malaria prevention to stop mosquito bites. But, as what was mentioned in this week’s lecture, the campaign was not as successful as expected when it was first employed. There were cultural barriers, and the lack of communication between the NGO’s and the local communities led to improper, inconsistent, or complete lack of use of the bug nets in the local residents’ homes. But the campaign had increased in success, along with other prevention and treatment programs, and the occurrence of malaria in sub-Saharan Africa has been cut by 1/3 in the past decade. Although, this is a major win, malaria continued to infect and kill at an alarming rate. Right now there is a move to find a preventative vaccine, that is widely effective and safe for mass use. Hopefully, malaria will go the way of other once deadly diseases, like polio, and be almost non-existent with a simple vaccine.

Many anthropologists and social scientists are studying the varying factors and impacts of malaria. Some are studying the behavioral impacts that dealing with being infected with malaria have caused, others are more focused on the economic impact that malaria plays on sub-Saharan Africa. One article, by Wendy P. O’Meara, breaks down the individual burdens of malaria based on regions and specific countries in Africa. This study shows that while some countries have seen a marked improvement on the burden of malaria, not all countries have been so lucky; some have not seen the amount or intensity of the malaria burden improved in their countries at all. The trend, however, is toward improvement, and I think as long as malaria affects so many people, it will be a topic research and discussed by anthropologists for a long time to come.

 

Sources:

1-      Williams, Holly A., and Caroline O.H. Jones. “A critical review of behavioral issues related to malaria control in sub-Saharan Africa: what contributions have social scientists made?.” Social Science and Medicine. 59. (2004): 501-523. http://ac.els-cdn.com/S0277953603005951/1-s2.0-S0277953603005951-main.pdf?_tid=9ccaaddcb01590c3c7a2a3fbb5e59f19&acdnat=1344654571_031b9dd8d2f2cbc88e240ed8f4373224 (accessed August 10, 2012).

2-      Prudhhomme O’Meara, Wendy. “Changes in the burden of malaria in sub-Saharan Africa.” Lancet on Infectious Disease. 3099. no. 10 (2010): 545-555. http://ac.els-cdn.com/S1473309910700967/1-s2.0-S1473309910700967-main.pdf?_tid=35e3d50564516efd5b1e2f215464c460&acdnat=1344654651_29e7704bde88c49bfa6ce9b1e708e825 (accessed August 10, 2012).

3-      Chima, R.I., C.A. Goodman, and A. Mills. “The economic impact of malaria in Africa: a critical review of the evidence.” Health Policy. 63. (2003): 17-36. http://ac.els-cdn.com/S0168851002000362/1-s2.0-S0168851002000362-main.pdf?_tid=d2bebfc66a3d9e2fa1a7e869a3651622&acdnat=1344654167_325bbd0ff29c58898357803b6451e90e (accessed August 10, 2012).

4-      World Health Organization, “World Health Organization- Malaria.” Last modified June 2012. Accessed August 10, 2012. http://www.who.int/malaria/en/.

5-      UNICEF, “UNICEF- Health- Malaria.” Last modified August 2, 2012. Accessed August 10, 2012. http://www.unicef.org/health/index_malaria.html.

6-      Roll Back Malaria Partnership, “Roll Back Malaria.” Last modified August 8, 2012. Accessed August 10, 2012. http://www.rbm.who.int/.

Epidemiology and Medical Anthropology

I decided to write about the increasingly common practice of combining medical anthropology and epidemiology to use interdisciplinary methods in solving important global health issues. I am personally very interested in the epidemiology as a field of study because the cause and spread of disease can be affected by so many factors, from huge macro-level events, to the most microscopic of organisms. Epidemiology is defined as “the study of the distribution and determinants of disease” (Trostle et al. 1996), and the reasons behind the distributions and the biological, social, and cultural determinants also factor in heavily to fields of study that are of interest in applied medical anthropology. I hope to one day be a geriatric primary physician, and although I may not be on the front lines collecting the data with the epidemiologists and anthropologists, it will be very important to me to know about what disease are currently being spread and who is at risk because the geriatric population typically is the most infected and least able to fight off general infectious diseases. The geriatric population, along with children and the chronically ill are part of the most vulnerable subgroup of the population when it comes to contracting diseases, and this is true in almost all areas of the world.

If I was working with an epidemiologist on trying to come up with answers to why a particular disease is spreading and behaving in a certain manner, the knowledge and methods used by applied medical anthropologists would be indispensible in coming up with ways to combat a disease and answering the major questions about how to solve that particular health problem. The anthropological theories could help to assess what macro-level structures could be contributing to the rate a disease is spreading and why it is spreading in a particular pattern. They could look at the ecological systems, transportation patterns, and the culture’s ethnomedical systems in order to present a complete picture to the epidemiologists to help determine the distribution pattern of a disease and more importantly, why the disease is spreading in that specific manner. Applied medical anthropologists could also help epidemiologists, by using anthropological methods to collect data that could look at individuals with the disease they are studying and collect enough qualitative data to help identify the determinants of the disease and who is most at risk. This interdisciplinary approach could help treat and then move to prevent the further spread of that specific disease. The overlap of interests and fields of study between epidemiology and applied medical anthropology have led to a great increase in scientific studies that utilize areas of both professions, which then join together to help solve important health issues.

 

Sources:

1-      Janes, Craig R. Anthropology and Epidemiology. Dordrecht, Holland: D. Reidel Publishing Company, 1986. http://books.google.com/books?hl=en&lr=&id=ggn-VgZceYAC&oi=fnd&pg=PR7&ots=BLo4530f_y&sig=pAEnIq_cFfQDZP7HrKlRcs5klJg

2-      Trostle, James, and Johannes Sommerfeld. “Medical Anthropology and Epidemiology.” Annual Review of Anthropology. 25. no. 1 (1996): 253-274. http://www.annualreviews.org/doi/pdf/10.1146/annurev.anthro.25.1.253 (accessed August 10, 2012).

Male/Female

The culture of biomedicine is how the medical system interacts with the culture and how it is in turn influenced by the culture at large. This relationship is very important to understand because it has a great influence on how the medical system works within our culture, and therefore how we have access to and get treatment in the biomedical system.

I choose the dichotomy of male vs. female. My own person view is quite broad when it comes to the definition of what makes someone a male or a female, a man or a woman, and even a mother or a father. I think my own personal views were developed during my adolescent years, where I embraced a much more liberal and open view than I had been previously exposed to. I became very tolerant and excepting of all people, I think the fact that I went to a very small, somewhat racist high school, caused me to go the complete opposite direction on how I defined social roles, particularly gender roles.

I think that people use nature as an excuse to have very narrow roles on the view of sex vs. gender. They often do not take in account that when it comes to nature, really there are many different sexes, not just male and female. Like what was mentioned in lecture, there are hermaphrodites, people with XXX, XXY chromosomes, and many other combinations. In the past these people were seen as abnormal or irregular, but with the increase of medical knowledge and genetics, it is my hope that these people will be seen as just another form of a natural biological sex. And also, hopefully these people will not be forced to choose to confine themselves to one gender role, to have to pick if they are a girl or a boy, if they do not want to make the distinction. I think as we learn more about genetics, sex and gender roles will both become broader and more inclusive.

High Cholesterol

I choose to right about the heavy medicalized condition of high cholesterol, this condition is particularly over-medicalized in the U.S. I am not saying that it cannot be a serious medical condition, but the overuse of medications when dealing with high cholesterol, especially only moderately high cholesterol, has made it one of the most heavily medicalized conditions in America. I believe that both cultural and economic factors have played the biggest role in this illness being over-marketed and over-treated with drugs. First, is the issue that culture has played in this, the reluctance of Americans to be responsible for their own health has been a big issue, people want to eat anyway they please and not exercise and then expect biomedical interventions to enhance their lives by keeping their cholesterol low, their blood pressure done, and so forth, without the effort on their parts. I know there are people who live very active lifestyles and still suffer from high cholesterol, but they are in the minority. This condition should not turn to medications first, which is what often happens due to the second major factor in this over-medicalization, the economic business of biomedicine.  Due to the heavy promotion of drugs as the first option when someone has high cholesterol, due to heavy advertisement that permeates the American biomedical culture; doctors often turn to these drugs first, instead of working with the patients to decrease their cholesterol naturally. Also, patients see these advertisements and request these medications from their doctors, thinking this is the best possible way to treat their conditions.

I have included a couple of links to commercials for cholesterol medications. The first includes a link to a Lipitor commercial featuring Dr. Robert Jarvik, the creator of the artificial heart, and at the time this commercial aired it was seen as one of the most dishonest drug ads out there, due to the minimalization of the harmful side effects this drug can cause. One of the advertising strategies used in this advertisement was using Dr. Jarvik as an authority figure and as someone who had access to privileged medical knowledge. It also used him in order to give a sense that it was a patient-doctor interaction, like your doctor talking directly to you, saying you need to ask about this drug. Overall, the commercial tried to present a sleek, modern presentation that was to appeal to consumers, hinting that this drug was the latest and greatest that biomedicine had to offer.

Commercial Sources:

1-      Pfizer. (Producer). (2010). Lipitor tv commercial – robert jarvik. [Web Video]. Retrieved from http://www.youtube.com/watch?v=Rt1xRPEjhrk

2-      Pfizer. (Producer). (2012). Lipitor (atorvastatin calcium) tablets tv commercials. [Web Video]. Retrieved from http://www.lipitor.com/toolsresources/lipitorontv.aspx

“I Have a Traumatic Brain Injury”

-In this episode it followed people who had suffered traumatic brain injuries. These people mostly followed a Restitution narrative in one way and in other a Quest narrative. These people suffered injuries and accidents and did not have these illnesses one day and then had brain injuries the next. One of the subjects was trying to return to school after going through extensive rehabbing from his brain injury. He still had to walk with a cane and had slurred speech, but was able to make a concerted effort to go back to school. Another one of the subjects, who was in an auto accident lacked facial recognition and social abilities after his brain injury and was trying to relearn social behaviors and reunite with his friends from school.

-These people mainly followed the major six aspects of an illness narrative. They kind of told what their story was generally about, then orientated their stories by saying what caused their injuries, what deficits they suffered from, and how it was presenting itself, then the complicating action was not only the injury itself, but how they were at rejoining their past lives, they then evaluated their illnesses and how they applied coping tools, and then how its resulted in where they are now and the overall effect it has on their present situation. Mostly these were quest narratives because they had the goal of making their lives complete with their injuries, not actually being cured on their symptoms.

-Particularly for the boy who had issues recognizing faces and adhering to social norms, it seemed there was a bit a cultural stigma. He was seen as being rude or disagreeable by the people who knew him before his injury, particularly his family and friends from school. He was also worried how his illness affected others, whether or not they would be offended that he no longer recognized them. The stigma was not so much on the illnesses itself, because no one can help a traumatic brain injury, but it was more the people around them not understanding why they were behaving in a certain way and it not being immediately obvious what injury or deficits they suffered form.

-These subjects were able to accept their sick roles and take on the rights and responsibilities of their injuries. They did this mainly by adapting to their new roles in their past lives. I think these illness narratives were not only helpful to the person with the disability themselves to grapple with their new lives, but also helped them to relate to those around them. And it helped their family and friends better connect with the person experience and illness and how their lives will be from now on.

 

MTV. (Producer) (2010). “true life: I have a traumatic brain injury” [Television series episode]. In True Life. MTV. Retrieved from http://www.mtv.com/videos/true-life-i-have-a-traumatic-brain-injury/1638298/playlist.jhtml

Bipolar Disorder

-Bipolar disorder is a mental illness, also known as manic-depressive disorder that is characterized by extreme mood swings between depressive states and manic states.  It is a long-term condition that significantly affects one’s daily life. It can be managed by treatment with a psychologist and medication therapy.  This illness is also misunderstood and over-simplified by the culture, it is often seen as just moodiness or as someone who is just “unbalanced”, but the psychological effects are much more far reaching and complex. This cultural view can often isolate those who suffer from this disorder and make them feel as if their friends and family just do not understand their chronic condition. Biomedicine in the U.S. mainly focuses on drug interventions, often mixing and experimenting with different drug programs, to see which is most effective for that particular patient.  Some medications have proven effective, but their effectiveness can often dissipate over time, which leads to higher dosage or trying a new medication.

-The video blog from “YouTube” that we watch was of a young man who has been suffering from Bipolar disorder for thirteen years. He first starting experiencing his symptoms as a freshman in college and would self-medicate with alcohol and mask his emotions with partying. As he began to seek more treatment he tried a few various drugs and would experience benefits from them, but as they would wear off he would experience extreme symptoms. After this poor experience with drug therapy, he tried to use his own healthy lifestyle approach to treating his illness and that worked for him for a while. Then a couple of years ago, he had a great increase in symptoms and his issues with alcohol and embarrassment over his illness led him to hit a low point. He then started treatment with a psychiatrist again and with therapy and medication was able to better manage his illness.

-For the man in the video blog and others like him, the effects of bipolar disorder and the way it is perceived in the culture can have a widespread impact on every aspect of life. His denial and embarrassment of his illness led him to put of getting treatment at first and led him, as many others do, to self-medicate with alcohol. Also, he suffered from feelings of loneliness and the feeling that his family and friends truly didn’t understand his illness, which leads those suffering from this illness to not be open about their symptoms which impact how others perceive them and how they cope with their illness.

-I think belief and healing are interconnected in ways that we still don’t fully understand. The example in the “Placebo” documentary about the fake knee surgery was interesting, particularly because they said they saw no difference at all between the three test groups. I think the ritual of the medical care does have a big impact on the way we think about healing and it can have a real effect on our health.

 

Mayo Clinic staff. (2012, 01 18). Bipolar disorder. Retrieved from http://www.mayoclinic.com/health/bipolar-disorder/DS00356

“Neurasthenia and Shenjing Shuairuo in Chinese Culture”

 

-I read an article based on the culture-bound syndrome of Shenjing Shuairuo, or Neurasthenia in western cultures. This article, by Lee and Wong, discussed how this once commonly diagnosed disease, had now made it on the DSM-IV list of “culture-bound syndromes” for its modern day prevalence in Chinese cultures. Neurasthenia was first coined in the United States in 1869, and was described as a disease with fatigue, headaches, anxiety, depression, and neuralgia. During the Victorian era this disease was commonly diagnosed in western countries, particularly the United States and Great Britain. As we progressed in the 20th century, the patients that were once diagnosed as having neurasthenia, were now typically diagnosed with more specific psychological or psycho-somatic diseases that better fit their actual symptoms. But the 20th century also saw the increase use of neurasthenia as a diagnosis for an array of symptoms in Asian countries, but mostly Chinese populations. The Chinese coined their own name for neurasthenia, “Shenjing Shuairuo” and described the symptoms based on principles of traditional Chinese medicine.

-The Chinese description of this illness was a “disharmony and imbalance of the qi (vital organs)”. The breakdown of the name “shenjing shuairuo” further describes the illness; “shenjing” means nerves or spirit, “shua” meaning degenerate, and “ruo” meaning weak. In China and in areas of high Chinese populations, the diagnosis of neurasthenia is often given to someone suffering from mental stress, depression, and anxiety. It is thought that using the diagnosis of neurasthenia or shenjing shuairuo in Chinese society because it is a very common term and diagnosis used between biomedical doctors and a lay person. This diagnosis is often used to prevent stigmatizing the patient, who may have actually schizophrenia or depression, and since this term is widely used and accepted, the person is much more likely to stay active in society and feel comfortable seeking and receiving psychiatric treatment.

-The articles I read made it clear that in Chinese society, the cultural prevalence of diagnosing a patient with shenjing shuairuo is in every sector or the culture- popular, folk, and professional. The articles stated that people in China were very quick and accepting of self-diagnosing themselves with this syndrome, and that traditional and biomedical practitioners both used this diagnosis rather frequently. They did state, however, that the professional sector doctors may do it more so patients don’t experience the stigma of mental disease, rather than clear-cut diagnosis.

References:

1-Lee, S., & Wong, K. C. (1995). Rethinking neurasthenia: The illness concepts of shenjing shuairuo among Chinese undergraduates in Hong Kong. Culture, medicine, and psychiatry, 19(1), 91-111. Retrieved from http://www.springerlink.com.proxy2.cl.msu.edu/content/j537g3k711631861/fulltext.pdf

2-Starcevic, V. (1999). Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome. General hospital psychiatry, 21(4), 249-255. Retrieved from http://ac.els-cdn.com/S0163834399000122/1-s2.0-S0163834399000122-main.pdf?_tid=83ce0582fbfc74acb1b97bb51a0b5773&acdnat=1343003336_40df3f9e79b8806bc8b2f5665ee64f7e

“A Doctor for Disease, a Shaman for the Soul”

-In the above titled article, by P.L. Brown, it discussed how a hospital in Merced, California had started to integrate the ceremonies of Hmong Shamans with the more traditional western medical care. This California hospital is in the Central Valley, where a large population of the Hmong settled after fleeing the post- Vietnam War aftermath in their home country Laos. In this particular hospital, Mercy Medical Center, the administration and staff have made a joint effort to incorporate Hmong traditions with the hospital’s medical care. They are doing this in order to integrate themselves within the ethnomedical system of the local Hmong. Before this program, many in the Hmong community would first go to their local Shaman and engage in traditional ceremonies, and only go to the hospital as a last resort. This waiting for treatment led to a high incident rate of ruptured appendixes, complications from diabetes, and end-stage cancers. One of the main reasons for this wait, was the distrust the local community had of western medicine, in their traditional Hmong belief system, they found invasive procedures to be taboo. To gain the Hmong community’s trust the hospital worked with local Shamans, cross-training them in western medicine, and working to accommodate their ceremonies. Although, not all ceremonies are permitted in the hospital, and they typically must keep the ceremonies under fifteen minutes, as opposed to ceremonies that traditionally can last all day. But this integration of non-western, traditional healing methods and the more biomedical, westernized medicine health system is a trend that seems to be gaining in popularity across the country.

-The healers discussed in this article are the Hmong Shamans and the medical doctors. The techniques used by the medical doctors are the “scientifically-excepted” biomedical practices and procedures common in westernized medicine. They interact with their patients in a more generalized manner and are mainly there to treat them biologically, as opposed to all aspects the patient might be dealing with. The Hmong Shamans use ceremonies that treat the person’s soul and their whole body in a more holistic fashion. These ceremonies can include chanting, incense, and animal sacrifice, but more importantly, these ceremonies involve the friends and family of the patient and the healing of that person is a community effort. In their communities, the Shamans are highly revered and are thought to have great powers of healing and spirit. But medical doctors are typically more highly regarded, in the overall population as a whole, than a Shaman would be to people who do not share the same beliefs.

-The basic biomedical doctors of Mercy Medical Center that are discussed in the article are considered to be part of the Professional sector of healthcare. This biomedical system is the dominate ethnomedical system in westernized, American culture and the professionals who practice this type of medicine are more authoritative in their knowledge and are seen as the gatekeepers of the main form of healthcare in our society. On the other hand, the Hmong Shamans showcased in Brown’s article would fall into the Folk sector of healthcare. They are sacred healers that share the patients’ beliefs and treat them in a holistic manner. In America, this form of healing would be a complementary ethnomedical system, because it is not the main form of healthcare in the U.S. These overlapping systems together can help treat the people of the Hmong body and mind.

 

 

Brown, P. L. (2009, September 20). A doctor for disease, a shaman for the soul. The New York Times. Retrieved from http://www.nytimes.com/2009/09/20/us/20shaman.html?_r=3

Place Matters

Health Equity Quiz: When I took the Health Equity Quiz I only got 50%. I knew a lot of the specific disparities, but I was unaware of most of the statistics about where the United States ranked among the world. I think the question that I got wrong, that I was most surprised about was the question about which ethnic group had the best overall health in the U.S. I had never heard of the “Latino Paradox”, and I think I would like to read up on that more, because that was quite an interesting statistic. On a side note, the statistic I found the most depressing was the one about the life expectancy of young Black men in Harlem. I answered that question correctly, but I still find it shocking and sad.

 

Unnatural Causes- “Place Matters: I chose the “Place Matters” episode. This short film was about once prosperous communities in the Pacific Northwest, that have fallen on very hard times. This film discussed the prevalence of disease in these low income neighborhoods. A lot of these families, that left their home countries in order to make a better life in the United States, have found their health in actually worse shape than it was before. Many of the illnesses that are endemic in these communities are heart disease and asthma. The emotional stresses and the environmental stressors that many of the adults endure, cause them to have severe cardiac diseases, which can cut their lifespan by 30%. The children in these communities have such poor air quality, outside with pollution and inside with mold and other contaminants, that they are six times more likely to be hospitalized for asthma. And since most of these people are too poverty stricken to have proper health insurance, they end up in the ER for every episode. There was some community action to help rebuild the neighborhood of High Point into a multi-income community, but some of the poorest of the poor lost out again and were permanently displaced.

Influences on Issues of Illness: There are many factors that affect the spread and treatment of illness, particularly in these impoverished, forgotten cities, like the one discussed in “Place Matters”. A lot of the community politics do not take into account the poorest residents and therefore they are under the radar and do not receive the services they are in need of. Also, the economics of a city fallen on hard times, causes those left there to be invisible to the surrounding communities, this is happening in parts of Detroit right now. Lastly, the environment presented in the film, shows that even if the residents are trying to take good care of their health and the health of their children, it is a lost cause, because they will still be exposed to the environmental hazards that make them ill in the first place. All of these factors lead to the constant spread of poverty and illness, which go hand and hand.

Multiple Sclerosis among Caucasians, Particularly Those of Northern European Descent

Multiple Sclerosis has so far been found to be most prevalent among Caucasians, particularly those of Northern European ancestry. There are a number of studies showing that whites are most likely to get MS. Caucasians are twice as likely to suffer from MS as African-Americans. MS is also not commonly found in people of Asian, Indian, South American, and Native American descent, and particularly uncommon in people from the African sub-continent. There have also been studies that have found that there are certain ethnicities that seem to have a resistance to MS, these groups include American Inuit, the Lapps of Scandinavia, and the Maoris of New Zealand. In addition to MS being most common among Caucasians, it is also two to three times more likely to occur in white females. There are numerous studies that have been carried out to try and explain the epidemiology of multiple sclerosis. One thing the medical community has come to a consensus on is the geographical distribution of MS. It has been found that MS occurs mostly in regions away from the equator- the Northern United States, Canada, Northern Europe, Southern Australia, and New Zealand. (As shown in the map below)

 

There is some debate though, to what actually causes this distribution. Some believe it is climatic, others believe it is related to patterns of migration and ancestry, and still others believe it is related to socioeconomic issues that hinder awareness and diagnoses. The climatic factors are an example of medical ecology. One of these factors being studied is the relation of the amount of sun a person gets, and therefore their vitamin D levels, and the fact that the prevalence seems to occur in areas away from the equator. This is an intersection of health and environment, and one of the arguments backing this line of thought, is that African-Americans who live in these northern regions have a much higher rate of MS than Africans living on the sub-continent. The migration argument is an example of political ecology. Some researchers think that this distribution of MS backs the race or ethnicity theory because it follows the historical migration patterns of Northern Europeans- to North America, Australia, and New Zealand- in particular the patterns of the ancient Vikings and Scots. One backing of this theory is that Northern Ireland has a much higher prevalence of MS than the Irish Republic, and this area was historically, much more populated with those of Scottish descent. Lastly, is the social determinant of perhaps a lack of awareness about MS, this falls into cultural ecology. Some researchers believe this distribution of MS is an indicator of cultures that are not readily aware of MS and therefore lack the number of diagnoses found elsewhere, in more developed countries. I personally believe it is a combination of all these factors. There are probably ancestral components, as well as relationships between the patterns of migration found in the geographical areas with more prevalence. Also, there has been a lot of convincing research regarding the climatic and environmental effects on the onset and prevalence of MS, that I believe must be factored in, when discussing the patterns of multiple sclerosis.

 

Sources:

1-      Marrie, R. (2004). Environmental risk factors in multiple sclerosis aetiology. The Lancet Neurology, 3(12), 709-718. Retrieved from http://www.sciencedirect.com/science/article/pii/S1474442204009330

2-      The Multiple Sclerosis Trust. http://www.mstrust.org.uk/information/publications/msexplained/who_gets_ms.jsp (Photo)

3-      Compston, A. (2008). Multiple sclerosis. The Lancet, 372(9648), 1502-1517. Retrieved from http://www.sciencedirect.com/science/article/pii/S0140673608616207