Everything is Malaria: An Infectious-Nutritional Disease Framework for an Archaeologically Invisible Disease in Tropical Asia-Pacific

Melandri Vlok

Malaria caused by parasites from the genus Plasmodium infect approximately 5 million people in tropical Asia-Pacific every year, with the rates and geographical spread surging due to the climate crisis. Archaeology has determined the presence of malaria as an endemic disease by at least 7,000 years ago in the region in foraging populations, thousands of years before agricultural efforts, revealing a very long co-evolutionary history between human and parasite. These findings are based off the strong evolutionary relationship between haemoglobinopathies and malaria, which has resulted in the rise of over 50 independent mutations of the disease in Southeast Asia alone. Nutritional diseases that are surprising for tropical sunlit countries like scurvy and rickets are now frequently observed in the tropical Asia-Pacific archaeological record. Along with neglected tropical diseases like leprosy and endemic treponematoses (such as yaws), nutritional diseases are most common in archaeological sites with archaeological and/or historical evidence for strong malarial burdens. I will discuss the archaeological evidence, and historical evidence (like historical outbreaks reported of ‘malarial scurvy’), that indicate malaria as an ultimate cause for the skeletal presentation of nutritional and infectious diseases. I will present the pathophysiological pathways of nutrition and co-infection in the tropics, and how the malaria encourages skeletal presentation of these conditions. I will then present a conceptual infectious- nutritional disease model that centres malarial burden within broader signs of ill health observed in the skeletal archaeological record.