Malaria-Associated Mortality in Australian and British Prisoners of War on the Thai–Burma Railway 1943–1944

Abstract

During the building of the Thai-Burma railway in 1943 Australian and British prisoners of war died at high rates from tropical infections and nutritional deficiencies. Mortality records from "F" Force (n = 7,000) showed nearly half (44%) of the soldiers perished in a single year, yet only 4% of these deaths were primarily attributed to malaria, with another 7% where malaria was listed as a major contributing cause. Case fatality rates were < 1%, with nearly all soldiers chronically infected with Plasmodium vivax > Plasmodium falciparum. Separate labor camp point prevalence malaria rates by microscopy ranged from 28% to 69% (median 54%) despite intermittent quinine suppression. During complex public health emergencies, malaria mortality may be disguised by its combination with other common infections and nutritional deficiencies.

Pernicious Plasmodium vivax as a Historical Cause of Malarial Cachexia?

“…Allied prisoners of war (POWs) on the Thai-Burma railway suffered huge casualties due to a combination of malnutrition, injury, and infection with tropical diseases. 18 Malaria was nearly universal in the POWs working in the Thai jungles, and the parasites were only variably suppressed with irregularly supplied quinine. Direct malaria mortality, largely from acute P. falciparum, caused , 5% of POW deaths.…”

“…Direct malaria mortality, largely from acute P. falciparum, caused , 5% of POW deaths. 18 Two to three times as many POW died of malaria-associated mortality that was largely due to multiple relapses of P. vivax causing severe anemia. Interestingly, whole blood transfusion administered by the captured Allied medical officers was life saving, indicating that much of the problem was a subacute effect on the bone marrow.…”

Decreased Mortality of falciparum Malaria in Anemic Prisoners of War?

“…1,2 Despite very high malaria attack rates, Second World War soldiers only rarely died of falciparum malaria even under extraordinarily adverse conditions such as those experienced by prisoners of war (POW). 3 In the Australian military experience during 1941-1945, only two specific instances of extraordinary mortality due to malaria were observed: Australian Army soldiers retreating from Rabaul, New Britain, in April 1942 and Imperial Japanese Navy POW who had been transported from Nauru to Fauro Islands in October 1945. 4 As both episodes occurred within the context of thousands of both Australian and Japanese POW with very low mortality rates due to malaria, contemporary records were examined to determine if some explanation could be found for this dichotomy.…”

“…13 When the Australian Army POW records were examined at the end of the Second World War for the purpose of war crime tribunals, relatively few deaths of the severely malnourished prisoners (n = 3,087) were directly attributed to malaria (4.3%). 3 Severe anemia was also a major problem at Chungkai Hospital necessitating a large blood transfusion clinic (100 transfusions/month) despite the primitive apparatus available. The indication for transfusion was < 2.5 million red blood cells/mm 3 (7 gm/dL); blood donors were only required to have a hemoglobin of > 10 gm/dL, which was estimated to be considerably higher than that of most of POW.…”

Describing Chronic Malaria Infections

“…Even under the worst possible conditions, the case fatality rate of falciparum malaria was relatively low as described in my other article in the same issue of Am J Trop Med Hyg . 3…”