An Epidemiologic Examination of the Strategy of Malaria Eradication

Abstract

Scholtens, R. G. (Technical Services Branch, Malaria Program, Center for Disease Control, Atlanta, Georgia, U.S.A.), Kaiser, Ft. L, and Langmuir, A. D. An epidemiologic examination of the strategy of malaria eradication. Int. J. Epid. 1972, 1: 15–24. The concept of malaria eradication developed over the first half of the twentieth century, gradually changing from multiple means of control to the single method of indoor insecticide spraying. Because of the dramatic effects of DDT and the fear of insecticide resistance malaria eradication programs—consisting of preparatory measures, an attack phase during which houses are sprayed and active case detection begins, a consolidation phase when spraying is discontinued and the few remaining cases of malaria are eliminated by case detection and treatment, and finally a maintenance phase when malaria surveillance responsibilities are transferred to the normal health services of the country—were planned to achieve their goals in five to ten years. But by 1970 it was evident that the total eradication of malaria through use of residual insecticides was not feasible, and the 23rd World Health Assembly adopted a revised strategy recognizing the need for malaria control and the use of diverse antimalarial methods. While there has been much success in the fight against malaria, with more than one-third of the population formerly at risk now living in malaria-free areas, there has been little progress and some regression in recent years. The case of India illustrates the predicament, including the relative importance of technical problems, operational difficulties, and the demand on resources by a multiplicity of health and social problems. The realization that the problem of malaria will continue, that it is only one of many pressing health needs, and that suitable locally-devised measures for its control are necessary is inescapable.