[Antimalarial activities: the last 40 years. Antimalarial action program].

Abstract

Around the turn of the century there were about 250 million cases of malaria each year and 2.5 million deaths. The introduction of DDT-type insecticides with residual effect around 1940 led to much more effective prevention than previously. WHO has been assisting Member States with malaria control ever since its foundation in 1948. In about 1950 it was proved that spraying DDT inside houses could interrupt transmission and lead to eradication within three years by exhausting the reservoir. Around the same time the discovery of the first cases of anopheline resistance to DDT introduced an element of urgency. The principle of eradication was adopted for the Americas by the Pan American Sanitary Conference in 1954, and for the world as a whole by the World Health Assembly in 1955, though it was acknowledged that the application of the principle to tropical Africa would be premature. With the aid of WHO, and under the leadership of its Expert Committee on Malaria, most control programmes outside tropical Africa were converted into eradication programmes. The results of the first 10 years of the global eradication programme (1957-1966) were spectacular but uneven; there were reverses due to financial, administrative or operational problems, or to the resistance or behaviour of the vectors, or to the inadequate development of basic health services. In Africa, the pilot projects generally failed to interrupt transmission. A new and more flexible strategy was adopted in 1969, whereby countries were invited to revise their programmes to take local circumstances into account. These revisions showed that in many countries eradication was not possible in the short term, but in the majority of cases they did not manage to put forward any genuine alternative strategy. Resources became increasingly difficult to obtain, whereas the cost of insecticides and transport went up with the price of oil. Research, which had been neglected for some time, once again became the order of the day and great importance was attached to malaria when the Special Programme for Research and Training in Tropical Diseases (TDR) was set up by WHO, UNDP and the World Bank. Since 1978 the emphasis has been on integrating malaria control with the primary health care system and on integrating health with development.(ABSTRACT TRUNCATED AT 400 WORDS)