Table 6, [Successful experiences with indoor residual...]. - Defining and Defeating the Intolerable Burden of Malaria III: Progress and Perspectives

Place	Context	Date	Control measures	Results
Madagascar Highlands	History of epidemic malaria in the highlands since the 1800s	1949–1960	IRS with DDT and chloroquine treatment of infected individuals⁸⁶	1954: disappearance of Anopheles funestus; eradication nearly achieved in 1960⁸⁴
	Weakening malaria control efforts	Post-1960	Spraying with DDT limited to 3 foci; closure of treatment centers⁸⁶	1980: 3-fold increase in the number of malaria cases⁸⁶ Reappearance of An. funestus in mid-1970s⁸⁴ Severe epidemic (1985–1990) with 40,000 deaths⁸⁵
	Launching of malaria control program, Opération de Pulvérisation Intra-Domiciliaire (OPID), financed by The World Bank	1993–1997	IRS with DDT in highland communities at 1,000–1,500 m in elevation covering 2.3 million inhabitants⁹¹ 1996: Establishment of malaria surveillance system to record malaria cases at the 536 health centers in the region⁸⁷	28% decrease in the incidence of malaria in sprayed areas only, with no change in incidence in unsprayed areas⁸⁷ 0.8% and 4.5% prevalence of malaria parasites in schoolchildren in sprayed and unsprayed areas, respectively, at 1,000–1,500 m⁸⁵ Prevalence of Plasmodium positive schoolchildren was 23.8% and 0.4% before and after OPID, respectively, at 1,000–1,500 m⁹¹
Eritrea	Implementation of a 5-year malaria control program	2000–2004	ITNs IRS with DDT IRS with malathion Improved patient management Antimalarial drugs Environment controls	Significant negative correlation between the number of ITNs distributed and the amount of DDT/malathion used for IRS with malaria morbidity No additional benefit from IRS when added to ITN vector control⁸⁸
South Africa: KwaZulu- Natal	Long history of malaria control with IRS	1946–1996	IRS with DDT began in 1946 with complete coverage of malarial regions by 1958²¹	600 reported cases of malaria in the Province in 1991–1992⁸⁹
	Concerns about the environmental effects of DDT and about DDT found in breast milk	1996–1999	1996: Synthetic pyrethroids were substituted for DDT²¹	1998–1999: reinvasion of An. funestus and doubling of malaria cases⁵⁶ 2000: 40,700 reported cases of malaria⁷⁹
	Identification of pyrethroid-resistant An. Funestus	2000	Reintroduction of DDT²¹ 2001: Artemether-lumefantrine became first-line therapy for un-complicated malaria⁹²	About 90% reduction of malaria cases after reintroduction (2000–2004) compared with before (1996–1999)⁹⁰ 2001: 17,500 reported cases; 2002: 3,500 reported cases⁸⁹

Place

Context

Date

Control measures

Results

Madagascar Highlands

History of epidemic malaria in the highlands since the 1800s

1949–1960

IRS with DDT and chloroquine treatment of infected individuals⁸⁶

1954: disappearance of Anopheles funestus; eradication nearly achieved in 1960⁸⁴

Weakening malaria control efforts

Post-1960

Spraying with DDT limited to 3 foci; closure of treatment centers⁸⁶

1980: 3-fold increase in the number of malaria cases⁸⁶
Reappearance of An. funestus in mid-1970s⁸⁴
Severe epidemic (1985–1990) with 40,000 deaths⁸⁵

Launching of malaria control program, Opération de Pulvérisation Intra-Domiciliaire (OPID), financed by The World Bank

1993–1997

IRS with DDT in highland communities at 1,000–1,500 m in elevation covering 2.3 million inhabitants⁹¹
1996: Establishment of malaria surveillance system to record malaria cases at the 536 health centers in the region⁸⁷

28% decrease in the incidence of malaria in sprayed areas only, with no change in incidence in unsprayed areas⁸⁷
0.8% and 4.5% prevalence of malaria parasites in schoolchildren in sprayed and unsprayed areas, respectively, at 1,000–1,500 m⁸⁵
Prevalence of Plasmodium positive schoolchildren was 23.8% and 0.4% before and after OPID, respectively, at 1,000–1,500 m⁹¹

Eritrea

Implementation of a 5-year malaria control program

2000–2004

ITNs
IRS with DDT
IRS with malathion
Improved patient management
Antimalarial drugs
Environment controls

Significant negative correlation between the number of ITNs distributed and the amount of DDT/malathion used for IRS with malaria morbidity
No additional benefit from IRS when added to ITN vector control⁸⁸

South Africa: KwaZulu- Natal

Long history of malaria control with IRS

1946–1996

IRS with DDT began in 1946 with complete coverage of malarial regions by 1958²¹

600 reported cases of malaria in the Province in 1991–1992⁸⁹

Concerns about the environmental effects of DDT and about DDT found in breast milk

1996–1999

1996: Synthetic pyrethroids were substituted for DDT²¹

1998–1999: reinvasion of An. funestus and doubling of malaria cases⁵⁶
2000: 40,700 reported cases of malaria⁷⁹

Identification of pyrethroid-resistant An. Funestus

2000

Reintroduction of DDT²¹
2001: Artemether-lumefantrine became first-line therapy for un-complicated malaria⁹²

About 90% reduction of malaria cases after reintroduction (2000–2004) compared with before (1996–1999)⁹⁰
2001: 17,500 reported cases; 2002: 3,500 reported cases⁸⁹

From: Dichlorodiphenyltrichloroethane (DDT) for Indoor Residual Spraying in Africa: How Can It Be Used for Malaria Control?

Cover of Defining and Defeating the Intolerable Burden of Malaria III: Progress and Perspectives

Defining and Defeating the Intolerable Burden of Malaria III: Progress and Perspectives: Supplement to Volume 77(6) of American Journal of Tropical Medicine and Hygiene.

Breman JG, Alilio MS, White NJ, editors.

Northbrook (IL): American Society of Tropical Medicine and Hygiene; 2007 Dec.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.