Learning from successful malaria control programs is critical to the efforts to combat
malaria in Africa. The effectiveness of approaches will vary from country to country,
given differences in environment, vectors and their resistance, infrastructure and national
capacity. It must be recognized that malaria is fundamentally a disease of poverty,
with poor rural communities accounting for the vast majority of cases around the world.
A malaria expert from Vietnam says the most critical lesson learned from their successful
program is the importance of 'tenacity, ingenuity, creativity and courage.' He
goes on to explain that 'there is no one measure that will bring about success; it is a
whole host of measures . that are needed.' In each of the success stories outlined
below, key elements include a strong national program with high level support, a dedicated
team, and a national health infrastructure that reaches the community level.
Vietnam
After initial success with malaria control in the 1960s, Vietnam experienced a resurgence
of malaria from the late 1970s until 1991, when malaria peaked at over a million
cases and 5,000 deaths. Responding to this deadly outbreak, the government of
Vietnam shifted away from their DDT-based malaria eradication strategy to a malaria
control approach that allocated significantly more funds to the program, distributed
drugs and free or subsidized mosquito nets in the neediest areas, carried out twiceyearly
home insecticide spraying with pyrethroid insecticides, and provided intensive
health education. Health education efforts involved village leaders, the Women's Union
cadres and commune health staff, as well as mobilization by local trainers of communities
in high risk malaria areas. By 1997, this integrated, community-based approach
reduced malaria deaths by 97% (from 5,000 to 190) and malaria cases by 59% (from
over 1 million to 348,500; 1,350 of these severe).
Mexico
Mexico's successful national malaria control program includes a combination of nonchemical
and chemical control measures. Currently, Mexico uses an integrated vector
and malaria management approach that includes: a) epidemiological surveillance that
allows early detection of the malaria cases and prompt medical treatment, b) community
participation in the notification of the cases and in the cleaning of the streams where
the mosquito eggs are; and c) chemical control with pyrethroids. Specific chemical controls
include the pesticide deltamethrin indoors, outdoor spraying of permethrin, and use
of a low volume yet effective spray technology for application of these pesticides. DDT
has not been used in Mexico since 2000.
India
India, which spends one-third of its national health budget on malaria control, is an
important case study on alternative approaches to malaria control. In 1997, the World
Bank approved $164 million for the Malaria Control Project in India to promote alternatives
to indoor spraying of DDT. Alternatives include selective vector control using targeted
spraying, non-insecticide methods such as larvae-eating fish and biological larvicides,
more environmentally friendly pesticides, medicated mosquito nets and
institutional strengthening. Biological larvicides and polystyrene beads (used to kill
mosquito larva and pupa) have proven highly effective. In the Hassan district in
Karnataka and in Maharashtra bioenvironmental methods have reported up to a 70%
reduction in malaria cases. The success of these alternative approaches is critical in a
country where the rural mosquito vector that transmits 65% of malaria is resistant to
DDT and at least two other pesticides.
For more case studies and additional information on malaria control, see PAN North America's
DDT and Malaria Resource Center.
1.World Health Organization. A Story to be Shared: The Successful Fight Against Malaria in
Vietnam, 2000, http://www.afronets.org/files/malaria.pdf, p14.
2. Ibid.
3. González FB, The Phasing Out of DDT in Mexico, Pesticide Safety News, 2001 Milan, Italy,
International Center for Pesticide Safety 5(2):5, 2001; and Situacion actual de la malaria y uso
del DDT in Mexico. Centro Nacional de Salud Ambiental. Centro de Vigilancia Epidemiologica.
Secreteria de Salud. Diciembre 2000; and Participación ciudadana y alternativas al DDT para el
control del la malaria. Memorias. RAPAM.World Wildlife Fund. Julio 1998. Texcoco, México.
4. Project Appraisal Document on a Proposed Credit in the Amount of SDR 119.2 Million to India
for a Malaria Control Project. May 15, 1997. The World Bank, Population and Human Resources
Operations Division, Country Department II, South Asia Region Report No 16571 - IN.
5. Sharma VP and Sharma RC, Cost Effectiveness of Bioenvironmental Control of Malaria in
Kheda District of Gujarat, Indian Journal of Malariology, 23(2):141-145, 1986; and Sharma VP
Laboratory experiments on the effectiveness of Expanded polystyrene beads in mosquito control,
Indian Journal of Malariology, 21:115-118, 1984.
6. Agarwal R, No Future in DDT: A Case Study of India, Pesticide Safety News, 2001 (Italy).
