Two methods of<unk> , direct and indirect, have been used. In direct<unk> , also referred to as ‘Mass<unk>  treatment’, a therapeutic dose of the antimalarial<unk> , usually in the form of tablets, is given to an entire population. In indirect<unk> , the antimalarial<unk>  is added to food, such as the fortification of salt. Direct<unk><unk>  The first, well documented use of direct<unk>  took place in a rubber plantation in Liberia in 1931. Two doses of the 8-aminoquinoline plasmoquine were given weekly to workers and their families in two camps. The prevalences of malaria parasite infections in humans and anopheline mosquitoes before and after treatment were studied. The authors concluded that ‘the fall in the mosquito infection rate of the two plasmoquine treated camps was so large as to indicate a local disappearance, or at least a great reduction, in gametocyte carriers in the treated population’. No long-term follow up data were provided for this study or most of the trials reported subsequently. The next documented use of<unk>  in sub-Saharan Africa took place in 1948 and 1949 in tea estates in Kericho, Kenya. Ten thousand inhabitants of the tea estates received twice weekly proguanil from April to July 1948. The intervention was supplemented with DDT spraying in March and June of the following year. Before the intervention the mean malaria incidence in July, the peak of the malaria transmission season, was 56 cases per 1000 population. Following the intervention 4 malaria cases were detected in July 1949. The author therefore recommended continuation of twice weekly proguanil prophylaxis on the estates. The Nandi district of Kenya was the scene of a large<unk>  in 1953 and 1954. The target population of 83,000 received a single dose of pyrimethamine at the beginning of the malaria season in 1953 and 1954. The coverage was estimated to be around 95%. Before the intervention severe malaria epidemics had been reported in the area. Following the intervention the parasite prevalence dropped from 23% to 2.3%. The author states that in a control area parasite prevalence rose over the same period to over 50%. It was felt that the<unk>  was effective in curbing severe malaria epidemics. In the following three years, 1955 to 1957, pyrimethamine<unk>  was replaced with Dieldrin spraying to consolidate malaria control, which makes an assessment of the long-term effect of this<unk>  impossible. During a pilot programme in Uganda in 1959<unk><unk>  of chloroquine / pyrimethamine was combined with spraying of residual insecticides (DDT). The success of the pilot programme led to a larger study targeted at a population of 16,000. Because of logistic problems, only half of the target population received the first round of<unk> . According to the investigators, the intervention resulted in the eradication of the vector and rapid elimination of malaria from the area. Two large trials of<unk>  combined with household spraying with DDT were conducted in Cameroun and Upper Volta (Burkina Faso) in 1960–1961. In both trials, substantial reductions in the prevalence of parasitaemia were achieved but transmission was not interrupted. In Bobo-Dioulasso, where primaquine was used in combination with either chloroquine or amodiaquine, the prevalence of gametocytes and Anopheles gambiae sporozoites were reduced substantially. A<unk>  was also combined with DDT spraying in Zanzibar (Dola 1974). After the<unk> , the parasite prevalence in children decreased, but the overall parasite prevalence increased slightly, thus failing to deplete the reservoir of infection. Two trials in Northern Nigeria combined multiple rounds of<unk>  and insecticide spraying. The first trial, in Kankiya, included 11 rounds of<unk>  combined with 8 rounds of DDT indoor spraying. The study was based on computer-aided models that showed that<unk>  could eradicate malaria in the study area if combined with an appropriate ‘insecticide attack’. Following<unk> s, parasite prevalence dropped from 19% to 1%. The investigators did not consider this a success because parasite prevalence increased again after the interventions were stopped. Entomological indices also showed only a temporary reduction in transmission, which was completely reversed after the control measures ceased. Because the investigators felt that the failure of the trial to interrupt transmission was due to operational inadequacies, they recommended a much larger and more sophisticated evaluation of insecticide spraying combined with<unk> . This recommendation helped to launch the Garki project, also in Northern Nigeria, in 1969. In the Garki project, all 164 study villages in the catchment area were sprayed with propoxur, a residual insecticide. In addition, in 60 villages,<unk>  with sulfalene / pyrimethamine was given at 10-week intervals for two years. In two small village clusters, house spraying was supplemented with larvicide and<unk>  every two weeks. With biweekly<unk> , parasite prevalence fell to 1% in the dry season and to 5% in the rainy season.<unk>  given every 10 weeks resulted in a parasite prevalence of 2% in the dry season and 28% in the rainy season. Transmission was not interrupted with either<unk>  regime. The authors concluded that spraying of residual insecticides and<unk>  did not result in a sustainable interruption of malaria transmission. In 1999 in The Gambia residents living in 33 of 42 villages in the catchment area received a single dose of sulfadoxine / pyrimethamine (SP) combined with artesunate while the residents of nine control villages received placebo. Following the<unk> , 1388 children ≤10 years of age living in nine control villages and in nine matched villages which had been allocated active treatment were kept under surveillance for clinical malaria throughout the transmission season. Initially, during July and August, the mean malaria incidence rate in treated villages was significantly lower than in the control villages. In subsequent months, the incidence was slightly higher in the<unk>  villages. The difference between the two groups was not statistically significant. Overall no benefit of the<unk>  was detected over the course of the malaria transmission season. A<unk>  campaign using S/P, artesunate and primaquine was completed in Moshi district, Tanzania in 2008. The findings have yet to be published. Outside of sub-Saharan Africa one of the larger reported malaria-control projects using<unk>  took place in Nicaragua in 1981 following the overthrow of the Somoza regime. An estimated 70% of Nicaragua’s total population (1.9 million people) received chloroquine and primaquine during the peak period of disease transmission (November). An estimated 9200 cases of malaria were prevented. The campaign had better results in preventing and curing malaria infections than in interrupting transmission. However, the<unk><unk>  of antimalarials was not sustainable and, as with other malaria-control efforts, collapsed following the return of politically conservative forces. In three malaria-control projects conducted in the Indian states of Andhra Pradesh, Uttar Pradesh, and Orissa in the early 1960s,<unk>  had an ancillary role and was mentioned only briefly in reports on these interventions. More detailed information is available following a focal outbreak in two villages in Gujarat State during 1978-1979. Here a<unk><unk>  of chloroquine was part of a programme of intensified surveillance, case management, health education, and residual spraying. The incidence of malaria decreased so that, by the end of 1979, the authors considered the intervention to be a success. In 1980, in areas of Andhra Pradesh State in India, residual spraying was combined with a<unk> . During the period of lowest malaria incidence a single dose of chloroquine plus primaquine was distributed to the whole population in eight villages. A second dose was given after an interval of 2–3 months. This project failed to reduce malaria incidence and was considered to be a failure. In 1984,<unk>  was added to the distribution of insecticide-impregnated bed nets (ITNs) in Sabah (Malaysia), but this failed to interrupt malaria transmission. A<unk>  in Sumatra, Indonesia in 1987 focused on schoolchildren. Eight months after the<unk> , Plasmodium falciparum prevalence had decreased from 14% to 1%. The only reported project with an<unk>  component which succeeded in permanently interrupting malaria transmission took place on the island of Aneityum, Vanuatu. Starting in September 1991, three malaria-control activities were employed – permethrin-impregnated bed nets, larvivorous fish and the<unk>  of three antimalarials. This<unk>  comprised 300 mg chloroquine base and 45 mg pyrimethamine weekly for nine weeks. An additional 300 mg chloroquine and 75 mg pyrimethamine plus 1500 mg sulfadoxine was added to this regimen in the first, fifth, and ninth week. Children received an adjusted equivalent of the adult dose. Follow-up consisted of yearly parasite surveillance. During the seven surveillance years following the<unk> , no P.falciparum infections were detected.<unk>  is included in the malaria-control policy of the People’s Republic of China. Following the first malaria-control phase from 1955 to 1962, which was mostly focused on malaria surveys,<unk><unk> s were added to vector control measures and improved case management in 10 of China’s 33 provinces. The<unk> s used in the<unk> s, mostly chloroquine and piperaquine, were provided free of charge by the central government. The economic reforms instituted by Deng Xiaoping, which ultimately put an end to the provision of free health care through the central
Mass drug administration
Patient education
Medicines reconciliation
Toxics use reduction
Automatic exposure control
Mosquito control
Coordinated diagnostics
Bed bug control techniques