West Africa was neglected in global eradication effort

With the success of DDT, the advent of less toxic, more effective synthetic antimalarials, and the enthusiastic and urgent belief that time and money were of the essence, the World Health Organization (WHO) submitted at the World Health Assembly in 1955 an ambitious proposal for the eradication of malaria worldwide. Eradication efforts began and focused on house spraying with residual insecticides, antimalarial drug treatment, and surveillance, and would be carried out in 4 successive steps: preparation, attack, consolidation, and maintenance.

Successes included eradication in nations with temperate climates and seasonal malaria transmission. Some countries such as India and Sri Lanka had sharp reductions in the number of cases, followed by increases to substantial levels after efforts ceased. Other nations had negligible progress (such as Indonesia, Afghanistan, Haiti, and Nicaragua). Some nations were excluded completely from the eradication campaign (most of sub-Saharan Africa).

The emergence of drug resistance, widespread resistance to available insecticides, wars and massive population movements, difficulties in obtaining sustained funding from donor countries, and lack of community participation made the long-term maintenance of the effort untenable. Completion of the eradication campaign was eventually abandoned to one of control.

Content source: Division of Parasitic Diseases

Eradication of Malaria in the United States (1947-1951)

The criteria for eradication as put forth by the National Malaria Society was: "Malaria may be assumed to be no longer endemic in any given area when no primary indigenous case has occurred there for three years".

The National Malaria Eradication Program, a cooperative undertaking by State and local health agencies of 13 Southeastern States and the Communicable Disease Center of the U. S. Public Health Service, originally proposed by Dr. L. L. Williams, commenced operations on July 1, 1947. The program consisted primarily of DDT application to the interior surfaces of rural homes or entire premises in counties where malaria was reported to have been prevalent in recent years. By the end of 1949, over 4,650,000 house spray applications had been made. Total elimination of transmission was slowly achieved. By 1951, CDC gradually withdrew from active participation in the operational phases of the program and shifted to its interest to surveillance, and in 1952, CDC participation in operations ceased altogether.

A major commitment was to the malaria control and assessment activities associated with the Tennessee Valley Authority. The advent of World War II necessitated the control of malaria in and around the many military bases located in malarious areas, primarily in Southeastern U. S. These efforts were so successful that at the end of the war and the founding of CDC, one of the initial tasks was to oversee the completion of the elimination of malaria as a major public health problem. In 1949, the country was declared free of malaria as a significant public health problem.

The role of CDC became one of surveillance within the U. S. and of assistance in the world-wide efforts to eliminate or control malaria in the economically underdeveloped areas of the world.

Malaria has been endemic in the US until the late 1940's. Most of the transmission occurred in the southeastern states. (From this derives the fact that CDC, originally derived from malaria control operations, is located in Atlanta, Georgia).

Malaria Morbidity and Mortality Rates in All States Reporting Cases and Deaths During 1920-1946 Inclusive Click here to open figure
	Distribution of malaria in the United States, 1882-1935

Control efforts conducted by the state and local health departments, supported by the federal government, resulted in the disease being eradicated by 1949. Such measures included drainage, removal of mosquito breeding sites, and spraying (occasionally from aircrafts) of insecticides.

Aircraft spraying insecticide, 1920's

Drainage activities, Virginia, 1920's

Why KMO 2009 in West Africa

• Each year approximate 515 million cases of malaria occur worldwide, and over one million people die, most of them young children in sub-Saharan Africa.

• In sub Saharan Africa with high malaria transmission, an estimated 1 million people die of malaria – over 2700 deaths per day, or 2 deaths per minute.

• Malaria is the highest cause of death in children in sub-Saharan Africa, after perinatal conditions (conditions occurring around the time of birth), lower respiratory infections (pneumonias), and diarrheal diseases.
  

• Malaria forms a huge part of widespread poverty in Africa. It causes a loss of almost 2% of economic growth, A 20% reduction in GNP after 15years and short term benefits control of up to $12billion each year. Very staggering indeed! If we can fight Mosquitoes (the cause of Malaria) Africa’s development will be accelerated because family incomes will rise.

• "Malaria is hurting the living standards of Africans today and is also preventing the improvement of living standards for future generations," said Dr Gro Harlem Brundtland, Director General of the World Health Organization. "This is an unnecessary and preventable handicap on the continent's economic development." According to statistical estimates in 2000 , sub-Saharan Africa's GDP would have been up to 32% greater that year if malaria had been eliminated 35 years ago. This would represent over $100 billion added to sub-Saharan Africa's current GDP of $300 billion. This extra $100 billion would be, by comparison,nearly five times greater than all development aid provided to Africa the year before. (Note: Nothing has change about this statistics till now.We are in 2009)