Malaria control: constraints and opportunities.

The malaria eradication campaign of the 1950s and 1960s achieved elimination of malaria from the industrialized world and drastic reduction of malaria elsewhere, especially Asia. In Africa, eradication was hardly attempted. For various reasons, results could not be maintained. Eradication had to be given up, control became the policy. Since 1992 malaria control is based on four principles: early diagnosis and treatment; selective and sustainable preventive measures, including vector control; detection, containment and prevention of epidemics, and building up of local capacity. Several constraints with the presently available tools are discussed. Major problems are drug resistance and poor performance of the health sector. International awareness of the problem and international co-operation, the financial resources now available and scientific advances offer opportunities for a concerted effort to reduce the burden of malaria. Operational research, field research and implementation and improvement of the peripheral health service will be of paramount importance.