Malaria, agriculture, and development: lessons from past campaigns.

The author presents in this article a historical-epidemiological evaluation of several anti-malaria campaigns and of the relative contribution of various direct measures employed and indirect factors operating during these campaigns. Approaches and factors that may be essential or at least useful for successful malaria control are identified. The malaria story in Palestine/Israel and the experience of the Tennessee Valley Authority are analyzed in some detail. In both cases, direct anti-malaria measures were versatile and based mostly on reduction of mosquito breeding and elimination of Anopheles larvae. Efficient organization and coordination of anti-malaria efforts, strenuous research and understanding of the vector biology, and accompanying socioeconomic and agricultural development contributed to successful campaigns. Malaria control in other parts of the United States and in Italy is also considered. The World Health Organization global anti-malaria campaign is discussed in the light of these earlier experiences. The study concludes that no single measure is sufficient to control malaria and that future anti-malaria campaigns need to adopt strategies that are flexible, incorporated into local health services, and interrelated with agricultural practices. Moreover, a certain threshold of socioeconomic development, health services infrastructure, and educational level may have to be reached for the successful application and maintenance of direct anti-malaria measures.