Use of drugs for malaria control in tropical Africa*

In most of the countries, the scope of activities is still limited to the administration of antimalarial drugs to sick persons through a limited network of health institutions. [...] However, surveys of antimalaria activities carried out in tropical Africa at the beginning of 1950, particularly in the field of malaria chemotherapy, indicated that physicians and public health administrators were often not fully aware of the properties of these drugs. [...] Studies on the comparative therapeutic value of single doses of mepacrine, proguanil, pyrimethamine, chloroquine, and amodiaquine were carried out by several workers in the 1950s in semi-immune Africans; the efficacy of the treatment in cases of light and moderate malaria infections was fully recognized and single-dose treatment was recommended for outpatient clinics. [...] In view of the failure of indoor spraying with insecticides to interrupt transmission in most of tropical Africa, it was thought that the addition of mass chemotherapy to the spraying operations might lead to eradication of the disease and mass drug administration was carried out as a supplementary measure in a number of malaria eradication pilot projects reported in the late 1950s. [...] Although, in fact, malaria transmission was not interrupted anywhere (with the posssible exception of Uganda), the effect of these measures on the level of malaria endemicity and on the population's health was considerable, particularly in young people.a By the mid-1960s, resistance to proguanil and pyrimethamine was reported from many countries of tropical Africa, and as a result chloroquine repl