Beware resurgence of malaria where incidence has fallen

doi:10.1136/bmj.a1592

Published 10 September 2008, doi:10.1136/bmj.a1592
Cite this as: BMJ 2008;337:a1592

Letters

Tackling malaria today

Beware resurgence of malaria where incidence has fallen

The first 150 words of the full text of this article appear below.

Lines et al are concerned that the strategy of "shrinking themap" to eliminate malaria will lead to inequitable allocationof resources, development of resistance to insecticides anddrugs, and inefficient combination of interventions.¹ But thesustained malaria control strategy that they suggest as an alterativeto elimination campaigns also has these risks.

Malaria transmission has fallen across Africa, as documentedin countries such as Kenya,² Tanzania,³ Mozambique,⁴ Swaziland,⁴South Africa,⁴ and Guinea Bissau.⁵ This trend is probably theresult of decades of malaria control activities, economic development,urbanisation, improved education, and access to health care.These countries also face the problems of inequitable and uncoordinatedcoverage of interventions, drug and insecticide resistance,and inappropriate allocation of resources.

The "tipping point" has been reached in many regions of theendemic countries in Africa, where the incidence of malariahas fallen in large communities and made them susceptible tothe resurgence . . . [Full text of this article]

Roly D Gosling, clinical lecturer¹, Daniel Chandramohan, reader¹

¹ Department of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London WC1E 7HT

roly.gosling@gmail.com