By the early 19th century, British colonists in India—most likely inspired by the example of Punjabi fishermen—also were sleeping under nets. However, it was not until World War II that textiles and insecticides were combined. In central Asia, the Soviet army applied juniper oil to bednets to repel mosquitoes, and sand flies bearing malaria and leishmaniasis (Blagoveschensky et al., 1945), while the American military in the Pacific theater impregnated bednets and jungle hammocks with 5 percent DDT to ward off malaria and filariasis (Harper et al., 1947).

Interest in insecticide-impregnated nets as a malaria control tool resurfaced in the late 1970s and early 1980s. By then, synthetic pyrethroids were the logical insecticide choice because of their low mammalian toxicity and known efficacy in killing and repelling a variety of nuisance and disease-bearing insects. Several governments including the Philippines, Solomon Islands, and Vanuatu began to include ITN promotion as one of their malaria control objectives (Chavasse et al., 1999). However the most successful government-financed ITN programs today are found in China and Vietnam, where the public sector’s chief contribution is to offer regular net re-treatment services. When re-treatment is provided free of charge (e.g., China and Vietnam), coverage is generally high (Curtis et al., 1992). Conversely, in Africa, where many nets and insecticides have been provided free or at subsidized prices through local projects and NGOs, less than 5 to 20 percent of nets are re-treated (Snow et al., 1999; Rowley et al., 1999; Guillet et al., 2001).

After a number of small-scale studies in the 1980s showed favorable effects, the first large-scale study of ITNs plus chemoprophylaxis reported a 60 percent reduction of all-cause child mortality (Alonso et al., 1991). These results prompted the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) to sponsor four randomized controlled trials in Africa to assess the effect of ITNs on all-cause mortality in African children in different epidemiologic settings. A cluster randomization design was used in all four trials. In The Gambia (D’Alessandro et al., 1995), a 25 percent reduction in all-cause mortality was seen in children less than 9 years old. In Kenya (Nevill et al., 1996) and Ghana (Binka et al., 1996), the introduction of ITNs was associated with 33 and 17 percent reductions in all-cause child mortality, respectively, in children under 5 years of age. Study populations in all three sites ranged from 60,000 to 120,000 (Table 8-1).

The fourth randomized controlled trial in Burkina Faso (Habluetzel et

Front Matter (R1-R20)

Executive Summary (1-16)

Part 1: A Response to the Current Crisis1 Malaria Today (17-60)

2 The Cost and Cost-Effectiveness of Antimalarial Drugs (61-78)

3 The Case for a Global Subsidy of Antimalarial Drugs (79-111)

4 An International System for Procuring Anitmalarial Drugs (112-122)

Part 2: Malaria Basics5 A Brief History of Malaria (123-135)

6 The Parasite, the Mosquito, and the Disease (136-167)

7 The Human and Economic Burden of Malaria (168-196)

8 Malaria Control (197-251)

9 Antimalarial Drugs and Drug Resistance (252-298)

Part 3: Advancing Toward Better Malaria Control10 Research and Development for New Antimalarial Drugs (299-311)

11 Maximizing the Effective Use of Antimalarial Drugs (312-328)

Acronyms and Abbreviations (329-333)

Glossary (334-346)

Index (347-364)