Malaria control in East Africa: The Kampala Conference and the Pare-Taveta Scheme: A meeting of common and high ground

Parassitologia

Volumn 42, Issue 1-2, 2000, Pages 149-166

  Dobson, Mary J ^a   Malowany, Maureen ^a   Snow, Robert W ^a,b  

^a UNIVERSITY OF OXFORD   (United Kingdom)

^b KENYA MEDICAL RESEARCH INSTITUTE   (Kenya)

Author keywords

D. Bagster Wilson; East Africa; Global Malaria Eradication Programme; Immunity; Kampala Conference; Malaria; Malaria control; Pare Taveta Scheme; S.P. James; World Health Organization

Indexed keywords

CHLORPHENOTANE; INSECTICIDE;

ADULT; AFRICA; ANIMAL; ART; ARTICLE; CHILD; HISTORY; HUMAN; IMMUNOLOGY; INFANT; INFANT MORTALITY; MALARIA; MORTALITY; MOSQUITO; WORLD HEALTH ORGANIZATION;

ADULT; AFRICA, EASTERN; ANIMALS; CHILD; DDT; HISTORY, 20TH CENTURY; HUMANS; INFANT; INFANT MORTALITY; INSECTICIDES; MALARIA; MOSQUITO CONTROL; PORTRAITS; WORLD HEALTH ORGANIZATION;

EID: 0034208257     PISSN: 00482951     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (144)

1. O.J.R. Howarth quoted in M. Warboys (1981). The British association and empire: science and social imperialism. 1880-1940. In: The parliament of science: the British association for the advancement of science 1831-1981 (Macleod R., Collins P., eds). Science Reviews, Northwood, 180.
2. The Dakar 1997 meeting had been preceded by the WHO Ministerial Conference in Amsterdam, attended by ministers of health and other health workers, NGOs and the scientific community, which had recommended support for a global malaria control strategy (WHO, 1992: Report of the Ministerial Conference on Malaria, Amsterdam, 26-27 October; Wellcome Trust, 1996: Malaria research, PRISM report No 7, September). It was in Senegal, however that the basis for an 'African Malaria Initiative' arose, from an international meeting, held significantly in Africa, which brought together scientists and health personnel from both the African continent and its international neighbours (Declan Butler, 1997. Briefing malaria. Nature 386, 10 April: 535-539; Jean-Marie Bruno et al., 1997. The spirit of Dakar: a call for action on malaria. Nature (Correspondence) 386, April: 541). The Dakar meeting was followed by a meeting in The Netherlands in July 1997 at which time a formal organisation, the Multilateral Initiative on Malaria (MIM) was established. One of the goals of the MIM was to spearhead a call for funding of malaria research (Declan Butler, 1997. Malaria meeting charts rocky path ahead. Nature 388, 17 July: 219). Director-General Dr Gro Harlem Brundt land announced in July 1998 that malaria was to be one of WHO's top priorities. On 30 October 1998, UN agencies jointly announced 'Roll Back Malaria' (RBM). See press release, WHO/77.
3. The Dakar 1997 meeting had been preceded by the WHO Ministerial Conference in Amsterdam, attended by ministers of health and other health workers, NGOs and the scientific community, which had recommended support for a global malaria control strategy (WHO, 1992: Report of the Ministerial Conference on Malaria, Amsterdam, 26-27 October; Wellcome Trust, 1996: Malaria research, PRISM report No 7, September). It was in Senegal, however that the basis for an 'African Malaria Initiative' arose, from an international meeting, held significantly in Africa, which brought together scientists and health personnel from both the African continent and its international neighbours (Declan Butler, 1997. Briefing malaria. Nature 386, 10 April: 535-539; Jean-Marie Bruno et al., 1997. The spirit of Dakar: a call for action on malaria. Nature (Correspondence) 386, April: 541). The Dakar meeting was followed by a meeting in The Netherlands in July 1997 at which time a formal organisation, the Multilateral Initiative on Malaria (MIM) was established. One of the goals of the MIM was to spearhead a call for funding of malaria research (Declan Butler, 1997. Malaria meeting charts rocky path ahead. Nature 388, 17 July: 219). Director-General Dr Gro Harlem Brundt land announced in July 1998 that malaria was to be one of WHO's top priorities. On 30 October 1998, UN agencies jointly announced 'Roll Back Malaria' (RBM). See press release, WHO/77.
4. The Dakar 1997 meeting had been preceded by the WHO Ministerial Conference in Amsterdam, attended by ministers of health and other health workers, NGOs and the scientific community, which had recommended support for a global malaria control strategy (WHO, 1992: Report of the Ministerial Conference on Malaria, Amsterdam, 26-27 October; Wellcome Trust, 1996: Malaria research, PRISM report No 7, September). It was in Senegal, however that the basis for an 'African Malaria Initiative' arose, from an international meeting, held significantly in Africa, which brought together scientists and health personnel from both the African continent and its international neighbours (Declan Butler, 1997. Briefing malaria. Nature 386, 10 April: 535-539; Jean-Marie Bruno et al., 1997. The spirit of Dakar: a call for action on malaria. Nature (Correspondence) 386, April: 541). The Dakar meeting was followed by a meeting in The Netherlands in July 1997 at which time a formal organisation, the Multilateral Initiative on Malaria (MIM) was established. One of the goals of the MIM was to spearhead a call for funding of malaria research (Declan Butler, 1997. Malaria meeting charts rocky path ahead. Nature 388, 17 July: 219). Director-General Dr Gro Harlem Brundt land announced in July 1998 that malaria was to be one of WHO's top priorities. On 30 October 1998, UN agencies jointly announced 'Roll Back Malaria' (RBM). See press release, WHO/77.
5. Declan Butler (1997). Time to put malaria control on the global agenda. Nature 386, 10 April: 535-536.
6. Dr P. Dorolle (1951). Opening speech by the Deputy Director-General of the World Health Organization. East African Medical Journal 28 (2): 88-89.
7. WHO (1951). Technical Report Series 38: 46.
8. Fred L. Soper (1942). Species eradication: a practical goal of species reduction in the control of mosquito-borne disease. J Nat Mal Soc 1: 5-24.
9. WHO (1955). Eighth World Health Assembly. Malaria eradication. The problem of finding an effective and economical method of eradicating malaria in tropical Africa has not yet been solved. A8/P&B/10 (3 May): 11. Socrates Litsios, 1996. The tomorrow of malaria. Pacific Press, Wellington, 106-126.
10. WHO (1955). Eighth World Health Assembly. Malaria eradication. The problem of finding an effective and economical method of eradicating malaria in tropical Africa has not yet been solved. A8/P&B/10 (3 May): 11. Socrates Litsios, 1996. The tomorrow of malaria. Pacific Press, Wellington, 106-126.
11. WHO. Afr/Mal/Conf/25. We are grateful to Dr Nanu Grewal for bringing this important document to our attention. Dr Grewal discovered the French version of this Conference document at the WHO Archives while carrying out research for his MSc thesis, under the supervision of Dr Mary Dobson. (Nanu Grewal, 1997. The rationality of the malaria eradication programme [M.E.P.] in sub-Saharan Africa and why it failed. University of Oxford, unpublished MSc thesis). Randy Packard in his article (1998) 'No other logical choice': global malaria eradication and the politics of international health in the post-war era, Parassitologia 40: 217-229, also cites from this document. For the original English document we thank Ms Paulette den Herder, Centre for Tropical Diseases, WHO, Geneva for her persistence and success in this search.
12. WHO. Afr/Mal/Conf/25. We are grateful to Dr Nanu Grewal for bringing this important document to our attention. Dr Grewal discovered the French version of this Conference document at the WHO Archives while carrying out research for his MSc thesis, under the supervision of Dr Mary Dobson. (Nanu Grewal, 1997. The rationality of the malaria eradication programme [M.E.P.] in sub-Saharan Africa and why it failed. University of Oxford, unpublished MSc thesis). Randy Packard in his article (1998) 'No other logical choice': global malaria eradication and the politics of international health in the post-war era, Parassitologia 40: 217-229, also cites from this document. For the original English document we thank Ms Paulette den Herder, Centre for Tropical Diseases, WHO, Geneva for her persistence and success in this search.
13. WHO. Archives: registry files, WHO.2.DC.Mal.20. African reports (microfiche), no author, 3.
14. WHO. Archives: registry files, WHO.2.DC.Mal.20. African reports (microfiche), no author.
15. This article is part of a larger project (The history of malaria and its control in twentieth century East Africa) funded by the Wellcome Trust, which has recently begun as a joint collaboration with the Kenya Medical Research Institute/Wellcome Trust Collaborative Programme in Nairobi, Kenya and the Wellcome Unit for the History of Medicine, Oxford. We explore many historical issues that remain as pertinent and debatable today as they did in the past. The dilemma of interrupting immunity, without understanding its full implications for longer-term shifts in mortality, has proved to be one of the most enduring themes of our project. In addition to an audit of official documents of the colonial and post-independence periods, the project will compile an archive of materials that includes memoirs, photos, maps and oral histories of personnel who have worked in and on malaria.
16. Richard Feachem, Director for Health, Nutrition and Population at the World Bank, in Butler (1997: 536).
17. Ombongi has called the 1926 epidemic a 'watershed' in anti-malaria programmes and policies in Kenya marking a shift from limited preventive and curative programmes to broader anti-malarial measures, organisational and scientific developments (Kenneth S. Ombongi, 1998. History of malaria research and control policy in Kenya. Unpublished paper presented to the African History Research Seminar, St John's College, University of Cambridge, February: 8-12).
18. S.P. James, Adviser on Tropical Diseases to the Ministry of Health (1929) Report on a visit to Kenya and Uganda to Advise on Antimalarial Measures. Crown Agents for the Colonies, London, 9.
19. S.P. James (1929: 31). We will explore the arguments raised by lames on malaria as a 'social disease' in a future paper.
20. S.P. James (1929: 43).
21. The broader historical context for the incorporation of acquired immunity in selection of controls has been perceptively reviewed and analysed by Corbellini. (C. Corbellini, 1998. Acquired immunity against malaria as a tool for the control of the disease: the strategy proposed by the Malaria Commission of the League of Nations in 1933. Parassitologia 40 (1-2): 109-116).
22. League of Nations. The therapeutics of malaria. Quarterly Bulletin of the Health Organisation of the League of Nations, Third General Report of the Malaria Commission, 202-203.
23. League of Nations. The therapeutics of malaria. Quarterly Bulletin of the Health Organisation of the League of Nations, Third General Report of the Malaria Commission, 302.
24. M. Watson (1953). African Highway. John Murray Publ Ltd, London, 43-44.
25. Early policies on residential segregation were guided by research conducted in West Africa. See S.R. Christophers and J.W.W. Stephens (1900). The native as the prime agent in the malarial infection of Europeans. A report to the Malaria Committee of the Royal Society. S.R. Christophers and J.W.W. Stephens (1900). Further reports to the Malaria Committee of the Royal Society. Harrison and Sons, London, 3-19; and Drs Stephens and Christophers (1900). Reports: from West Coast of Africa. Reports to the Malaria Committee, third series. Harrison and Sons, London, 2-24; especially, The segregation of Europeans, 21-24.
26. Early policies on residential segregation were guided by research conducted in West Africa. See S.R. Christophers and J.W.W. Stephens (1900). The native as the prime agent in the malarial infection of Europeans. A report to the Malaria Committee of the Royal Society. S.R. Christophers and J.W.W. Stephens (1900). Further reports to the Malaria Committee of the Royal Society. Harrison and Sons, London, 3-19; and Drs Stephens and Christophers (1900). Reports: from West Coast of Africa. Reports to the Malaria Committee, third series. Harrison and Sons, London, 2-24; especially, The segregation of Europeans, 21-24.
27. Early policies on residential segregation were guided by research conducted in West Africa. See S.R. Christophers and J.W.W. Stephens (1900). The native as the prime agent in the malarial infection of Europeans. A report to the Malaria Committee of the Royal Society. S.R. Christophers and J.W.W. Stephens (1900). Further reports to the Malaria Committee of the Royal Society. Harrison and Sons, London, 3-19; and Drs Stephens and Christophers (1900). Reports: from West Coast of Africa. Reports to the Malaria Committee, third series. Harrison and Sons, London, 2-24; especially, The segregation of Europeans, 21-24.
28. We are currently preparing a paper on the ideas and work of S.P. James, based both on his field and laboratory experiences.
29. Although Bagster Wilson, because of his challenging presence in East Africa at the Kampala Conference and during the Pare-Taveta Scheme, figures prominently in this paper's discussion, we are interested in those researchers and policy personnel whose work impinged on malaria within East Africa. These include policy-makers within the Departments of Medical Services, at the regional level, WHO consultants and advisors at the international level as well as those scientists, such as Professor Sir Ian McGregor and Dr Brian Greenwood, whose work in other parts of Africa has had great impact on East Africa as well. We are very grateful for donations made to our malaria archive from other 'fields' (e.g., Dr Lewis Gavin for his donation of malaria maps of areas of Sierra Leone; Dr Gerry Pringle for his loan of books and materials on malaria in Greece and Iraq as well as East Africa and Dr David F. Clyde for his donation of the complete set of Tanganyika/Tanzania Annual Medical Reports).
30. The historical discussion on race and immunity will be developed in a further paper on acquired immunity. The Wilsons' summary statement on this point was: 'It may be that the greater contrasts found in a country are associated with race; but we believe that the reasons for such contrasts in the malarial status are primarily historical or social and not a function of some inherited difference in immunity'. (D. Bagster Wilson, Margaret E. Wilson, 1937. The manifestations and measurement of immunity to malaria in different races. Trans R Soc Trop Med Hyg 30 (4): 444).
31. Obituary (1961). Br Med J 1: 134.
32. Rockefeller Archive Center (hereafter RAC), Sleepy Hollow, NY, USA (1948) Russell diaries, RF 12.1.
33. 'When justified they must be continuous; he [Wilson] considers that the aggregation of any considerable number of non-immunes in a sufficiently endemic locality is the indication for control...'. R.R. Scott in Bagster Wilson (1936). Report of the Malaria Unit. Moshi, 1.
34. D. Bagster Wilson (1949). On the present and future malaria outlook in East Africa. East African Medical Journal 26 (12): 381-382.
35. D. Bagster Wilson (1936). Report of the Malaria Unit. Moshi, 32.
36. This model would be formally structured by a young researcher, Dr Ian McGregor, who went to The Gambia in the 1950s for two to three years, only to stay almost 23 years in what must be the first extensive and successful community field study in this past century in Africa.
37. '...those [Africans] who are exposed only to infrequent or seasonal re-infection...Communities of the last type we term sub-immune communities'. Bagster Wilson (1936). Report of the Malaria Unit. Moshi, 20.
38. Correspondence among P.C.C. Garnham, N.H. Swellengrebel and D. Bagster Wilson began in the early 1940's. (Contemporary Medical Archives Centre (CMAC). Wellcome Institute for the History of Medicine, London, PP/PCG/C.21. Two publications signalled the importance of 'common ground' knowledge, a year prior to the Kampala Conference: D. Bagster Wilson, 1949. On the present and future malaria outlook in East Africa. East Afr Med J 26 (12): 378-385; and P.C.C. Garnham, 1949. Malarial immunity in Africans: effects in infancy and early childhood. Annls Trop Med Parasit 43: 47-61. Although they cite each other's work in their respective publications, the first joint publication, again appearing just before the Kampala Conference, was: D. Bagster Wilson, P.C.C. Garnham and N.H. Swellengrebel, 1950. A review of hyperendemic malaria. Tropical Diseases Bulletin 47: 677-698.
39. Correspondence among P.C.C. Garnham, N.H. Swellengrebel and D. Bagster Wilson began in the early 1940's. (Contemporary Medical Archives Centre (CMAC). Wellcome Institute for the History of Medicine, London, PP/PCG/C.21. Two publications signalled the importance of 'common ground' knowledge, a year prior to the Kampala Conference: D. Bagster Wilson, 1949. On the present and future malaria outlook in East Africa. East Afr Med J 26 (12): 378-385; and P.C.C. Garnham, 1949. Malarial immunity in Africans: effects in infancy and early childhood. Annls Trop Med Parasit 43: 47-61. Although they cite each other's work in their respective publications, the first joint publication, again appearing just before the Kampala Conference, was: D. Bagster Wilson, P.C.C. Garnham and N.H. Swellengrebel, 1950. A review of hyperendemic malaria. Tropical Diseases Bulletin 47: 677-698.
40. Correspondence among P.C.C. Garnham, N.H. Swellengrebel and D. Bagster Wilson began in the early 1940's. (Contemporary Medical Archives Centre (CMAC). Wellcome Institute for the History of Medicine, London, PP/PCG/C.21. Two publications signalled the importance of 'common ground' knowledge, a year prior to the Kampala Conference: D. Bagster Wilson, 1949. On the present and future malaria outlook in East Africa. East Afr Med J 26 (12): 378-385; and P.C.C. Garnham, 1949. Malarial immunity in Africans: effects in infancy and early childhood. Annls Trop Med Parasit 43: 47-61. Although they cite each other's work in their respective publications, the first joint publication, again appearing just before the Kampala Conference, was: D. Bagster Wilson, P.C.C. Garnham and N.H. Swellengrebel, 1950. A review of hyperendemic malaria. Tropical Diseases Bulletin 47: 677-698.
41. Bagster Wilson, Garnham and Swellengrebel (1950). This joint paper was published in August 1950, three months prior to the November-December 1950 Kampala Conference and the debates. We are searching for the questionnaires sent to Conference participants prior to the Conference and would appreciate receiving any suggestions on locating these sources.
42. Bagster Wilson, Garnham and Swellengrebel, 1950: 694.
43. Bagster Wilson, Garnham and Swellengrebel, 1950: 695.
44. CMAC. PP/PCG. Letter from D. Bagster Wilson to Swellengrebel and Garnham (1 January 1950) 'Margaret Elizabeth says it is most important to get this paper written as soon as possible, for so soon this whole subject will be no more than a historical curiosity'.
45. WHO.IC/Mal/1.
46. J. Jackson (1998). Cognition and the Global Malaria Eradication Programme. Parassitologia 40 (1-2): 193-216; R.M. Packard (1998). 'No other logical choice': global malaria eradication and the politics of international health in the post-war era. Parassitologia 40 (1-2): 217-229; S. Litsios (1998). Arnoldo Gabaldón's independent path for malaria control and public health in the Tropics: a lost 'paradigm' for WHO. Parassitologia 40 (1-2): 231-238.
47. J. Jackson (1998). Cognition and the Global Malaria Eradication Programme. Parassitologia 40 (1-2): 193-216; R.M. Packard (1998). 'No other logical choice': global malaria eradication and the politics of international health in the post-war era. Parassitologia 40 (1-2): 217-229; S. Litsios (1998). Arnoldo Gabaldón's independent path for malaria control and public health in the Tropics: a lost 'paradigm' for WHO. Parassitologia 40 (1-2): 231-238.
48. J. Jackson (1998). Cognition and the Global Malaria Eradication Programme. Parassitologia 40 (1-2): 193-216; R.M. Packard (1998). 'No other logical choice': global malaria eradication and the politics of international health in the post-war era. Parassitologia 40 (1-2): 217-229; S. Litsios (1998). Arnoldo Gabaldón's independent path for malaria control and public health in the Tropics: a lost 'paradigm' for WHO. Parassitologia 40 (1-2): 231-238.
49. Packard. Politics of international health, 217.
50. WHO. Archives: registry files, WHO.2, DC Mal 20. Africa report (microfiche), no author (anonymous observer).
51. WHO. Archives: registry files, WHO.2.
52. WHO. Archives: registry files, WHO.2.
53. WHO. Archives: registry files, WHO.2.
54. WHO. Archives: registry files, WHO.2.
55. WHO. Archives: registry files, WHO.2.
56. Afr/Mal/Conf/25, 9.
57. This was reduced to two and a half pages in the printed version. (Afr/Mal/Conf/25, 43-77; WHO. 1951. Technical Report Series 38: 21-23).
58. Prof G. Macdonald, Director, Ross Institute, London School of Hygiene and Tropical Medicine, UK; Dr LJ Bruce-Chwatt, Senior Malariologist, i/c Malaria Service of Nigeria, Lagos, Nigeria; Dr P.P. Russell, Malaria Adviser. Rockefeller Foundation, Rome; Dr P.C.C. Garnham, Reader in Medical Parasitology, London School of Hygiene and Tropical Medicine, UK; Prof N.H. Swellengrebel, Director, Institute of Tropical Hygiene of the Royal Institute for the Indies, and Professor at the University of Amsterdam, The Netherlands; Dr D. Bagster Wilson, Director, East African Malaria Unit, Muheza, Tanganyika.
59. P.C.C. Garnham (1989). Professor L.J. Bruce-Chwatt's 80th birthday. Journal of Tropical Medicine and Hygiene 92: 68.
60. Afr/Mal/Conf/25 and interview with Dr Kay Hocking, Cornwall, May 1998, delegate to the Kampala Conference from the Colonial Insecticides Research Unit, Arusha, Tanganyika.
61. Afr/Mal/Conf/25, 49 and 57.
62. Afr/Mal/Conf/25, 52-53.
63. WHO. Registry files, WHO.2. DC.Mal.20. Africa Reports (microfiche), no author, 3.
64. Afr/Mal/Conf/25, 47.
65. Afr/Mal/Conf/25, 51. Questions of immunity and controls for African adults was further complicated by the migration of non-immune populations who were put at risk when moving into areas of intense transmission. This was a particular problem in the colonial period of East Africa as labourers migrated from regions of low or moderate transmission to those of high transmission. The complexity of this relationship of non-immune communities moving to and living in areas of high endemicity with Africans who have acquired immunity was raised at the Kampala Conference and further elaborated in: R Mansell Prothero (1965). Migrants and malaria. Longmans, London.
66. WHO. Registry files, WHO.2. DC.Mal.20. Africa Reports (microfiche), no author.
67. Afr/Mal/Conf/25, 53-55.
68. Dr Henry Foy, Director, Nairobi Wellcome Trust Research Laboratories, Afr/Mal/Conf/25, 57.
69. WHO. Registry files. WHO.2. DC.Mal.20, Africa Reports (microfiche), no author, 5.
70. Afr/Mal/Conf/25, 54.
71. Afr/Mal/Conf/25, 55.
72. Dr D.M. Blair, Director of Preventive Services Health Department, Salisbury, Southern Rhodesia. Afr/Mal/Conf/25, 60.
73. Afr/Mal/Conf/25, 62.
74. Afr/Mal/Conf/25, 65.
75. Afr/Mal/Conf/25, 65.
76. Afr/Mal/Conf/25, 66.
77. Afr/Mal/Conf/25, 67.
78. Afr/Mal/Conf/25, 97-98 and 116-125. Reference is made to the 'Draft Report' for the Conference which includes all draft recommendations. We are attempting to locate this document.
79. Afr/Mal/Conf/25, 97-98.
80. WHO (1951). Technical Report Series 38: 22, 46.
81. Members of the Expert Committee on Malaria at this meeting were: Dr S. Annccke, Professor F.J.C. Cambournac, Major-General Sir Gordon Covell, Professor G. Macdonald, Dr P.F. Russell, Lieut-Col J. Singh, Professor N.H. Swellengrebel, Medecin-General M.A. Vaucel, and Dr D.B. Wilson. For the WHO Secretariat sat Dr E.J. Pampana and J.W. Wright.
82. WHO (1951). Technical Report Series 39: 21.
83. Paul Russell Diaries, 12 December 1950, RAC.
84. S.P. James (1931). Some general results of a study of induced malaria in England. Trans R Soc Trop Med Hyg 24: 497.
85. The Pare-Taveta Malaria Scheme 1954-1959 was conducted by the East African Institute of Malaria and Vector-Borne Diseases in collaboration with the Colonial Pesticides Research Unit, financed by the Colonial Development and Welfare Scheme and East African governments with contributions of insecticides and vehicles from the United Nations' Children's Fund. Dr D. Bagster Wilson, Director, Malaria Institute, Amani, Tanganyika administered the project. East Africa High Commission (1960). Report on the Pare-Taveta Malaria Scheme 1954-1959. Government Printer, Dar es Salaam, 90 pp.
86. East Africa High Commission (1951-1953). East African Malaria Unit Annual Report 1950 and East African Malaria Unit Annual Report 1951. High Commission Printer, Nairobi.
87. East Africa High Commission (1960). East African Institute of Malaria and Vector-Borne Diseases in collaboration with the Colonial Pesticides Research Unit. Report on the Pare-Taveta Malaria Scheme 1954-1959. Government Printer, Dar es Salaam [written by D. Bagster Wilson]; C.C. Draper, J.L.M. Lelijveld, Y.G. Matola and G.B. White (1972). Malaria in the Pare Area of Tanzania. IV. Malaria in the human population 11 years after the suspension of residual insecticide spraying, with special reference to the serological findings. Trans R Soc Trop Med Hyg 66 (6): 905-992; C.C. Draper and A. Voller with R.G. Carpenter (1972). The epidemiologic interpretation of serologic data in malaria. Am J Trop Med Hyg 21 (5, Sept): 696-703; G. Pringle (1964). Malaria and vital rates in three East African Bantu communities. I. Initial demographic survey. Br J Prev Soc Med 18 (1, Jan): 43; David J. Bradley (1991). Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Disease and mortality in sub-Saharan Africa, Ch 17 (T.C.G.A. Feacham, D.T. Jamison, eds). Oxford University Press for the World Bank, Oxford, 248-263. Bradley's assessment of both phases of the Scheme provides a comprehensive list of published references.
88. East Africa High Commission (1960). East African Institute of Malaria and Vector-Borne Diseases in collaboration with the Colonial Pesticides Research Unit. Report on the Pare-Taveta Malaria Scheme 1954-1959. Government Printer, Dar es Salaam [written by D. Bagster Wilson]; C.C. Draper, J.L.M. Lelijveld, Y.G. Matola and G.B. White (1972). Malaria in the Pare Area of Tanzania. IV. Malaria in the human population 11 years after the suspension of residual insecticide spraying, with special reference to the serological findings. Trans R Soc Trop Med Hyg 66 (6): 905-992; C.C. Draper and A. Voller with R.G. Carpenter (1972). The epidemiologic interpretation of serologic data in malaria. Am J Trop Med Hyg 21 (5, Sept): 696-703; G. Pringle (1964). Malaria and vital rates in three East African Bantu communities. I. Initial demographic survey. Br J Prev Soc Med 18 (1, Jan): 43; David J. Bradley (1991). Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Disease and mortality in sub-Saharan Africa, Ch 17 (T.C.G.A. Feacham, D.T. Jamison, eds). Oxford University Press for the World Bank, Oxford, 248-263. Bradley's assessment of both phases of the Scheme provides a comprehensive list of published references.
89. East Africa High Commission (1960). East African Institute of Malaria and Vector-Borne Diseases in collaboration with the Colonial Pesticides Research Unit. Report on the Pare-Taveta Malaria Scheme 1954-1959. Government Printer, Dar es Salaam [written by D. Bagster Wilson]; C.C. Draper, J.L.M. Lelijveld, Y.G. Matola and G.B. White (1972). Malaria in the Pare Area of Tanzania. IV. Malaria in the human population 11 years after the suspension of residual insecticide spraying, with special reference to the serological findings. Trans R Soc Trop Med Hyg 66 (6): 905-992; C.C. Draper and A. Voller with R.G. Carpenter (1972). The epidemiologic interpretation of serologic data in malaria. Am J Trop Med Hyg 21 (5, Sept): 696-703; G. Pringle (1964). Malaria and vital rates in three East African Bantu communities. I. Initial demographic survey. Br J Prev Soc Med 18 (1, Jan): 43; David J. Bradley (1991). Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Disease and mortality in sub-Saharan Africa, Ch 17 (T.C.G.A. Feacham, D.T. Jamison, eds). Oxford University Press for the World Bank, Oxford, 248-263. Bradley's assessment of both phases of the Scheme provides a comprehensive list of published references.
90. East Africa High Commission (1960). East African Institute of Malaria and Vector-Borne Diseases in collaboration with the Colonial Pesticides Research Unit. Report on the Pare-Taveta Malaria Scheme 1954-1959. Government Printer, Dar es Salaam [written by D. Bagster Wilson]; C.C. Draper, J.L.M. Lelijveld, Y.G. Matola and G.B. White (1972). Malaria in the Pare Area of Tanzania. IV. Malaria in the human population 11 years after the suspension of residual insecticide spraying, with special reference to the serological findings. Trans R Soc Trop Med Hyg 66 (6): 905-992; C.C. Draper and A. Voller with R.G. Carpenter (1972). The epidemiologic interpretation of serologic data in malaria. Am J Trop Med Hyg 21 (5, Sept): 696-703; G. Pringle (1964). Malaria and vital rates in three East African Bantu communities. I. Initial demographic survey. Br J Prev Soc Med 18 (1, Jan): 43; David J. Bradley (1991). Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Disease and mortality in sub-Saharan Africa, Ch 17 (T.C.G.A. Feacham, D.T. Jamison, eds). Oxford University Press for the World Bank, Oxford, 248-263. Bradley's assessment of both phases of the Scheme provides a comprehensive list of published references.
91. East Africa High Commission (1960). East African Institute of Malaria and Vector-Borne Diseases in collaboration with the Colonial Pesticides Research Unit. Report on the Pare-Taveta Malaria Scheme 1954-1959. Government Printer, Dar es Salaam [written by D. Bagster Wilson]; C.C. Draper, J.L.M. Lelijveld, Y.G. Matola and G.B. White (1972). Malaria in the Pare Area of Tanzania. IV. Malaria in the human population 11 years after the suspension of residual insecticide spraying, with special reference to the serological findings. Trans R Soc Trop Med Hyg 66 (6): 905-992; C.C. Draper and A. Voller with R.G. Carpenter (1972). The epidemiologic interpretation of serologic data in malaria. Am J Trop Med Hyg 21 (5, Sept): 696-703; G. Pringle (1964). Malaria and vital rates in three East African Bantu communities. I. Initial demographic survey. Br J Prev Soc Med 18 (1, Jan): 43; David J. Bradley (1991). Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Disease and mortality in sub-Saharan Africa, Ch 17 (T.C.G.A. Feacham, D.T. Jamison, eds). Oxford University Press for the World Bank, Oxford, 248-263. Bradley's assessment of both phases of the Scheme provides a comprehensive list of published references.
92. Bradley describes the Scheme as 'one of the important, yet most neglected, longitudinal studies of health in an African community' (Bradley, 1991: 248). We are currently examining the morbidity, mortality and other demographic indices emanating from this survey with a view to revisiting the Pare-Taveta Scheme in the light of current research questions.
93. D. Bagster Wilson (1964). Introduction. Report on Pare-Taveta Malaria Scheme, iii. G. Pringle (1964). Malaria and vital rates in three East African Bantu communities. I. Initial demographic survey. Br J Prev Soc Med 18 (1, Jan): 43- 51, The second phase of the Scheme was made possible by a grant from the Nuffield Foundation.
94. D. Bagster Wilson (1964). Introduction. Report on Pare-Taveta Malaria Scheme, iii. G. Pringle (1964). Malaria and vital rates in three East African Bantu communities. I. Initial demographic survey. Br J Prev Soc Med 18 (1, Jan): 43-51, The second phase of the Scheme was made possible by a grant from the Nuffield Foundation.
95. Although Bagster Wilson supported the use of airspray as control of seasonal breeding of A. gambiae as more efficient than larvicidal ground control, he felt the high price of DDT rendered the choice of questionable economic value. D. Bagster Wilson and A.G. Robertson (1947). DDT airspray in malaria control in East Africa. Trans R Soc Trop Med Hyg 40 (6, July): 823-849.
96. In the early 1950s a variety of organochlorine insecticides were available (e.g., BHC, DDT and dieldrin). Dieldrin had the advantage of less excito-repellancy. According to Dr Graham White, entomologist on the second stage of the Pare-Taveta Scheme in the 1960s, dieldrin might have been chosen as a combination of entomological logic and commercial expediency. Personal communication.
97. The second phase of the Pare-Taveta Scheme, scheduled to last for five years, began in 1961 two years after the interventions of the initial scheme had ceased. G. Pringle continued to collect data for this five year programme from one malaria-free and two hyperendemic communities in East Africa. 'It is planned to broaden the scope of the original investigation and to collect data from which age-specific mortality and fertility rates can eventually be constructed for two distinct communities living in zones where malaria has returned'. Reports on this continuation project were not compiled into one volume but published in a variety of journals both during the project and following its completion. The initial publication was G. Pringle (1964). Malaria and vital rates, 43 pp.
98. Bradley has compared the data from both phases of the project. Looking at childhood mortality figures over time. Bradley noted that the failure of infant mortality to rise whereas child mortality had reverted after transmission had resumed raised new and interesting questions. Bradley's points highlight Bagster Wilson's contention that the longer the study, the more useful the data. Bagster Wilson's analysis was restricted to the first phase only. David J. Bradley (1991). Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Disease and mortality in sub-Saharan Africa, Ch 17 (T.C.G.A. Feacham, D.T. Jamison, eds). Oxford University Press for the World Bank, Oxford, 254. D.J. Bradley (1992). Malaria: old infections, changing epidemiology. Health Trans Rev 2 (Suppl): 137-153.
99. Bradley has compared the data from both phases of the project. Looking at childhood mortality figures over time. Bradley noted that the failure of infant mortality to rise whereas child mortality had reverted after transmission had resumed raised new and interesting questions. Bradley's points highlight Bagster Wilson's contention that the longer the study, the more useful the data. Bagster Wilson's analysis was restricted to the first phase only. David J. Bradley (1991). Morbidity and mortality at Pare-Taveta, Kenya and Tanzania, 1954-66: the effects of a period of malaria control. In: Disease and mortality in sub-Saharan Africa, Ch 17 (T.C.G.A. Feacham, D.T. Jamison, eds). Oxford University Press for the World Bank, Oxford, 254. D.J. Bradley (1992). Malaria: old infections, changing epidemiology. Health Trans Rev 2 (Suppl): 137-153.
100. The use of anti-malaria treatments during and after the spraying may have had longer-term benefits.
101. While indices of height and weight did not provide significant evidence of the deleterious effect of malaria on child health, Bagster Wilson noted in the results of the Report that malaria did reduce haemoglobin levels. Children were most adversely affected in infancy although levels remained constant through adult life, rising at the end of the life span. Bagster Wilson cautioned that the overall health implications, although important, were complicated to measure. He also stressed that diet was an important factor. Bagster Wilson (1960). Report on Pare-Taveta Malaria Scheme, 79.
102. There is considerable overlap here in the ideas of Bagster Wilson and lames that we are currently exploring. Bagster Wilson (1960). Report on Pare-Taveta Malaria Scheme, 79.
103. Publications from this project by Drs C. and K. Draper. M.T. Gillies, C. Pringle and A. Smith are numerous. Involved in both phases of the project, Dr Alec Smith subsequently worked from WHO headquarters in Geneva and wrote the revised WHO policy guidelines for insecticide use. Alec Smith (1993). Insect Man. Radcliffe Press, London and New York; and personal interview with Dr Alec Smith.
104. K. Marsh (1992). Malaria: a neglected disease? Parasitology 104: S53-S69.
105. Packard (1998). The politics of international health, 228-229.
106. The series of letters can be found in the UNICEF Archives, Programme Division, Africa, CF/NYH/PD. Folder AO29, Box Year 1948. File: Kenya, Tanganyika and Uganda, Malaria. AFP-6, 1954. We are grateful to Dr Socrates Litsios for bringing these documents to our attention.
107. The correspondents were Dr Charles Egger, Director, UNICEF-AEMERO, Paris; Frederick W Tooby, Chief of Section, UNICEF-AEMERO, New York; Gordon Carter, Chief. UNICEF-FOD, Neuilly-sur-Seine, France; Dudley Ward. UNICEF, London; Mr Karl H. Borch, Field Rep, UNICEF-Brazzaville, French Equatorial Africa; Dr F J Cambournac, Director, WHO Regional Office for Africa, Brazzaville, French Equatorial Africa and Dr K Sinclair-Loutit, WHO Medical Adviser, Neuilly-sur-Seine, France; Dr B. Borcic, Medical Adviser, UNICEF, New York.
108. Sinclair-Loutit to Borcic, 22 February 1954.
109. Sinclair-Loutit to Borcic, 22 February 1954.
110. Afr/Mal/Conf/25: 65.
111. Sinclair-Loutit to Borcic, 22 February 1954.
112. UNICEF, CF/NYH/PD, Kenya-Malaria 1953-55 (AFP-18) J McTurk to R Marti, 11 August 1953.
113. WHO (1957). Technical Report Series No. 123. Expert Committee on Malaria, Sixth Report, 16. The falling by the wayside of the immunity debate, as Africa was caught up in the global eradication campaign, has been raised by Litsios. Socrates Litsios (1996). The tomorrow of malaria. Pacific Press, Wellington, NZ, 112.
114. WHO (1957). Technical Report Series No. 123. Expert Committee on Malaria, Sixth Report, 16. The falling by the wayside of the immunity debate, as Africa was caught up in the global eradication campaign, has been raised by Litsios. Socrates Litsios (1996). The tomorrow of malaria. Pacific Press, Wellington, NZ, 112.
115. Dr H. Foy, Director, Nairobi Wellcome Trust Research Laboratories, Afr/Mal/Conf/25: 68.
116. As Bradley has commented, the initial programs were aimed at research and were not conducted on a national or regional scale. Bradley (1992). Malaria: old infections, changing epidemiology, 243.
117. WHO/VBC/89.981 (1989). The use of impregnated bednets and other materials for vector borne disease control; C. Lengeler, ed (1997). Net Gain; a new method of preventing malaria deaths. WHO/IDRC;
118. J. Cattani (1996). Meeting on insecticide-impregnated materials. TDR News 50 (June): 3-5;
119. B.M. Greenwood, H. Pickering (1993). A review of the epidemiology of control of malaria in The Gambia, West Africa. Trans R Soc Trop Med Hyg 87, Suppl 2: 3-12.
120. Madeleine Thomson et al. (1996). Geographical perspectives on bednet use and malaria transmission in The Gambia, West Africa. Soc Sci Med 43 (1): 101-112.
121. We revisit this debate within the East African context in a forthcoming article on immunity, 'Bounce Back Malaria: the challenges and fears of malaria control in twentieth century Africa', drawing on one of the central conundrums to highlight the continuity of debate, the tendency to polarise discussion, and the need to draw on historical links and data to understand the contemporary period.
122. The initial trials began in 1985 and led to mortality trials between 1989 and 1990. B.M. Greenwood (1993). Summary and Conclusions. A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, West Africa. Trans R Soc Trop Med Hyg 87, Suppl 2: 59-60.
123. P.L. Alonso et al. (1993). The impact of the interventions on mortality and morbidity from malaria. Trans R Soc Trop Med Hyg 87, Suppl 2: 37-44.
124. P.L. Alonso et al. (1991). The effect of insecticide treated bed nets on mortality of Gambian children. Lancet 337: 1499-1502; U. D'Allesandro et al. (1995). Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme. Lancet 345: 479-483; C.G. Nevill et al. (1996). Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop Med Int Hlth 1 (2): 139-146; and F.N. Binka et al. (1996). Impact of permethrin impregnated bednets on child mortality in Kassena-Nakana district, Ghana: A randomised controlled trial. Trop Med Int Hlth 1 (2): 147-154.
125. P.L. Alonso et al. (1991). The effect of insecticide treated bed nets on mortality of Gambian children. Lancet 337: 1499-1502; U. D'Allesandro et al. (1995). Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme. Lancet 345: 479-483; C.G. Nevill et al. (1996). Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop Med Int Hlth 1 (2): 139-146; and F.N. Binka et al. (1996). Impact of permethrin impregnated bednets on child mortality in Kassena-Nakana district, Ghana: A randomised controlled trial. Trop Med Int Hlth 1 (2): 147-154.
126. P.L. Alonso et al. (1991). The effect of insecticide treated bed nets on mortality of Gambian children. Lancet 337: 1499-1502; U. D'Allesandro et al. (1995). Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme. Lancet 345: 479-483; C.G. Nevill et al. (1996). Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop Med Int Hlth 1 (2): 139-146; and F.N. Binka et al. (1996). Impact of permethrin impregnated bednets on child mortality in Kassena-Nakana district, Ghana: A randomised controlled trial. Trop Med Int Hlth 1 (2): 147-154.
127. P.L. Alonso et al. (1991). The effect of insecticide treated bed nets on mortality of Gambian children. Lancet 337: 1499-1502; U. D'Allesandro et al. (1995). Mortality and morbidity from malaria in Gambian children after introduction of an impregnated bednet programme. Lancet 345: 479-483; C.G. Nevill et al. (1996). Insecticide-treated bednets reduce mortality and severe morbidity from malaria among children on the Kenyan coast. Trop Med Int Hlth 1 (2): 139-146; and F.N. Binka et al. (1996). Impact of permethrin impregnated bednets on child mortality in Kassena-Nakana district, Ghana: A randomised controlled trial. Trop Med Int Hlth 1 (2): 147-154.
128. n.a. (1997). Plagued by cures. The Economist (Nov 22): 135-138; L. Molineaux (1997). Nature's experiment: what implications for malaria prevention?, Lancet 349, 7 June: 1636-1637; R.W. Snow et al. (1997). Relation between severe malaria morbidity in children and level of Plasmodium falciparum transmission in Africa. Lancet 349, June: 1650-1654.
129. n.a. (1997). Plagued by cures. The Economist (Nov 22): 135-138; L. Molineaux (1997). Nature's experiment: what implications for malaria prevention?, Lancet 349, 7 June: 1636-1637; R.W. Snow et al. (1997). Relation between severe malaria morbidity in children and level of Plasmodium falciparum transmission in Africa. Lancet 349, June: 1650-1654.
130. n.a. (1997). Plagued by cures. The Economist (Nov 22): 135-138; L. Molineaux (1997). Nature's experiment: what implications for malaria prevention?, Lancet 349, 7 June: 1636-1637; R.W. Snow et al. (1997). Relation between severe malaria morbidity in children and level of Plasmodium falciparum transmission in Africa. Lancet 349, June: 1650-1654.
131. R.W. Snow et al. (1997). Relation between severe malaria morbidity in children and level of Plasmodium falciparum transmission in Africa. Lancet 349, June: 1650-1654.
132. R.W. Snow, 1997; Molineaux, 1997; Greenwood and Pickering, 1993; no author (1997). Plagued by cures. The Economist, Nov 22; Brown, 1997.
133. R.W. Snow, 1997; Molineaux, 1997; Greenwood and Pickering, 1993; no author (1997). Plagued by cures. The Economist, Nov 22; Brown, 1997.
134. R.W. Snow, 1997; Molineaux, 1997; Greenwood and Pickering, 1993; no author (1997). Plagued by cures. The Economist, Nov 22; Brown, 1997.
135. Brown, 1997: 16.
136. Jacqueline Cattani, WHO/TDR, in Brown, 1997: 16.
137. Kevin Marsh, Robert W. Snow (1999). Malaria transmission and morbidity. Parassitologia 41: 241-246.
138. Richard Feachem, Director of Health, Nutrition and Population at the World Bank, quoted in Butler, 1997: 536.
139. R.W. Snow, K. Marsh, D. le Sueur (1996). The need for maps of transmission intensity to guide malaria control in Africa. Parasitol Today 12: 455-457; J. Omumbo, J. Ouma, B. Rapuoda, M. Craig, D. le Sueur, R.W. Snow (1998). Mapping malaria transmission intensity using geographical information systems (GIS): an example from Kenya. Annls Trop Med Parasitol 92: 7-21; WHO (1998). Towards an atlas of malaria risk in Africa. First Technical Report of the MARA/AMRA Collaboration, MARA/ARMA, Durban.
140. R.W. Snow, K. Marsh, D. le Sueur (1996). The need for maps of transmission intensity to guide malaria control in Africa. Parasitol Today 12: 455-457; J. Omumbo, J. Ouma, B. Rapuoda, M. Craig, D. le Sueur, R.W. Snow (1998). Mapping malaria transmission intensity using geographical information systems (GIS): an example from Kenya. Annls Trop Med Parasitol 92: 7-21; WHO (1998). Towards an atlas of malaria risk in Africa. First Technical Report of the MARA/AMRA Collaboration, MARA/ARMA, Durban.
141. R.W. Snow, K. Marsh, D. le Sueur (1996). The need for maps of transmission intensity to guide malaria control in Africa. Parasitol Today 12: 455-457; J. Omumbo, J. Ouma, B. Rapuoda, M. Craig, D. le Sueur, R.W. Snow (1998). Mapping malaria transmission intensity using geographical information systems (GIS): an example from Kenya. Annls Trop Med Parasitol 92: 7-21; WHO (1998). Towards an atlas of malaria risk in Africa. First Technical Report of the MARA/AMRA Collaboration, MARA/ARMA, Durban.
142. G.S. Nelson (1959). Atlas of Kenya. Ed 1. Surveys of Kenya. Crown Printers, Nairobi; D. Bagster Wilson (1956). Atlas of Tanzania. Ed 3. Survey Division. Department of Lands and Surveys, Government Printers, Dar es Salaam.
143. G.S. Nelson (1959). Atlas of Kenya. Ed 1. Surveys of Kenya. Crown Printers, Nairobi; D. Bagster Wilson (1956). Atlas of Tanzania. Ed 3. Survey Division. Department of Lands and Surveys, Government Printers, Dar es Salaam.
144. Brown, 1997: 17.