Controling malaria by reducing transmission? A controversy

The place of the vector control in the malaria control is currently debated for areas of high and medium endemic malaria (i.e. mainly in rural tropical Africa). The short-term impact of interventions reducing transmission by means of insecticides, such as house spraying or impregnated bednets, shows an important reduction of malarial morbidity and mortality. On the contrary, the comparison of various situations with different levels of malaria transmission suggest that a decrease of transmission would have only consequences in the delay of the mean age at which malaria attacks occur but not in the overall importance of malarial morbidity and mortality. The obvious discrepancy between the observed results reflect different approaches. It reveals above all the importance of the malaria control challenges.