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pregnant women during their last two trimesters (intermittent preventive
treatment for pregnancy or IPTp) ( ter Kuile et al., 2007 ). Rapid drug treat-
ment of febrile school children by their teachers has also been shown to
reduce mortality in some African settings. Such presumptive treatments to
prevent mortality or severe morbidity are not a form of malaria elimination,
but a means to decrease the malaria burden in an area still experiencing
high levels of transmission. Concerted and resource demanding efforts to
stop malaria transmission can really only be done from a base of excellent
malaria control with a functional health system already able to deliver cura-
tive treatment to those infected or highly likely to be infected with malaria.
3.2. Historical Use of Drugs for Malaria Control/Elimination
There are many instances of antimalarial drugs being used within specific
populations such as rubber tappers ( Kingsbury and Amies, 1931 ), banana
growers ( Macphail, 1927 ), tea estate workers ( Ray, 1948 ; Strangeways-
Dixon, 1950 ), villagers ( Clark et al., 1942 ; Kondrashin and Sanyal, 1985 ;
Dapeng et al., 1996 ; Escudie et al., 1962 ), school children ( Miller, 1955 ,
1956 ; Clyde, 1962 ), soldiers ( Shanks et al., 1992 , 1995a , 1995b ; Malaria in
the army in India, 1934 ) and miners ( Gunther, 1951 ; Gunther et al., 1952 ;
Shanks et al., 1993 ) as a means of controlling malaria, where the aim was
protection of an occupational group rather than elimination in a geographic
area. Antimalarial drug use for MDA focused on falciparum malaria has
been reviewed ( Greenwood, 2004 ; von Seidlein et al., 2003 ). The Italian
elimination program was ultimately successful after 60 years despite many
setbacks largely due the social disruption of two World Wars ( Snowden,
2006 ). It arose from a social concern for rural farm labourers whose poverty
exposed them to lethal malaria as an occupational hazard in certain high-
transmission areas. The technologic advance that made the quinine distribu-
tion program of the Italian malaria control program possible was the greatly
expanded cultivation of cinchona trees in the then Dutch East Indies rather
than its native South America. The price of quinine, then the only specific
drug known for malaria, dropped dramatically making its wide-spread dis-
tribution affordable and feasible. An Italian state quinine monopoly was set
up to distribute medication to the rural poor as a means of social justice and
an attempt to raise agricultural output. This well-intentioned effort largely
failed because of limitations inherent to quinine and lack of other forms of
socioeconomic progress. Quinine was bad-tasting and in sufficient doses
to be effective induced unpleasant adverse events such as tinnitus. Heroic
amounts of quinine were distributed and when it was actually ingested, did
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