In the irrigated zones of North-eastern region of Afghanistan malaria transmission is sustained by A. pulcherrimus and A. hyrcanus despite many years of DDT spraying. A. hyrcanus is an exophilic and exophagic mosquito, strongly resistant to DDT. A. pulcherrimus is still largely susceptible to the insecticide but seems to be deterred from entering houses when these are sprayed with DDT. Entomological and parasitological studies in an area of the province of Kunduz where DDT has not been applied for 2 consecutive years have clearly indicated that the insecticide still plays an important role in reducing malaria transmission in the area though, as expected, it cannot interrupt transmission. A deterioration of the epidemiological situation in the area can be expected if the insecticide is withdrawn. The technical problems now existing in the irrigated zones of the North-eastern region of Afghanistan cannot be solved by routine attack measures. Malaria in the area can be eradicated only with the introduction of new attack measures which are very expensive and for which, at present, the necessary funds are not available.

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In this study the efficacy of chlorproguanil (20 mg base weekly) was compared in schoolchildren with that of chloroquine (200 mg base weekly) and that of both drugs combined (20 mg base + 200 mg base weekly). The double blind trial was performed in the rice field area of the Ruzizi valley in Burundi, where Plasmodium falciparum is widely resistant to chloroquine, and where pyrimethamine resistance with cycloguanil cross-resistance had been demonstrated. After 17 weeks, when the trial was ended, 60% breakthroughs had been observed among the children taking chloroquine, 72% among those under chlorproguanil and 61% among those under chlorproguanil and chloroquine. In children weighing between 15 and 24 kg, the failure rate was significantly higher in those treated with chlorproguanil than in the group treated with chloroquine. No difference in efficacy was observed in children weighing 25 to 39 kg. There was no significant increase of efficacy when chlorproguanil was given in association with chloroquine. The mean titre of fluorescent antibodies was the same in each treated group on week 5 and week 15. The comparison of these data with the infection rates in non-protected children suggests that malaria could not be prevented with any of the drug regimens utilized in the study.

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