Comparison of methods of malaria control

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This page is a comparison of methods of malaria control, covering methods of both prevention and treatment.


Drug Methods

Use of insecticides has two main variables: method of delivery and the insecticide itself. This table covers the former; the latter are numerous and are covered separately in a second table below.

Type := Prevention | Treatment | Both

ACT (artemisinin combinatorial therapy) -- different from artenisinin?

also "comprehensive surveillance" gets mentioned a lot, in the course of using the other things.

Chemoprophylaxis -- which drugs are included?

consider "patient compliance" as a column

include various Artemisinin-based combination therapies (ACTs)

Method Type Acts against Route of administration First use First resistance Locations where used Advantages Disadvantages Combines with Status
Amodiaquine Treatment "some chloroquine-resistant strains, particularly Plasmodium falciparum"[1] oral[2] 1951[3] 1971[3] Africa Absorption is not influenced by food (compared with partner drug lumefantrine which should be taken with fatty food).[4] "Formation of toxic amodiaquine quinone imine (AQQI) metabolites"[5] Artesunate WHO Essential Medicine
Artemether Treatment[6] "Acute uncomplicated malaria."[6] Oral[7], intramuscular injection[8] 1987 Complementary advantage with lumefantrine. "Artemether has an initial burst effect on Plasmodium schizonts and a variety of drug-resistant malaria strains."[9] Lumefantrine WHO Essential Medicine
Artemisinin Treatment Plasmodium falciparum oral, intramuscular, rectal[10][11] 1970s[3] 1998[3], 2009[12] Safe antimalarial in pregnancy.[13] More expensive than SP or chloroquine.[14]:165
Artemotil Treatment "Rapidly against Plasmodium during the early blood stage of its development. It also shows gametocytocidal activity against Plasmodium falciparium."[15] "Intramuscular injection only."[16] 2000 [17] "Excellent alternative to quinine, over which it has clear advantages: it causes a swifter decrease in parasite numbers; is simpler to apply; has far fewer undesirable side-effects." "Also has advantages in cases where the patient is not able to retain food (and thus cannot be treated with oral medication)."[17]
Artemether/lumefantrine Treatment Plasmodium falciparum "Artemether-lumefantrine benefits from coformulation, approval in multiple countries in the developing world and Europe, and demonstrated excellent efficacy and safety "[18] "Disadvantages of artemether-lumefantrine therapy include the need for twice-per-day dosing, irregular bioavailability, and recommendation for ingestion with a fatty meal to improve drug levels."[18]
Artesunate Treatment Uncomplicated falciparum malaria (orally), severe falciparum malaria (parenterally)[19] Oral, parenteral[19] 1996[20] Advantages over quinine: Acts rapidly. Causes faster clearance of parasite. It is better tolerated, more effective and more safe.[13]
Artesunate/amodiaquine Treatment[21] "Uncomplicated Plasmodium falciparum malaria, especially in paediatric patients"[21] Oral[22] 2007[23] Sub-Saharan Africa
Artesunate suppositories
Atovaquone-proguanil (Malarone) Treatment, prevention[24] Blood and liver phases of Plasmodium falciparum[25] Oral 1996[3] 2002[3] Found to be 95% effective in otherwise drug resistant falciparum malaria.[26]
Chloroquine Both "Intraerythrocytic Plasmodium falciparum stages"[27] Oral ~1940s (during WWII) 1957[28] "The disadvantages of chloroquine are its effects on protein degradation and direct block of other cardiac ion channels"[29] Safer than quinine. Safe antimalarial in pregnancy.[13] "Low toxicity and cost" "high effectiveness".[30] Proguanil
Chlorproguanil-Dapsone Treatment "uncomplicated falciparum malaria"[31] "cheap, rapidly eliminated, more potent than pyrimethamine-sulfadoxine, and could be introduced in the near future to delay the onset of antifolate resistance and as "salvage therapy" for pyrimethamine-sulfadoxine failure."[31]
Clindamycin Treatment[32] Plasmodium falciparum[32] oral, topical, intravenous, intravaginal[33][34] 1960s[32] "Considered safe for use in pregnant women and very young children."[35] "Clindamycin’s disadvantages are its high cost, the common occurrence of rash and the predisposition of patients taking clindamycin to Clostridium difficile-associated colitis. Based on cohort studies, the risk of severe diarrhea in out-patients is as low as one per 1000, but the risk of in-patients acquiring C difficile colonization may be as high as 30%."[36] Used in conjunction with quinine, doxycycline, tetracycline, clindamycin, atovaquone and proguanil[33]
Dihydroartemisinin-Piperaquine (Artekin) Oral (pills)[37] "Excellent antimalarial efficacy in available trials and appears to offer advantages over artemether-lumefantrine, including simpler dosing and the longer half-life of piperaquine, compared with that of lumefantrine."[18]
Doxycycline Treatment
Halofantrine Treatment "Introduced in the 1980s"[26] "A major advantage of halofantrine is it's rapid onset of action."[38] "Due to its short half life of 1 to 2 days, is not suitable for use as a prophylactic."[26] "Resistant forms are increasingly being reported and there is some concern about its side effects. Halofantrin has been associated with neuropsychiatric disturbances. It is contraindicated during pregnancy and is not advised to women who are breastfeeding. Abdominal pain, diarrhea, puritus and skin rash have also been reported."[26]
Intermittent preventive therapy
Lumefantrine (benflumetol) Treatment[16] "Multidrug resistant Plasmodium falciparum".[16] "Oral preparation coformulated with artemether."[16]
Mefloquine Both Plasmodium falciparum, Plasmodium vivax 1977[3] 1982[3] "The once-weekly dosing is quite attractive to some people" " Mefloquine is relatively inexpensive"[39] "There can be severe neurological and psychiatric side effects, especially for people with any history of mental illness" "A major drawback is intolerability" "The issues are as minor as unpleasant dreams to issues as major as severe neuropsychiatric adverse events in the range of 1 in 10,000 healthy people."[39]
Piperaquine Plasmodium vivax, Plasmodium falciparum[40] 1963[41]
Primaquine Treatment "Plasmodium vivax and plasmodium ovale."[16] "Gametocytocidal against plasmodium falciparum".[16] "The only antimalatial drug that is effective against exo-erythrocytic schizogony and is used for radical cure of Plasmodium vivax malaria."[13] "Hemolysis in patients with Glucose-6-phosphate dehydrogenase deficiency."[13]
Proguanil Both Plasmodium falciparum chloroquine, atovaquone
Quinine Treatment "asexual erythrocytic forms of malaria, including Plasmodium vivax, Plasmodium malariae and Plasmodium falciparum and is gametosidal to Plasmodium vivax and Plasmodium malariae."[42] <1700[43] 1910[3]
RTS,S Prevention Plasmodium falciparum
Tafenoquine "Tafenoquine and mefloquine exhibit similar prophylactic efficacy against Plasmodium falciparum and Plasmodium vivax in field studies"[44]
Trimethoprim-sulfamethoxazole Treatment[45]
Sulfadoxine/pyrimethamine (Fansidar) Treatment 1967[3] 1967 (same year it was introduced)[3] "cheap, practicable (only one dose is needed because it eliminates from the body slowly)"[3]

Non-drug Methods

Method Type Acts against First use Locations where used Advantages Disadvantages Status
Chicken scent Prevention Mosquito
Sulfonamide compounds
Environmental management ("encompasses draining and filling of breeding habitats, clearance of vegetation, and eliminating pools of stagnant water.")[46] Prevention Mosquito "
  • Prevent mosquito maturation by eliminating breeding sites
  • Community-wide protective effect
  • Useful in peri-urban and urban areas where transmission is focal77
  • Useful in economic development sites where nonimmune populations may be concentrated
  • Sustainable reductions in transmission, morbidity, and mortality observed when integrated with other interventions


  • Difficult to implement and maintain because of operational complexity (e.g., periodic maintenance, labor intensive)
  • Programs require technical capacity for implementation and vector surveillance
  • High initial costs
  • Intersectoral action is required
  • Impact difficult to quantify when integrated wth other interventions
  • Some undesirable environmental impact if activities target wetlands


Exchange transfusion (ET) Treatment[47] Severe malaria[47]
Swamp draining Prevention Mosquito
Indoor residual spraying Prevention Mosquito "Large-scale IRS with DDT for malaria control started in 1946."[48] "A single spraying can protect a home for up to 9 months."[49] "Spraying requires no behavourial change – after spraying teams have treated a dwelling, the occupiers can continue as before."[49] "
  • Mosquitoes killed and repelled
  • Community-wide protective effect
  • Once sprayed, *no additional commitment from community
  • Residual activity: 3–12 months, depending on the insecticide
  • Proven effectiveness in a variety of epidemiological settings
  • No documented serious adverse effects on human health and the environment.

"[46] "


  • Insecticide resistance monitoring and management
  • Ineffective against exophilic malaria vectors
  • Difficult to implement and maintain because of operational complexity (e.g., transportation into remote communities are difficult, labor intensive) and resource requirements
  • Programs require technical capacity for implementation and vector surveillance
  • Acceptability among community members
  • Required removal of all belongings, except large pieces of furniture, from the home
  • Health and safety of sprayers and communities[46]

" "homes must be regularly resprayed for the treatment to remain effective over longer periods."[49]

Insecticide–treated nets Prevention Mosquito "
  • Mosquitoes killed and repelled
  • Community-wide protective effect, if coverage rate is high, extended to neighboring communities15
  • Rebound effect not observed75
  • Individual and community decisions to use
  • Effectively treated nets with sizeable holes remain effective76
  • Proven effectiveness in a variety of epidemiological settings
  • No documented serious adverse effects on human health and the environment


  • Ineffective against exophagic malaria Vectors
  • Decreased susceptibility and increasing resistance to pyrethroids, but nets may still be a practical means of personal protection65
  • Periodic net retreatment is required (as long-lasting nets become available, retreatment will cease to be a problem)
  • Distribution and sustainability problems, particularly in impoverished areas when nets are not distributed free of charge
  • Low coverage rates, particularly in high-risk groups such as children and pregnant women, when nets are not distributed free of charge
  • Difficult to promote in areas of unstable transmission
  • Individual attitudes and practices (e.g., ineffective for persons sleeping outside)"[49]

Mosquitoes are becoming highly resistant to insecticides on nets. "Insecticides are designed to kill mosquitoes immediately on contact, so when more than 10% of them are still alive in the day following exposure we know they are getting resistant to insecticides."[50]

Larviciding (application of insecticides to mosquito breeding sites)
Genetic blood disorders
Selective eradication of certain mosquito species
Use of decoys[51]
Personal protection (like long-sleeved clothing?)
Other forms of larval control?
Pyrethroid nets Prevention It has promoted resistance among malaria vectors in specific geographic areas.[52]
Mosquito coil Prevention Mosquito
Mosquito mat Prevention Mosquito
Mosquito net Prevention Mosquito 484–?425 BC[53]
Immunity from repeated infection Prevention Malaria (just P. falciparum?)


All insecticides act against mosquitoes and are used for prevention. (?)

Surface := Bednet | Wall | Swamp

Also consider the length the insecticide lasts (in different contexts)? For IRS, DCP2 p423 gives 6+ months for DDT, 3–6 months for lambda-cyhalothrin, and 2–3 months for malathion and deltamethrin.

Name Surface First use First resistance Locations where used Advantages Disadvantages Duration of effective action (months) Usage status
Alpha-cypermethrin 4–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Bifenthrin circa 1984[55] "There is a low risk of groundwater contamination based on its chemical properties and it is not persistent in soil."[55] "There are some concerns about bioaccumulation and the pesticide shows a high oral toxicity to mammals as well as being an endocrine distupter and a neurotoxicant. It is toxic to birds, most aquatic organisms, honeybees and earthworms."[55] 3–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Cyfluthrin Field corn, Sweetcorn, Popcorn, Silage corn, Citrus, Public health situations[56] 1983[57] 3–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Deltamethrin 1974, first described[58] "It has a low aqueous solubility, is semi-volatile and has a low potential to leach to groundwater. It is not persistent in soil and is non-mobile."[58] "Highly toxic to humans and other mammals and is a neurotoxin. It is relatively non-toxic to birds and earthworms although it presents a high risk to most aquatic organisms and honeybees."[58] 3–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Dichlorodiphenyltrichloroethane (DDT) 1943[59]:7 1946[59]:9 Cheap, chemically stable, lipophilic (so not easily washed off)[59]:7 Persists in environment, accumulates along food chain[59]:7
Dihydrolipoamide dehydrogenase (DLD)
Etofenprox Fruit, Vegetables, Paddy fields[60] 1987[60] 3–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Bendiocarb 2–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
BHC (Lindane?)
Fenitrothion 3–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Lambda-cyhalothrin 3–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Malathion 2–3[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Paris green
Pirimiphosmethyl 2–3[54] "Recommended by the World Health Organization for indoor residual spraying."[54]
Propoxur 3–6[54] "Recommended by the World Health Organization for indoor residual spraying."[54]

Carbamate insecticides

See also

Funding information for this timeline is available.

What the table is missing


External links


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