Mass administrations of antimalarial drugs.

Administration of antimalarial drugs to whole populations has been used as a malaria-control measure for more than 70 years. Drugs have been administered either directly as a full therapeutic course of treatment or indirectly through the fortification of salt. Mass drug administrations (MDAs) were generally unsuccessful in interrupting transmission but, in some cases, had a marked effect on parasite prevalence and on the incidence of clinical malaria. MDAs are likely to encourage the spread of drug-resistant parasites and so have only a limited role in malaria control. They could have a part to play in the management of epidemics and in the control of malaria in areas with a short transmission season. To reduce the risk of spreading drug resistance, MDAs should use more than one drug and, preferably include a drug, such as an artemisinin, which has a gametocidal effect.