3.3 billion people, almost half the world’s population, live in areas at risk of malariatransmission. Though it is endemic in 109 countries and territories, 89% of worldwide malaria deaths occur in sub-Saharan Africa. Indeed, malaria is the ﬁfthmost prevalent cause of death in low-income countries in this region, accounting for5.2% of all mortality.The gravity and severity of the clinical condition is almost universally known. As isthe stiﬂing and repressive inﬂuence a high prevalence of malaria tends to exert onthe populations of endemic areas.During the 1950s the idea that malaria could be eliminated as a result of humanintervention started to become popular. In the words of G. Macdonald, ‘naturalhappenings can be simulated be deliberate effort’
.In Italy, malaria was controlled and ultimately eliminated from the area aroundRome by draining the Pontine marshes. In 1947, the United States’ National MalariaEradication Program, which comprised government and local health agencies fromthirteen southeastern states, began a campaign to eliminate malaria
. By the end of 1949, over 4,650,000 indoor residual sprayings had been made and the malariaincidence dropped from 15,000 cases in 1947 to 2,000 three years later. By 1951,malaria was deemed to have been eliminated from the United States and thecondition became widely regarded as something which could be overcome.
In 1955 the World Health Organisation announced an ambitious proposal for theeradication of malaria worldwide. The project proved unfeasibly ambitious andthough the program had many successes, the ultimate goal was not achieved.
However, in 2007 the Bill and Melinda Gates Foundation announced a plan
whichwas once, and in some quarters still is, regarded as an impossible dream: theeradication of malaria from the face of the earth.The task laid out before them, and before us, is vast and daunting. But it is achallenge which demands a response. The question this dissertation will address is:to what extent is malaria elimination an achievable goal in the southern-Africannation of Swaziland?
Elimination, Eradication and Extinction: Deﬁnitions
For any discussion to be meaningful, the parameters must be clear. The World HealthOrganisation deﬁnes malaria eradication as complete interruption of local mosquito- borne malaria transmission in a deﬁned geographical area.