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Current malaria-control strategies emphasise domestic protection against adult mosquitoes
with insecticides, and improved access to medical services. Malaria prevention by
killing adult mosquitoes is generally favoured because moderately reducing their longevity
can radically suppress community-level transmission. By comparison, controlling larvae
has a less dramatic effect at any given level of coverage and is often more difficult
to implement. Nevertheless, the historically most effective campaign against African
vectors is the eradication of accidentally introduced Anopheles gambiae from 54000
km(2) of largely ideal habitat in northeast Brazil in the 1930s and early 1940s. This
outstanding success was achieved through an integrated programme but relied overwhelmingly
upon larval control. This experience was soon repeated in Egypt and another larval
control programme successfully suppressed malaria for over 20 years around a Zambian
copper mine. These affordable approaches were neglected after the advent of dichlorodiphenyl
trichloroethane (DDT) and global malaria-control policy shifted toward domestic adulticide
methods. Larval-control methods should now be re-prioritised for research, development,
and implementation as an additional way to roll back malaria.