Since the 1970s, when the world seemed on the threshold of malaria eradication, the incidence of the disease has increased in several countries. The upturn in cases raised a series of questions, and for some time malariologists and public health authorities scarcely understood what was happening. In an attempt to better comprehend the process, this article reviews the frequency of malaria cases in São Paulo, Brazil, between 1930 and 1990, examining
ABSTRACTThe purpose of the research reported here was two-fold: first, to examine why the incidence of malaria increased in various regions of the world in the 1980s, precisely at a time when hopes for eradicating this disease were highest; and second, to seek an explanation by applying a theoretical model capable of articulating epidemiologic knowledge, social needs, and the practices adopted to satisfy those needs.Initially, reasons suggested to explain the increased incidence focused on problems directly related to the way eradication campaigns were conducted. Failure of the campaign-based strategy was attributed to a wide range of things, including difficulties of a technical, operational, administrative, financial, and political nature. However, more detailed analysis linking various factors (the presence of the disease, its social repercussions, current epidemiologic concepts, and the control measures adopted) within a single theoretical framework pointed up new issues requiring different explanations.The central purpose of our research has been to assess, through various historical periods, how malaria became a health problem of a social nature that evoked certain institutional control practices, and to determine how much the epidemiologic knowledge available in each period has served to guide the planning of interventions.The selection of São Paulo as the state for this study was based on practical considerations, such as ease of access to information, as well as theoretical considerations, such as the fact that the organizations engaged in malaria control activities in São Paulo are the oldest currently in operation in Brazil and that the eradication campaign has not been beset by economic, administrative, operational, or political difficulties.
MATERIALS AND METHODSThe research, based on document analysis, took the following method-1 This article was published in Spanish in this jour-