Karen Barnes and colleagues describe and evaluate the new measures against malaria put in place in the KwaZulu-Natal province, where cases had risen fifteen-fold during the 1990s. AL was introduced to the area in 2000 alongside an intensified effort to control mosquitoes with insecticides. Reviewing data from four health care facilities representative of the province, the researchers found that admissions for malaria had declined by 89% in the year following the changes. By 2003 the decline in malaria had been sustained throughout the province: outpatient cases fell by 99% and malaria-related deaths had decreased by 97%.

The authors are keen to stress the vital importance of a health care infrastructure that can deliver prompt diagnosis, as well as perceptions within the community that treatment for malaria should be sought urgently and completed at public-health care facilities. These favourable factors combined with better control of mosquitoes, including the use of DDT for reed and mud homesteads, maximized the benefits of AL treatment in Africa. It makes KwaZulu-Natal an encouraging example of how to combat malaria following its dramatic and deadly increase.

In an accompanying Perspective, Patrick Duffy (of the Seattle Biomedical Research Institute) and Thehonest Mutabingwa (of the National Institute for Medical Research in Tanzania) highlight lessons learned from the "notable success" in KwaZulu-Natal "amid the dire statistics showing a deadly resurgence of malaria."