Editing DDT (section)

===Initial effectiveness===
When it was introduced in World War II, DDT was effective in reducing malaria [[morbidity]] and [[mortality rate|mortality]].<ref name=Dunlap/> WHO's anti-malaria campaign, which consisted mostly of spraying DDT and rapid treatment and diagnosis to break the transmission cycle, was initially successful as well. For example, in [[Sri Lanka]], the program reduced cases from about one million per year before spraying to just 18 in 1963<ref>{{cite book|title=The Coming Plague: Newly Emerging Diseases in a World Out of Balance|page=51|last=Garrett|first=Laurie|url=https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|year=1994|publisher=Farrar, Straus and Giroux|isbn=978-1-4299-5327-6|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019223243/https://books.google.com/books?id=v9RY2PVOtOMC&pg=PA51|url-status=live}}</ref><ref>{{cite news | url = https://www.nytimes.com/2010/12/28/health/28global.html | title = Malaria: A Disease Close to Eradication Grows, Aided by Political Tumult in Sri Lanka | first = Donald G. | last = McNeil | name-list-style = vanc | work = The New York Times | date = December 27, 2010 | access-date = February 7, 2017 | archive-date = January 4, 2017 | archive-url = https://web.archive.org/web/20170104050535/http://www.nytimes.com/2010/12/28/health/28global.html | url-status = live }}</ref> and 29 in 1964. Thereafter the program was halted to save money and malaria rebounded to 600,000 cases in 1968 and the first quarter of 1969. The country resumed DDT vector control but the mosquitoes had evolved resistance in the interim, presumably because of continued agricultural use. The program switched to [[malathion]], but despite initial successes, malaria continued its resurgence into the 1980s.<ref name="Gordon">{{cite book|name-list-style=vanc|title=Mosquitoes, Malaria, and Man: A History of the Hostilities Since 1880|isbn=978-0-525-16025-0|first=Gordon A.|last=Harrison|url=https://books.google.com/books?id=mfkBr2oskyEC|year=1978|publisher=Dutton|access-date=August 29, 2022|archive-date=October 19, 2021|archive-url=https://web.archive.org/web/20211019210418/https://books.google.com/books?id=mfkBr2oskyEC|url-status=live}}</ref><ref>{{cite journal | vauthors = Karunaweera ND, Galappaththy GN, Wirth DF | title = On the road to eliminate malaria in Sri Lanka: lessons from history, challenges, gaps in knowledge and research needs | journal = Malaria Journal | volume = 13 | page = 59 | year = 2014 | pmid = 24548783 | pmc = 3943480 | doi = 10.1186/1475-2875-13-59 | doi-access = free }}</ref>

DDT remains on WHO's list of insecticides recommended for IRS. After the appointment of [[Arata Kochi]] as head of its anti-malaria division, WHO's policy shifted from recommending IRS only in areas of seasonal or episodic transmission of malaria, to advocating it in areas of continuous, intense transmission.<ref>
{{cite web | url =https://www.who.int/mediacentre/news/releases/2006/pr50/en/index.html | archive-url =https://web.archive.org/web/20060918220144/http://www.who.int/mediacentre/news/releases/2006/pr50/en/index.html | url-status =dead | archive-date =September 18, 2006 | publisher = World Health Organization | title = Who gives indoor use of DDT a clean bill of health for controlling malaria }}</ref> WHO reaffirmed its commitment to phasing out DDT, aiming "to achieve a 30% cut in the application of DDT world-wide by 2014 and its total phase-out by the early 2020s if not sooner" while simultaneously combating malaria. WHO plans to implement alternatives to DDT to achieve this goal.<ref>{{cite web | url =https://www.who.int/mediacentre/news/releases/2009/malaria_ddt_20090506/en/index.html | archive-url =https://web.archive.org/web/20090506212626/http://www.who.int/mediacentre/news/releases/2009/malaria_ddt_20090506/en/index.html | url-status =dead | archive-date =May 6, 2009 | title = Countries move toward more sustainable ways to roll back malaria | publisher = World Health Organization }}</ref>

South Africa continues to use DDT under WHO guidelines. In 1996, the country switched to alternative insecticides and malaria incidence increased dramatically. Returning to DDT and introducing new drugs brought malaria back under control.<ref>{{cite journal | vauthors = Yamey G | title = Roll Back Malaria: a failing global health campaign | journal = BMJ | volume = 328 | issue = 7448 | pages = 1086–1087 | date = May 2004 | pmid = 15130956 | pmc = 406307 | doi = 10.1136/bmj.328.7448.1086 }}</ref> Malaria cases increased in [[South America]] after countries in that continent stopped using DDT. Research data showed a strong negative relationship between DDT residual house sprayings and malaria. In a research from 1993 to 1995, Ecuador increased its use of DDT and achieved a 61% reduction in malaria rates, while each of the other countries that gradually decreased its DDT use had large increases.<ref name="Roberts 1997"/><ref>{{cite journal | vauthors = Griffing SM, Gamboa D, Udhayakumar V | title = The history of 20th century malaria control in Peru | journal = Malaria Journal | volume = 12 | page = 303 | year = 2013 | pmid = 24001096 | pmc = 3766208 | doi = 10.1186/1475-2875-12-303 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Curtis CF | title = Should the use of DDT be revived for malaria vector control? | journal = Biomédica | volume = 22 | issue = 4 | pages = 455–461 | date = December 2002 | pmid = 12596442 | doi = 10.7705/biomedica.v22i4.1171| doi-access = free }}</ref>