It all began with Ronald Ross: 100 years of malaria research and control in Sierra Leone (1899-1999)

It was in Sierra Leone, 100 years ago in 1899, that human malarial parasite s were first observed in wild-caught Anopheles gambiae and An. funestus, th e principal vectors of malaria in Africa. In the same year, Ronald Ross ini tiated the first antilarval measures for malaria control. This paper review s 100 years of malaria field research and control in Sierra Leone, which be came known as the 'White Man's Grave' in the 19th century largely because o f the high malaria-related mortality amongst Europeans living there. The es tablishment of a field laboratory for the Liverpool School of Tropical Medi cine in Freetown in 1920 made Sierra Leone the centre for malaria field res earch in Africa up to and during the Second World War. Eminent malariologis ts including Ronald Ross, Samuel Christophers, George Macdonald, Leonard Br uce-Chwatt, Brian Maegraith, Ian Macgregor, Brian Greenwood and Michael Ser vice visited Sierra Leone for malaria-related activities. This review highl ights the tremendous efforts made towards defining the epidemiological pict ure of the disease and the most effective means of combatting it. Malaria c ontrol in Sierra Leone, as in many other parts of the world, used to be bas ed largely on mosquito eradication. However, experience gained over the pas t 100 years has shown that mosquito control is often not cost-effective in areas where the interruption of transmission cannot be sustained. Emphasis should now be on early diagnosis, treatment with effective antimalarials, a nd the selective use of preventive measures including vector control and in secticide-treated materials where they can be sustained.