French Guiana is the only French department (along with the territorial community of Mayotte) where malaria is endemic. More than 97% of infections occur in the area of year-round transmission, located along the rivers bordering Suriname and Brazil, as well as in municipalities in the interior of the department. The annual incidence there ranges from 80 to 300 cases per 1,000 inhabitants, depending on the year and the municipalities concerned. In the coastal zone, malaria transmission remains sporadic. The objective of this report is to assess the current malaria surveillance system in French Guiana and to make recommendations for improving it. It is based on the findings of an evaluation mission conducted in November 2003 by the Cire Antilles-Guyane and the International and Tropical Department of the InVS, as well as on a series of consultations held throughout 2004 with the various stakeholders in the surveillance system. These consultations enabled the joint development of proposals and recommendations. Only the existing malaria surveillance system in coastal areas is truly geared toward alert and response. In areas of year-round transmission, the complexity of the validation processes for parasitological tests and the significant delays in transmitting and processing information mean that surveillance data are rarely used to guide malaria control efforts. The case definitions used are very specific but not very sensitive. The high incidence of indigenous malaria makes it impossible to enforce the mandatory reporting regulations in French Guiana. Finally, the results of drug resistance surveillance, based solely on in vitro tests conducted on samples whose representativeness is not guaranteed, are difficult to extrapolate. The report’s main recommendations include revising case definitions, simplifying information transmission channels and centralizing data processing, integrating malaria surveillance into a sustainable surveillance system for priority infectious diseases in French Guiana, and finally, improving monitoring of resistance to antimalarial treatments. (R.A)