Abstract
Malaria Elimination – The Way Forward
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Malaria is one of the oldest protozoan parasitic
infections to human. Several methods and strategies have been applied to
contain this disease from time to time. In the early part of 20th
century, control measures were focused on vector sanitation, environment
management and general improvement of living conditions. All these measures
were aimed at larval source management (LSM). Everything changed soon after the
application of DDT and many countries achieved malaria eradication. Following
this, there was a resurgence of malaria in 1976 especially in the Southeast
Asia region. The main reasons were resistance of drugs to parasites and
insecticides to vector mosquitoes. Several measures are initiated aiming to
eliminate malaria by 2030. Roll Back Malaria by WHO, President Malaria Initiative
by the USA, Malaria Elimination Research Alliance in India and many others made
significant impacts on malaria burden. The main intervention strategy was
universal coverage of long-lasting insecticide treated nets (LLINs) with
different classes of synthetic pyrethroids (SPs). This made huge impact on
malaria burden especially in Africa which is responsible for 90% of total
malaria worldwide. In the last four years, reduced susceptibility of SPs halted
the progress of the malaria elimination goal. However, adding piperonyl
butoxide (PBO) to LLINs enhanced the susceptibility of SPs. But adding PBO
doubled the cost that is limiting the universal coverage of LLINs. Recent
reports on long and high distance night migration of mosquitoes and finding of Plasmodium
falciparum parasites to new areas make the malaria elimination process more
difficult. Invasion of Anophelesstephensi in some African countries and
in Sri Lanka in the post-elimination period is one such example shrub cuttings
around houses, mosquito killing fungus, ivermectin as insecticide and vaccines
inhibiting transmission are some new strategies that may be useful in malaria
elimination process. Two innovations GIS-tagged tablet-based digital
surveillance and improved micro PCR-based point-of-care diagnosis would dent on
malaria transmission. Repurposing of larvivorous fish under bioenvironmental
control strategy and community engagement are easing out malaria elimination
process in India. This may be applied globally and regions thriving for malaria
elimination.
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