Preface

Malaria, even though preventable and curable, continues to inflict insurmountable morbidi‐ ty particularly in resource-poor countries affecting equitable socio-economic development. Over the past few decades, a lot of new information has been generated on disease distribu‐ tion and determinants in understanding parasite biology and vector bionomics aided by molecular tools [1,2], but what ails mankind is the proper utilization of study results and equity in healthcare services in place and time, as well as lack of unified intercountry strat‐ egies to contain the disease spread. *Plasmodium* parasites and their vectors are continuously evolving in the changing disease epidemiology landscape challenging the human endeav‐ ours to conquer malaria. Human population with the expanding growth of "after popula‐ tion" movements are also increasingly functioning as 'vectors' of the disease. Human malaria parasites are getting multi-resistant to available armamentarium and so do mosqui‐ to vector species to insecticides establishing outdoor transmission hard to control, evading exposure. However, at the turn of century, the advent of new intervention tools including Noble prize–winning discovery of artemisinin by Tu Youyou for treatment of malaria, com‐ bined with large-scale implementation of insecticide-treated netting materials for vector containment, has once again renewed the optimism of malaria elimination globally. With large-scale funding from international agencies/philanthropists for 'universal coverage' of these intervention tools, malaria map is shrinking with more than 35 countries certified to be malaria-free and another 21 countries that are likely to reach zero indigenous transmission (categorized by WHO as E-2020) set to be declared malaria-free by 2020 [3,4]. Many more countries are moving forward from control to elimination, and given the continuing declin‐ ing trends of malaria transmission, WHO has given a clarion call for 'Malaria-Free World by 2030' [5].

Nevertheless, the path to malaria elimination seems to be an uphill task given the con‐ straints and myriad of challenges. After a decade of decrease of malaria cases and deaths in all regions of the world due to roll-out of core interventions, including wide-scale use of long-lasting insecticidal nets and improved treatments, WHO expressed the concern that malaria control is stalling and could reverse the gains due to insufficient funding and defi‐ ciency of political will [3]. However, a number of bodies and alliances have come forward, viz., Malaria Eradication Scientific Alliance (MESA), Malaria Eradication Research Agenda (malERA), Multilateral Initiative on Malaria (MIM), Asia Pacific Leaders Malaria Alliance (APLMA), Asia-Pacific Malaria Elimination Network (APMEN) and Regional Malaria Elimi‐ nation Initiative (RMEI), involved at different scales, for shared experiences and to promote coordinated actions for decisive attack to 'kill malaria'. In addition, after decades of the use of routine vector control tools based on insecticides, scientists are now deploying new inno‐ vative approaches that are environment-friendly to be used in integrated control manage‐ ment that would include chemotherapy, vector control, manipulation of environmental and ecological characteristics, and vaccination. This book is one little step forward to bring to‐ gether experiences of 67 malaria experts from 5 continents to present updated information

on disease epidemiology and control at the national/regional level, highlighting the con‐ straints, challenges, accomplishments and prospects in achieving the cherished goal of elim‐ ination. It is a compilation of 17 chapters, and what evolved from these contributions is that among array of issues specific to the region, most share common denominators such as (i) emerging multidrug-resistant malaria and pandemic risk, (ii) cross-border malaria, (iii) asymptomatic sea of parasite reservoir, (iv) surfacing of *Plasmodium vivax* in the disappear‐ ing phase, (v) insecticide resistance in *Anopheles* vectors and outdoor malaria transmission and (vi) emergence of the fifth human malaria parasite, *P. knowlesi*, making inroads in Southeast Asia; all of which call for sustained research to develop more robust and innova‐ tive tools in addressing these issues, which continue to thwart the elimination efforts.

tivity and professionalism in making this project a reality. We also wish to thank Ms. Ana Pantar, Senior Commissioning Editor, for her help and extended cooperation all throughout the publication process. Finally, we do wish to acknowledge the initiative, sponsorship and concept of the IntechOpen publishers (www.intechopen.com) to share knowledge for open

[1] Anopheles mosquitoes – New insights into malaria vectors. Edited by Sylvie Manguin. Published by InTech Open Access (www.intechopen.com, http://

[2] Malaria – Biology in the Era of Eradication. A subject collection from Cold Spring Harbor Perspectives in Medicine. Edited by Dyann F. Wirth and Pedro L. Alonso.

[3] WHO. World Malaria Report 2017. World Health Organization, Geneva, Switzer‐ land, 2017, 196 pp. Available at http://www.who.int/malaria/world\_malar‐

[4] Newby G, Bennett A, Larson E, Cotter C, Shretta R, Phillips AA, Feachem RG. The path to eradication: a progress report on the malaria-eliminating countries.

[5] WHO. Global Technical Strategy 2016-2030. Global Malaria Programme, World Health Organization, Geneva, Switzerland, 30 pp. Available at http://

[6] Singh KP, Travis P. Universal health coverage in the World Health Organization South-East Asia Region: how can we make it "business unusual"? WHO South-

www.who.int/malaria/areas/global\_technical\_strategy/en/.

East Asia Journal of Public Health, 2018;7: 1-4.

Cold Spring Harbor Laboratory Press, New York, USA, 2017, 312 pp.

dx.doi.org/10.5772/3392). Croatia, 2013, 813 pp.

**Sylvie Manguin, PhD**

University Montpellier Montpellier, France

**Vas Dev, PhD**

Preface XI

New Delhi, India

Institute of Research for Development (IRD), HSM, CNRS

Formerly with the National Institute of Malaria Research (NIMR)

science and open minds for wider public access.

ia\_report\_2017.

Lancet, 2016;387: 1775-1784.

**References**

The disease remains geographically entrenched in low-socioeconomic population groups living in poverty and/or regions under political instability across tropical countries little aware of disease prevention and cure or with no access to medical care due to chaotic eco‐ nomic situation. Southeast Asia is only second to African countries (South of Sahara), which contribute 90% of cases; together, they account for 97% of the malaria global burden. It is the Southeast Region, considered the epicentre of emerging drug-resistant strains, for which we believe that larger share of global investments in this part of the world would yield rich div‐ idend in preventing next pandemic in Africa. Currently, the funding gap is too wide (less than half of what is required) between demand and supply in strengthening healthcare serv‐ ices ensuring equity in access to prevention and treatment achieving 'universal coverage' [6]. Even more important are the information, education and communication activities for keeping informed the stakeholders and the beneficiaries alike for enhanced compliance and concerted action against the age-old scourge. No one should get sick of malaria and die in this age of information dissemination and high technologies, and everyone has the right to access for prevention and treatment. In keeping pace with the malaria elimination efforts, it is the opportune time for national governments and international donors alike for firm and sustained commitment to increased allocation of resources for 'universal health coverage (UHC)' of core interventions ensuring that everyone, everywhere, can access essential quali‐ ty health services without facing financial hardship (Dr. Tedros Adhanom Ghebreyesus, World Health Day 2018). Together, we can beat malaria and create the enabling environ‐ ment to overcome the dogma of '*business as usual'* rather making it '*business unusual'* acceler‐ ating towards malaria elimination [6]. We strongly believe that 'malaria elimination' will be a big leap forward of this millennium in service to the mankind.

It is projected that this document would inspire, motivate and guide the programme offi‐ cials, policy-/decision-makers and stakeholders towards this objective and invigorate frater‐ nity of research scientists and students to address emerging issues and invent newer intervention tools that are community-based and sustainable in making 'malaria history'.

We are deeply indebted to our contributors spread across continents for sharing updated information in understanding the biology of malaria parasite and its vectors, and presenting newer and promising interventions in the context of malaria elimination. We are particular‐ ly grateful to Prof. Pierre Carnevale, who developed in 1983 the innovative concept of insec‐ ticide-treated nets that greatly improved malaria control efforts, for kindly accepting to write the foreword of this book. We do sincerely hope that the next decade would be an exciting and promising one in transforming this knowledge to spearheading technologies to end malaria transmission for good. We are particularly grateful to Ms. Romina Skomersic, the Author Service Manager at InTechOpen, and her team for their unstinted support, crea‐ tivity and professionalism in making this project a reality. We also wish to thank Ms. Ana Pantar, Senior Commissioning Editor, for her help and extended cooperation all throughout the publication process. Finally, we do wish to acknowledge the initiative, sponsorship and concept of the IntechOpen publishers (www.intechopen.com) to share knowledge for open science and open minds for wider public access.

#### **Sylvie Manguin, PhD**

Institute of Research for Development (IRD), HSM, CNRS University Montpellier Montpellier, France

#### **Vas Dev, PhD**

Formerly with the National Institute of Malaria Research (NIMR) New Delhi, India

#### **References**

on disease epidemiology and control at the national/regional level, highlighting the con‐ straints, challenges, accomplishments and prospects in achieving the cherished goal of elim‐ ination. It is a compilation of 17 chapters, and what evolved from these contributions is that among array of issues specific to the region, most share common denominators such as (i) emerging multidrug-resistant malaria and pandemic risk, (ii) cross-border malaria, (iii) asymptomatic sea of parasite reservoir, (iv) surfacing of *Plasmodium vivax* in the disappear‐ ing phase, (v) insecticide resistance in *Anopheles* vectors and outdoor malaria transmission and (vi) emergence of the fifth human malaria parasite, *P. knowlesi*, making inroads in Southeast Asia; all of which call for sustained research to develop more robust and innova‐ tive tools in addressing these issues, which continue to thwart the elimination efforts.

X Preface

The disease remains geographically entrenched in low-socioeconomic population groups living in poverty and/or regions under political instability across tropical countries little aware of disease prevention and cure or with no access to medical care due to chaotic eco‐ nomic situation. Southeast Asia is only second to African countries (South of Sahara), which contribute 90% of cases; together, they account for 97% of the malaria global burden. It is the Southeast Region, considered the epicentre of emerging drug-resistant strains, for which we believe that larger share of global investments in this part of the world would yield rich div‐ idend in preventing next pandemic in Africa. Currently, the funding gap is too wide (less than half of what is required) between demand and supply in strengthening healthcare serv‐ ices ensuring equity in access to prevention and treatment achieving 'universal coverage' [6]. Even more important are the information, education and communication activities for keeping informed the stakeholders and the beneficiaries alike for enhanced compliance and concerted action against the age-old scourge. No one should get sick of malaria and die in this age of information dissemination and high technologies, and everyone has the right to access for prevention and treatment. In keeping pace with the malaria elimination efforts, it is the opportune time for national governments and international donors alike for firm and sustained commitment to increased allocation of resources for 'universal health coverage (UHC)' of core interventions ensuring that everyone, everywhere, can access essential quali‐ ty health services without facing financial hardship (Dr. Tedros Adhanom Ghebreyesus, World Health Day 2018). Together, we can beat malaria and create the enabling environ‐ ment to overcome the dogma of '*business as usual'* rather making it '*business unusual'* acceler‐ ating towards malaria elimination [6]. We strongly believe that 'malaria elimination' will be

It is projected that this document would inspire, motivate and guide the programme offi‐ cials, policy-/decision-makers and stakeholders towards this objective and invigorate frater‐ nity of research scientists and students to address emerging issues and invent newer intervention tools that are community-based and sustainable in making 'malaria history'. We are deeply indebted to our contributors spread across continents for sharing updated information in understanding the biology of malaria parasite and its vectors, and presenting newer and promising interventions in the context of malaria elimination. We are particular‐ ly grateful to Prof. Pierre Carnevale, who developed in 1983 the innovative concept of insec‐ ticide-treated nets that greatly improved malaria control efforts, for kindly accepting to write the foreword of this book. We do sincerely hope that the next decade would be an exciting and promising one in transforming this knowledge to spearheading technologies to end malaria transmission for good. We are particularly grateful to Ms. Romina Skomersic, the Author Service Manager at InTechOpen, and her team for their unstinted support, crea‐

a big leap forward of this millennium in service to the mankind.


**Section 1**

**Introduction**

**Section 1**
