**8. Discussion**

The very decision to go for malaria elimination with the existing tools and intervention strategies was very challenging. Many initiatives have been undertaken. The President's Malaria Initiative (PMI) in 2005 to Malaria Elimination Research Alliance—India (MERA—India) in 2019 are all to accelerate the process of malaria elimination in all the high burden areas especially in Africa, Mekong Delta region and India, respectively [1]. A special initiative by the WHO in 2016, 21 endemic countries was identified for malaria elimination by 2020 i.e. E-2020 initiative [1]. In this direction zero malaria cases were reported from China and El Salvador in 2017. In 2018, Paraguay was certified as malaria free by the WHO. In 2019, Algeria achieved this goal. Three countries—the Islamic Republic of Iran, Malaysia and Timor-Leste—achieved zero malaria cases in 2018. In 2016, Sri Lanka achieved zero malaria certification, but in 2018 local transmission was reported from a case imported from India. But the local authorities immediately took action. Such quick public health response is required to maintain no transmission threat [45].

Vector control operations mainly rely on insecticide sprays. In most situations the spray operations are carried out by the local contract workers not properly trained; the spray equipments also not maintained properly; pressure not maintained while spraying; patchy and low coverage spraying; late supply of materials that force to defer the spray schedule; lack of supervision, low quality materials, improper storing warehouse, etc. All these confounding factors are responsible for continuation of transmission. Vector behavior also changes for prolonged insecticidal mode of operations [24].

Assessment of two important parameters—human blood index (HBI) and entomological inoculation rate (EIR) of important local vectors enable workers to develop an effective vector management. The global map of HBI of important malaria vectors revealed the highest index exists in African countries [26]. This indicates low ratio between human and animal populations forcing the vector mosquitoes feeding on human host. Emphasis on encouraging the local community to

grow animals should be given priority which will change the transmission potential if the local vectors are primarily zoophagic [1].

Bioenvironmental control of vector populations is a part of the integrated vector management (IVM) concept. In this process control of other vectors of related diseases can also be achieved. *Swachh Bharat Abhiyan/Mission* (Clean India Movement) can be linked in such activity to gain better results. Larval Source Management using larvivorous fish is one of the intervention tools under IVM. This strategy is very effective when implemented at grass root levels with proper supervision and monitoring. Little or no serious emphasis has been given to this strategy. In many situations, it is overlooked and demeaned compared to other methods, mostly insecticides are available in hand. In fact, it works as a `social vaccine'. Globally, around 300 fish species have been identified as larvivorous nature. Two Poeciliid fish *Poecilia reticulata* and *Gambusia affinis* are widely used. The former is best for wells and other confined water bodies, while the later one is best for ponds and lakes [1]. There are many reports on adverse effects of the non-native fish on the local fish, but recent meta-analysis does not support this theory [46].

A new anti-larval product Aquatain AMF™ is available for anti-larval operation. It is a silicon-bases liquid (polydimethylsilicone—PDMS) formulation that forms a very thin film on standing water surface causing physical cover over its entire extension. The mosquito larvae are killed due to physical and mechanical action. There does not seem to develop insect resistance to this technique [47].

Community engagement through health education and empowering local policymakers help in taking appropriate decisions in vector control. Engaging some local school children as volunteers will laterally support such program [48]. In India, every year June is observed as anti-malaria month. Several activities highlighting the program on malaria are displayed. Local administration also actively takes part and makes some decisive actions.

Two vaccine candidates RTS, S/AS01 (TRADE NAME Mosquirix) and PfSPZ are under trial even though their protection level is moderately low. The former is undergoing phase 3 trial in children in three African countries. Possibly this will help reducing child mortality which is a major concern in most of African countries [1].

India contributes most of *P. vivax* malaria cases outside the high burden districts where *P. falciparum* is most dominant. Recent studies also indicate the presence of *P. ovale curtisi* and *P. ovale wallikeri*. *P. malariae* is also co-existent in the high burden tribal districts. All these are possible due to application of molecular diagnostic techniques [49]. Expert recommended genome mining studies which will unravel some underlying issues of malaria epidemiology [13]. Moreover, molecular DNA bar coding of parasites will also help in identifying their actual geographic origin [50]. This will surely assist in managing the drug resistance problem.

The recent identification of *P. knowlesi* as a human malaria with a zoonotic source prevalent in Malaysia and Southeast Asian countries may be very important [51]. Another disturbing factor is recent discovery of *P. falciparum* infection in two common Indian non-human primates *Macaca mulatta* and *M. radiata* [52]. This matter should be taken seriously when malaria elimination is underway. A distinct barrier between human and animal is essential to the ongoing elimination efforts.

#### **9. Conclusion**

There is a great movement and opportunity for malaria elimination globally. Many countries have already achieved this goal. The most success part of this movement is reporting zero malaria cases in China in 2017 and 2018, and preparing for malaria elimination certification in 2020. China made elaborate arrangements

**47**

*New Ways to Tackle Malaria*

*DOI: http://dx.doi.org/10.5772/intechopen.89467*

should be implemented in other areas also [1].

The authors declare no conflict of interest.

\* and Chaitali Ghosh2

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 ICMR-National Institute of Malaria Research, Bengaluru, India

2 Tata Institute for Genetics and Society, Bengaluru, India

\*Address all correspondence to: ghoshnimr@gmail.com

provided the original work is properly cited.

other vector borne diseases [53].

**Acknowledgements**

**Conflict of interest**

**Author details**

Susanta Kumar Ghosh1

time to time.

with full financial, administrative and operational commitment. This indicates that malaria elimination is possible with the existing tools and strategies. In the present situation dependence of insecticide should be minimized and promote other alternate strategies to avert the issue of insecticide resistance. India is making all efforts for a successful mission. Reduction of malaria cases and related deaths in 2017 is an indication. This was mainly the efforts made in eight most high burden districts in Odisha with the implementation of a program called *Durgama Anchalare Malaria Nirakaran* (DAMaN malaria elimination in inaccessible areas). Such initiatives

In the elimination phase, there is a need to strengthen the existing public health

The authors acknowledge the support from Indian Council of Medical Research, New Delhi; the Directors of ICMR-National Institute of Malaria Research, staff of ICMR- National Institute of Malaria Research, Bengaluru Field Unit. Also acknowledge the people in the community who helped and encouraged our studies from

system. The local health system should be quick and responsive to any malariarelated fevers. Routine in-house training, workshops should be conducted to maintain the malaria elimination momentum. A recent 5 days WHO workshop for South-East Asia Region (SEAR) recommended the global vector control response (GVCR). Entomologists from 11 countries participated in this workshop. Detailed reviews were exercised to find out the ongoing program implementation in each country. Such state-level workshops would help in malaria elimination and also

#### *New Ways to Tackle Malaria DOI: http://dx.doi.org/10.5772/intechopen.89467*

*Vector-Borne Diseases - Recent Developments in Epidemiology and Control*

local fish, but recent meta-analysis does not support this theory [46].

does not seem to develop insect resistance to this technique [47].

[50]. This will surely assist in managing the drug resistance problem.

The recent identification of *P. knowlesi* as a human malaria with a zoonotic source prevalent in Malaysia and Southeast Asian countries may be very important [51]. Another disturbing factor is recent discovery of *P. falciparum* infection in two common Indian non-human primates *Macaca mulatta* and *M. radiata* [52]. This matter should be taken seriously when malaria elimination is underway. A distinct barrier between human and animal is essential to the ongoing elimination efforts.

There is a great movement and opportunity for malaria elimination globally. Many countries have already achieved this goal. The most success part of this movement is reporting zero malaria cases in China in 2017 and 2018, and preparing for malaria elimination certification in 2020. China made elaborate arrangements

takes part and makes some decisive actions.

if the local vectors are primarily zoophagic [1].

grow animals should be given priority which will change the transmission potential

Bioenvironmental control of vector populations is a part of the integrated vector management (IVM) concept. In this process control of other vectors of related diseases can also be achieved. *Swachh Bharat Abhiyan/Mission* (Clean India Movement) can be linked in such activity to gain better results. Larval Source Management using larvivorous fish is one of the intervention tools under IVM. This strategy is very effective when implemented at grass root levels with proper supervision and monitoring. Little or no serious emphasis has been given to this strategy. In many situations, it is overlooked and demeaned compared to other methods, mostly insecticides are available in hand. In fact, it works as a `social vaccine'. Globally, around 300 fish species have been identified as larvivorous nature. Two Poeciliid fish *Poecilia reticulata* and *Gambusia affinis* are widely used. The former is best for wells and other confined water bodies, while the later one is best for ponds and lakes [1]. There are many reports on adverse effects of the non-native fish on the

A new anti-larval product Aquatain AMF™ is available for anti-larval operation. It is a silicon-bases liquid (polydimethylsilicone—PDMS) formulation that forms a very thin film on standing water surface causing physical cover over its entire extension. The mosquito larvae are killed due to physical and mechanical action. There

Community engagement through health education and empowering local policymakers help in taking appropriate decisions in vector control. Engaging some local school children as volunteers will laterally support such program [48]. In India, every year June is observed as anti-malaria month. Several activities highlighting the program on malaria are displayed. Local administration also actively

Two vaccine candidates RTS, S/AS01 (TRADE NAME Mosquirix) and PfSPZ are under trial even though their protection level is moderately low. The former is undergoing phase 3 trial in children in three African countries. Possibly this will help reducing child mortality which is a major concern in most of African countries [1]. India contributes most of *P. vivax* malaria cases outside the high burden districts where *P. falciparum* is most dominant. Recent studies also indicate the presence of *P. ovale curtisi* and *P. ovale wallikeri*. *P. malariae* is also co-existent in the high burden tribal districts. All these are possible due to application of molecular diagnostic techniques [49]. Expert recommended genome mining studies which will unravel some underlying issues of malaria epidemiology [13]. Moreover, molecular DNA bar coding of parasites will also help in identifying their actual geographic origin

**46**

**9. Conclusion**

with full financial, administrative and operational commitment. This indicates that malaria elimination is possible with the existing tools and strategies. In the present situation dependence of insecticide should be minimized and promote other alternate strategies to avert the issue of insecticide resistance. India is making all efforts for a successful mission. Reduction of malaria cases and related deaths in 2017 is an indication. This was mainly the efforts made in eight most high burden districts in Odisha with the implementation of a program called *Durgama Anchalare Malaria Nirakaran* (DAMaN malaria elimination in inaccessible areas). Such initiatives should be implemented in other areas also [1].

In the elimination phase, there is a need to strengthen the existing public health system. The local health system should be quick and responsive to any malariarelated fevers. Routine in-house training, workshops should be conducted to maintain the malaria elimination momentum. A recent 5 days WHO workshop for South-East Asia Region (SEAR) recommended the global vector control response (GVCR). Entomologists from 11 countries participated in this workshop. Detailed reviews were exercised to find out the ongoing program implementation in each country. Such state-level workshops would help in malaria elimination and also other vector borne diseases [53].
