Advances in Diagnosis

**3**

**Chapter 1**

Challenges

**1. Introduction**

severe malaria in travelers [18–20].

Introductory Chapter: Malaria

Elimination - A Challenge with

*Alfonso J. Rodriguez-Morales, Jaime A. Cardona-Ospina,* 

*D. Katterine Bonilla-Aldana, Luis Andrés Salas-Matta,* 

*Juan-Carlos Navarro, Tomas Orduna and José A. Suárez*

*Lucia E. Alvarado-Arnez, Carlos Franco-Paredes,* 

*Wilmer E. Villamil-Gómez, Juan Pablo Escalera-Antezana,* 

Malaria has been a major parasitic disease affecting humankind over centuries, with a disproportionate impact among populations, regions of the world and living conditions [1–5]. Caused by five well-accepted species, *Plasmodium falciparum, P. vivax, P. malariae, P. ovale,* and *P. knowlesi* [6] malaria remains a global public health threat due to multiple reasons [7, 8] including biological, social and climatic factors [3, 9–13] influencing the distribution of *Anopheles* vectors, especially *A. darlingi* in the Americas [14, 15]. There is an ongoing debate regarding the potential role of *Plasmodium cynomolgi* as the sixth etiological species of human malaria [16, 17]. The etiological diagnosis and the epidemiological and clinical management of malaria remains a major challenge in many settings, populations, and during specific clinical scenarios including cases of

**2. Major challenges in malaria elimination: social and economic downturn in Latin America and the role of climate change**

Over decades, especially in the 20th century, malaria has been a major cause of morbidity and mortality at national and regional level in Latin America and the Caribbean (LAC) [21, 22]. The epidemiological transition and improvement of social conditions (i.e. social determinants of disease) have concomitantly reduced malaria-associated morbidity and mortality in many countries [1, 5, 23–25]. Since 2000, drastic reductions in the incidence of malaria occurred in countries with the highest burden of disease (i.e., Brazil) [26–28]. Between 1962 and 1973 other countries in the region such as Grenada, Dominica, Barbados, Chile (a country where never was confirmed the occurrence of autochthonous transmission) [29], Saint Lucia, and Trinidad and Tobago received official certification as malaria-free, after the implementation of specific control measures. More recently, Argentina,

Multiple Emerging Ecosocial

#### **Chapter 1**
