Introductory Chapter: Malaria Elimination - A Challenge with Multiple Emerging Ecosocial Challenges

*Alfonso J. Rodriguez-Morales, Jaime A. Cardona-Ospina, D. Katterine Bonilla-Aldana, Luis Andrés Salas-Matta, Wilmer E. Villamil-Gómez, Juan Pablo Escalera-Antezana, Lucia E. Alvarado-Arnez, Carlos Franco-Paredes, Juan-Carlos Navarro, Tomas Orduna and José A. Suárez*

#### **1. Introduction**

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 severe malaria in travelers [18–20].

#### **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,

Bahamas, Antigua and Barbuda, Paraguay, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Uruguay (another country that never has autochthonous malaria) [30], and lately El Salvador, were added to the list [31]. Experiences in malaria elimination, such as those of El Salvador, have been of significant impact. In other countries of the region, such as Ecuador, malaria had fallen to very low levels between 2000-2009, with transmission increasing again between 2014 and 2020, due to carelessness in the control campaigns in traditional outbreaks, as well as due to the mobilization and immigration from both the northern and southern borders [32, 33]. The starting point was the elimination of foci in each municipality, where active detection was included (searching of malaria cases), considering the DTIR strategy (Detection, Diagnosis, Treatment, Intervention and Response), so that more cases are diagnosed instead of stopping after the index case detection. Specific activities at the local level were monitored and evaluated for an overall impact that led the country to elimination [34].

Unfortunately, factors such as climate change represents a major negative factor that could potentially favor the spread of malaria-to-malaria-free areas [9, 35–40]. Mass deforestation, landscape change, wildfires, and other anthropogenic threats [41] influence the distribution of vector-borne diseases such as malaria [42]. Furthermore, the etiological agents of human malaria have been already detected in non-human primates, especially in Asia [17, 43–50], but also in LAC, particularly in Brazil [51–53] illustrating the risk of humans amplifying the spread of malaria to animal species.

Malaria transmission depends on several weather conditions including rainfall patterns, humidity and temperature (i.e., the ideal environmental characteristics of the malaria transmission are present in the Amazon Basin) and also depends of occurrence of water bodies and associated floating or emerging vegetation, as well as the surrounding forest cover that provides shade on the edges of lagoons. Malaria is associated with climate change [54] because the environmental consequences are linked to specific conditions that would benefit *Anopheles* population, and not only the life and distribution of the vector but the possibility of transmission of malaria too. The influence of climate change is highly relevant as the mosquitoes are ectotherm hosts [55]. To increase the knowledge of what could happen in the future, Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report (AR5) provides an interesting review and evaluation of the science of the climate change and their multiple future scenarios (https:// www.ipcc.ch/report/ar5/syr/). In general, all depends on the real trajectory of the greenhouse gases (GHG) but the development of the global warming is always related with increasing average temperatures and changes in precipitation patterns that has an effect on malaria causal factors [56, 57]. In spite of what acknowledgment we probably want to reach, there are several possible effects as potential scenarios, therefore estimation models are required to approach the most potential situation [58]. To directly associate the increasing of the average temperature with malaria, is known that the distribution of species as *P. falciparum* would expand depending on the increase of the temperatures even in greater latitudes and altitudes [59]. In the case of the changes in precipitation patterns, it is related with the zones where the mosquito breeding proliferates due to water levels decreasing and forming pools after the extreme increase of rivers because of the rain or other reasons like ice melting of the mountains. Nonetheless, species like *Anopheles darlingi* which appears to be directly associated with high levels of precipitation [60], would decrease their population on several scenarios in the future, so the study of climate change and malaria should be specifics owing to the effects of temperature and precipitations could

**5**

Venezuela [75].

*Introductory Chapter: Malaria Elimination - A Challenge with Multiple Emerging Ecosocial…*

be different if we evaluate combined possibilities [61]. Even in Europe, some studies have pointed out that climate change is a significant factor associated with

Two recent initiatives, the World Health Organization (WHO) Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication, have assessed the feasibility of achieving global malaria eradication and proposed strategies to succeed at it. Both reports (WHO and Lancet Commission) rely on a climate-driven model of malaria transmission to conclude that long-term trends in climate will assist eradication efforts overall and, consequently, neither prioritize strategies to manage the effects of climate variability and change on malaria programming [65]. Climate change associated factors and consequences is key for the consideration of ecosocial and integrative vector control strategies, as has been proposed for decades by the WHO. In the case of Latin America, there is still a long road to improve the associated situation, mitigation, and adaption on climate change according to the Intergovernmental Panel on Climate Change (IPCC) [66–73]. Then, climate change, is definitively a "stone in

In addition, multiple social factors are still present in the region with a complex interplay, such as uncontrolled mining, poverty, the recent impact of Coronavirus Disease 2019 (COVID-19), political, economic, and social crisis, in countries from different ideological political positions, such as Brazil, Argentina, Peru, Bolivia, but especially Venezuela. The situation in the latter, once considered as the richest in the region, started to fall into a spiral of social devastation since 1998, impacting especially all the health aspects. Malaria control, in the past highlighted as the best program (1930s–1960s), today raises many concerns. Venezuela is the main focus of malaria in LAC, amid a humanitarian crisis, that also impacted Colombia and Brazil, as neighboring countries, but also to distant nations in South and Central America, even generating imported cases to Argentina or Mexico [3, 8, 11–13, 21, 22, 74]. The humanitarian crisis has led to a reemergence of multiple infectious diseases, but also the persistence and increase of multiple endemic diseases including malaria. In this context the forced migration occurring to multiple countries also constitute a challenge in the control of malaria in endemic and even not-endemic countries in LAC. Imported cases may be associated with local transmission by multiples routes, vector and not-vector-borne (e.g., blood transfusion, transplantation, congenital). Unfortunately, such crisis will not be solved in the near future, therefore it lies to the other countries in the region to prioritize the best strategy in managing imported cases, assuring early diagnosis and treatment to avoid potentially associated consequences, and to enhance surveillance and consider

the importance of specific programs targeting migrant populations.

Regarding the COVID-19 pandemic, this has posed multiples challenges, including coinfections (SARS-CoV-2/*Plasmodium*), in the efforts of malaria elimination. During 2019–2020, malaria cases increased by 26%, in the countries where malaria is targeted for elimination in the Americas. In particular, there was increased malaria transmission in three countries of Mesoamerica: Nicaragua, Honduras, Panama. With a reduced number of laboratory samples and diagnostic tests, reduced mobility of people and disruption of health services, limited field operations due to social restriction gaps in ensuring personal

protective equipment, malaria elimination is facing multiple difficulties. These existing gaps in malaria case detection and treatment may translate into increased chaos by 2021, added to the regional situation above mentioned of

reemergence of malaria in southern areas of the continent [62–64].

the shoe" in the control and elimination of malaria in LAC.

*DOI: http://dx.doi.org/10.5772/intechopen.98579*

#### *Introductory Chapter: Malaria Elimination - A Challenge with Multiple Emerging Ecosocial… DOI: http://dx.doi.org/10.5772/intechopen.98579*

be different if we evaluate combined possibilities [61]. Even in Europe, some studies have pointed out that climate change is a significant factor associated with reemergence of malaria in southern areas of the continent [62–64].

Two recent initiatives, the World Health Organization (WHO) Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication, have assessed the feasibility of achieving global malaria eradication and proposed strategies to succeed at it. Both reports (WHO and Lancet Commission) rely on a climate-driven model of malaria transmission to conclude that long-term trends in climate will assist eradication efforts overall and, consequently, neither prioritize strategies to manage the effects of climate variability and change on malaria programming [65]. Climate change associated factors and consequences is key for the consideration of ecosocial and integrative vector control strategies, as has been proposed for decades by the WHO. In the case of Latin America, there is still a long road to improve the associated situation, mitigation, and adaption on climate change according to the Intergovernmental Panel on Climate Change (IPCC) [66–73]. Then, climate change, is definitively a "stone in the shoe" in the control and elimination of malaria in LAC.

In addition, multiple social factors are still present in the region with a complex interplay, such as uncontrolled mining, poverty, the recent impact of Coronavirus Disease 2019 (COVID-19), political, economic, and social crisis, in countries from different ideological political positions, such as Brazil, Argentina, Peru, Bolivia, but especially Venezuela. The situation in the latter, once considered as the richest in the region, started to fall into a spiral of social devastation since 1998, impacting especially all the health aspects. Malaria control, in the past highlighted as the best program (1930s–1960s), today raises many concerns. Venezuela is the main focus of malaria in LAC, amid a humanitarian crisis, that also impacted Colombia and Brazil, as neighboring countries, but also to distant nations in South and Central America, even generating imported cases to Argentina or Mexico [3, 8, 11–13, 21, 22, 74]. The humanitarian crisis has led to a reemergence of multiple infectious diseases, but also the persistence and increase of multiple endemic diseases including malaria. In this context the forced migration occurring to multiple countries also constitute a challenge in the control of malaria in endemic and even not-endemic countries in LAC. Imported cases may be associated with local transmission by multiples routes, vector and not-vector-borne (e.g., blood transfusion, transplantation, congenital). Unfortunately, such crisis will not be solved in the near future, therefore it lies to the other countries in the region to prioritize the best strategy in managing imported cases, assuring early diagnosis and treatment to avoid potentially associated consequences, and to enhance surveillance and consider the importance of specific programs targeting migrant populations.

Regarding the COVID-19 pandemic, this has posed multiples challenges, including coinfections (SARS-CoV-2/*Plasmodium*), in the efforts of malaria elimination. During 2019–2020, malaria cases increased by 26%, in the countries where malaria is targeted for elimination in the Americas. In particular, there was increased malaria transmission in three countries of Mesoamerica: Nicaragua, Honduras, Panama. With a reduced number of laboratory samples and diagnostic tests, reduced mobility of people and disruption of health services, limited field operations due to social restriction gaps in ensuring personal protective equipment, malaria elimination is facing multiple difficulties. These existing gaps in malaria case detection and treatment may translate into increased chaos by 2021, added to the regional situation above mentioned of Venezuela [75].

*Current Topics and Emerging Issues in Malaria Elimination*

impact that led the country to elimination [34].

animal species.

Bahamas, Antigua and Barbuda, Paraguay, Saint Kitts and Nevis, Saint Vincent and the Grenadines, Uruguay (another country that never has autochthonous malaria) [30], and lately El Salvador, were added to the list [31]. Experiences in malaria elimination, such as those of El Salvador, have been of significant impact. In other countries of the region, such as Ecuador, malaria had fallen to very low levels between 2000-2009, with transmission increasing again between 2014 and 2020, due to carelessness in the control campaigns in traditional outbreaks, as well as due to the mobilization and immigration from both the northern and southern borders [32, 33]. The starting point was the elimination of foci in each municipality, where active detection was included (searching of malaria cases), considering the DTIR strategy (Detection, Diagnosis, Treatment, Intervention and Response), so that more cases are diagnosed instead of stopping after the index case detection. Specific activities at the local level were monitored and evaluated for an overall

Unfortunately, factors such as climate change represents a major negative factor that could potentially favor the spread of malaria-to-malaria-free areas [9, 35–40]. Mass deforestation, landscape change, wildfires, and other anthropogenic threats [41] influence the distribution of vector-borne diseases such as malaria [42]. Furthermore, the etiological agents of human malaria have been already detected in non-human primates, especially in Asia [17, 43–50], but also in LAC, particularly in Brazil [51–53] illustrating the risk of humans amplifying the spread of malaria to

Malaria transmission depends on several weather conditions including rainfall patterns, humidity and temperature (i.e., the ideal environmental characteristics of the malaria transmission are present in the Amazon Basin) and also depends of occurrence of water bodies and associated floating or emerging vegetation, as well as the surrounding forest cover that provides shade on the edges of lagoons. Malaria is associated with climate change [54] because the environmental consequences are linked to specific conditions that would benefit *Anopheles* population, and not only the life and distribution of the vector but the possibility of transmission of malaria too. The influence of climate change is highly relevant as the mosquitoes are ectotherm hosts [55]. To increase the knowledge of what could happen in the future, Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report (AR5) provides an interesting review and evaluation of the science of the climate change and their multiple future scenarios (https:// www.ipcc.ch/report/ar5/syr/). In general, all depends on the real trajectory of the greenhouse gases (GHG) but the development of the global warming is always related with increasing average temperatures and changes in precipitation patterns that has an effect on malaria causal factors [56, 57]. In spite of what acknowledgment we probably want to reach, there are several possible effects as potential scenarios, therefore estimation models are required to approach the most potential situation [58]. To directly associate the increasing of the average temperature with malaria, is known that the distribution of species as *P. falciparum* would expand depending on the increase of the temperatures even in greater latitudes and altitudes [59]. In the case of the changes in precipitation patterns, it is related with the zones where the mosquito breeding proliferates due to water levels decreasing and forming pools after the extreme increase of rivers because of the rain or other reasons like ice melting of the mountains. Nonetheless, species like *Anopheles darlingi* which appears to be directly associated with high levels of precipitation [60], would decrease their population on several scenarios in the future, so the study of climate change and malaria should be specifics owing to the effects of temperature and precipitations could

**4**

## **3. Conclusions**

We face multiple and perennial challenges when controlling tropical infectious diseases, such as malaria [42]. Despite many achievements in malaria control efforts during the last few decades, there are many countries in LAC where malaria transmission remains or revert to being a major public health concern for the region. In other regions of the world, such as Africa and Asia, the recent emergence of zoonotic species of *Plasmodium*, coupled with the impacts of climate change, economic downturn post-COVID-19, and globalization are also causing significant concern. There is an urgent need for local, national, and international health authorities to strengthen surveillance and multisectorial control approaches to advance the noble effort of malaria control and elimination in LAC and other regions.

**7**

*Introductory Chapter: Malaria Elimination - A Challenge with Multiple Emerging Ecosocial…*

, Luis Andrés Salas-Matta<sup>2</sup>

3 Semillero de Investigación en Zoonosis, Grupo BIOECOS, Fundación Universitaria

4 Emerging Infectious Diseases and Tropical Medicine Research Group, Instituto

5 Infectious Diseases and Infection Control Research Group, Hospital Universitario

6 Coordinación Nacional de Investigación, Universidad Privada Franz Tamayo

7 Programa del Doctorado de Medicina Tropical, SUE Caribe, Universidad del

8 Direction of Second Level Hospitals, Secretaría Municipal de Salud, Gobierno

9 Department of Medicine, Division of Infectious Diseases, School of Medicine,

10 Research Group of Emerging Diseases, Ecoepidemiology and Biodiversity, Health Sciences Faculty, Universidad Internacional SEK, Quito, Ecuador

12 Investigador SNI Senacyt Panamá, Instituto Conmemorativo Gorgas de Estudios

© 2021 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,

University of Colorado Denver, Aurora, CO, United States of America

Autónomo Municipal de Cochabamba, Cochabamba, Bolivia

11 Hospital de Infecciosas FJ Muñiz, Buenos Aires, Argentina

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

para la Investigación en Ciencias Biomédicas-Sci-Help, Pereira, Colombia

, Carlos Franco-Paredes9

1 Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia

,

,

, Juan-Carlos Navarro10,

Alfonso J. Rodriguez-Morales1,2,3,4,5,6\*, Jaime A. Cardona-Ospina1,4,

Wilmer E. Villamil-Gómez5,7, Juan Pablo Escalera-Antezana8

*DOI: http://dx.doi.org/10.5772/intechopen.98579*

**Author details**

D. Katterine Bonilla-Aldana3

Tomas Orduna11 and José A. Suárez12

2 Universidad Cientifica del Sur, Lima, Peru

Autónoma de las Américas, Pereira, Colombia

de Sincelejo, Sincelejo, Sucre, Colombia

(UNIFRANZ), La Paz, Bolivia

de la Salud (ICGES), Panama

provided the original work is properly cited.

Atlántico, Barranquilla, Colombia

Lucia E. Alvarado-Arnez6

## **Author details**

*Current Topics and Emerging Issues in Malaria Elimination*

We face multiple and perennial challenges when controlling tropical infectious diseases, such as malaria [42]. Despite many achievements in malaria control efforts during the last few decades, there are many countries in LAC where malaria transmission remains or revert to being a major public health concern for the region. In other regions of the world, such as Africa and Asia, the recent emergence of zoonotic species of *Plasmodium*, coupled with the impacts of climate change, economic downturn post-COVID-19, and globalization are also causing significant concern. There is an urgent need for local, national, and international health authorities to strengthen surveillance and multisectorial control approaches to advance the noble effort of malaria control and elimination

**3. Conclusions**

in LAC and other regions.

**6**

Alfonso J. Rodriguez-Morales1,2,3,4,5,6\*, Jaime A. Cardona-Ospina1,4, D. Katterine Bonilla-Aldana3 , Luis Andrés Salas-Matta2 , Wilmer E. Villamil-Gómez5,7, Juan Pablo Escalera-Antezana8 , Lucia E. Alvarado-Arnez6 , Carlos Franco-Paredes9 , Juan-Carlos Navarro10, Tomas Orduna11 and José A. Suárez12

1 Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia

2 Universidad Cientifica del Sur, Lima, Peru

3 Semillero de Investigación en Zoonosis, Grupo BIOECOS, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia

4 Emerging Infectious Diseases and Tropical Medicine Research Group, Instituto para la Investigación en Ciencias Biomédicas-Sci-Help, Pereira, Colombia

5 Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Sucre, Colombia

6 Coordinación Nacional de Investigación, Universidad Privada Franz Tamayo (UNIFRANZ), La Paz, Bolivia

7 Programa del Doctorado de Medicina Tropical, SUE Caribe, Universidad del Atlántico, Barranquilla, Colombia

8 Direction of Second Level Hospitals, Secretaría Municipal de Salud, Gobierno Autónomo Municipal de Cochabamba, Cochabamba, Bolivia

9 Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Colorado Denver, Aurora, CO, United States of America

10 Research Group of Emerging Diseases, Ecoepidemiology and Biodiversity, Health Sciences Faculty, Universidad Internacional SEK, Quito, Ecuador

11 Hospital de Infecciosas FJ Muñiz, Buenos Aires, Argentina

12 Investigador SNI Senacyt Panamá, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Panama

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

© 2021 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, provided the original work is properly cited.

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[19] Gallego V, Berberian G, Lloveras S, Verbanaz S, Chaves TS, Orduna T, et al. The 2014 FIFA World Cup: communicable disease risks and advice for visitors to Brazil--a review from the Latin American Society for Travel Medicine (SLAMVI). Travel Med Infect Dis. 2014;12(3):208-218.

[20] Gallego V, Berberian G, Siu H, Verbanaz S, Rodriguez-Morales AJ, Gautret P, et al. The 2019 Pan American games: Communicable disease risks and travel medicine advice for visitors to Peru - Recommendations from the Latin American Society for Travel Medicine (SLAMVI). Travel Med Infect Dis. 2019;30:19-24.

[21] Griffing SM, Villegas L, Udhayakumar V. Malaria control and elimination, Venezuela, 1800s -1970s. Emerg Infect Dis. 2014;20(10): 1697-1704.

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[26] Nekkab N, Lana R, Lacerda M, Obadia T, Siqueira A, Monteiro W, et al. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLoS Med. 2021;18(4):e1003535.

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**8**

*Current Topics and Emerging Issues in Malaria Elimination*

and implications for spillover in the

[9] Chowdhury FR, Ibrahim QSU, Bari MS, Alam MMJ, Dunachie SJ, Rodriguez-Morales AJ, et al. The association between temperature, rainfall and humidity with common climate-sensitive infectious diseases in

[10] Gutierrez-Ocampo E, Villamizar-Pena R, Holguin-Rivera Y, Molina-Ortiz K, Puerta-Laverde V, Rodriguez-Morales AJ. Malaria in Bogota, Colombia (2007-2017) - An analysis of notified domestic and international cases. Travel

Med Infect Dis. 2020;33:101560.

challenges for border countries receiving Venezuelan migrants. Travel

Med Infect Dis. 2019;30:4-6.

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Suarez JA, Risquez A, Cimerman S, Valero-Cedeno N, Cabrera M, et al. In the eye of the storm: Infectious disease

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syndemic in Venezuela: Measles, malaria and more co-infections coupled with a breakdown of social and healthcare infrastructure. Quo vadis? Travel Med

[13] Rodriguez-Morales AJ, Suarez JA, Risquez A, Villamil-Gomez WE, Paniz-Mondolfi A. Consequences of Venezuela's massive migration crisis on imported malaria in Colombia, 2016- 2018. Travel Med Infect Dis. 2019;28:

[14] Maldonado V, Finol HJ, Navarro JC. Anopheles aquasalis eggs from two Venezuelan localities compared by scanning electron microscopy. Mem Inst Oswaldo Cruz. 1997;92(4):487-491.

[11] Rodriguez-Morales AJ,

region. Lancet Infect Dis. 2019;19(5):e149-ee61.

Bangladesh. PLoS One. 2018;13(6):e0199579.

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[3] Rodriguez-Morales AJ, Paniz-Mondolfi AE. Venezuela's failure in malaria control. Lancet. 2014;384

[4] Rodriguez-Morales AJ, Sanchez E, Arria M, Vargas M, Piccolo C, Colina R, et al. Haemoglobin and haematocrit: the threefold conversion is also non valid for assessing anaemia in Plasmodium vivax malaria-endemic settings. Malar J.

Karamehic-Muratovic A, Goitom A, et al. Retrospective data analyses of social and environmental determinants of malaria control for elimination prospects in Eritrea. Parasit Vectors.

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**11**

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[38] Alimi TO, Fuller DO, Qualls WA, Herrera SV, Arevalo-Herrera M,

Parasit Vectors. 2015;8:431.

[39] Lubinda J, Haque U, Bi Y, Hamainza B, Moore AJ. Near-term climate change impacts on sub-national

malaria transmission. Sci Rep.

[40] Siraj AS, Santos-Vega M, Bouma MJ, Yadeta D, Ruiz Carrascal D, Pascual M. Altitudinal changes in malaria incidence in highlands of Ethiopia and Colombia. Science. 2014;343(6175):1154-1158.

[41] Bonilla-Aldana DK, Suarez JA, Franco-Paredes C, Vilcarromero S, Mattar S, Gomez-Marin JE, et al. Brazil burning! What is the potential impact of the Amazon wildfires on vector-borne and zoonotic emerging diseases? - A statement from an international experts

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in Tropical Diseases. 2021;2(3).

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the Zoonotic Malaria Parasite, Plasmodium knowlesi. Bio Protoc.

2020;10(17):e3743.

Draper SJ, Moon RW. Multiplication and Growth Inhibition Activity Assays for

2019;31:101474.

2021;11(1):751.

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[30] Ceruzzi O, Paparamborda M, Coppola J. Malaria en el Uruguay: vigilancia de los casos posteriores al regreso de misiones a zonas endémicas.

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en/ 2019

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northern coastal, Ecuador: a pilot study. Malar J. 2020 Oct 2;19(1):354. doi: 10.1186/s12936-020-03426-y

Valle-Campos A, Mena CF, Zaitchik BF, Lescano AG, Pan WK, Janko MM. Malaria Transmission and Spillover across the Peru-Ecuador Border: A Spatiotemporal Analysis. Int J Environ

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Res Public Health. 2020 Oct 13;17(20):7434. doi: 10.3390/

[34] BID. El Salvador, primer país de Mesoamérica libre de malaria. https:// blogs.iadb.org/salud/es/el-salvador-

[35] Poveda G. Concomitant malaria,

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ijerph17207434.

libre-de-malaria/ 2021

dengue and COVID-19: an

Environ Res. 2021;197:111017.

story/2019/05/1456411

**10**

[45] Ramasamy R. Zoonotic malaria global overview and research and policy needs. Front Public Health. 2014;2:123.

[46] Iseki H, Kawai S, Takahashi N, Hirai M, Tanabe K, Yokoyama N, et al. Evaluation of a loop-mediated isothermal amplification method as a tool for diagnosis of infection by the zoonotic simian malaria parasite Plasmodium knowlesi. J Clin Microbiol. 2010;48(7):2509-2514.

[47] Tan CH, Vythilingam I, Matusop A, Chan ST, Singh B. Bionomics of Anopheles latens in Kapit, Sarawak, Malaysian Borneo in relation to the transmission of zoonotic simian malaria parasite Plasmodium knowlesi. Malar J. 2008;7:52.

[48] Kawai S, Hirai M, Haruki K, Tanabe K, Chigusa Y. Cross-reactivity in rapid diagnostic tests between human malaria and zoonotic simian malaria parasite Plasmodium knowlesi infections. Parasitol Int. 2009;58(3): 300-302.

[49] Medeiros-Sousa AR, Laporta GZ, Coutinho RM, Mucci LF, Marrelli MT. A mathematical model for zoonotic transmission of malaria in the Atlantic Forest: Exploring the effects of variations in vector abundance and acrodendrophily. PLoS Negl Trop Dis. 2021;15(2):e0008736.

[50] Scott J. Proposed Integrated Control of Zoonotic Plasmodium knowlesi in Southeast Asia Using Themes of One Health. Trop Med Infect Dis. 2020;5(4).

[51] de Abreu FVS, Dos Santos E, Gomes MQ, Vargas WP, de Oliveira Passos PH, Nunes ESC, et al. Capture of Alouatta guariba clamitans for the

surveillance of sylvatic yellow fever and zoonotic malaria: Which is the best strategy in the tropical Atlantic Forest? Am J Primatol. 2019;81(6):e23000.

[52] Abreu FVS, Santos ED, Mello ARL, Gomes LR, Alvarenga DAM, Gomes MQ, et al. Howler monkeys are the reservoir of malarial parasites causing zoonotic infections in the Atlantic forest of Rio de Janeiro. PLoS Negl Trop Dis. 2019;13(12):e0007906.

[53] de Alvarenga DAM, Culleton R, de Pina-Costa A, Rodrigues DF, Bianco C, Jr., Silva S, et al. An assay for the identification of Plasmodium simium infection for diagnosis of zoonotic malaria in the Brazilian Atlantic Forest. Sci Rep. 2018;8(1):86.

[54] Ferreira MU, Castro MC. Challenges for malaria elimination in Brazil. Malar J. 2016;15(1):284.

[55] Laporta GZ, Linton YM, Wilkerson RC, Bergo ES, Nagaki SS, Sant'Ana DC, et al. Malaria vectors in South America: current and future scenarios. Parasit Vectors. 2015;8:426.

[56] Gething PW, Smith DL, Patil AP, Tatem AJ, Snow RW, Hay SI. Climate change and the global malaria recession. Nature. 2010;465(7296):342-345.

[57] Martens P, Kovats RS, Nijhof S, de Vries P, Livermore MTJ, Bradley DJ, et al. Climate change and future populations at risk of malaria. Global Environmental Change. 1999;9:S89-S107.

[58] Parham PE, Michael E. Modeling the effects of weather and climate change on malaria transmission. Environ Health Perspect. 2010;118(5): 620-626.

[59] Caminade C, Kovats S, Rocklov J, Tompkins AM, Morse AP, Colon-Gonzalez FJ, et al. Impact of climate change on global malaria

distribution. Proc Natl Acad Sci U S A. 2014;111(9):3286-3291.

[60] Sinka ME, Rubio-Palis Y, Manguin S, Patil AP, Temperley WH, Gething PW, et al. The dominant Anopheles vectors of human malaria in the Americas: occurrence data, distribution maps and bionomic precis. Parasit Vectors. 2010;3:72.

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[62] Brugueras S, Fernandez-Martinez B, Martinez-de la Puente J, Figuerola J, Porro TM, Rius C, et al. Environmental drivers, climate change and emergent diseases transmitted by mosquitoes and their vectors in southern Europe: A systematic review. Environ Res. 2020;191:110038.

[63] Fischer L, Gultekin N, Kaelin MB, Fehr J, Schlagenhauf P. Rising temperature and its impact on receptivity to malaria transmission in Europe: A systematic review. Travel Med Infect Dis. 2020;36:101815.

[64] Mihailovic DT, Petric D, Petrovic T, Hrnjakovic-Cvjetkovic I, Djurdjevic V, Nikolic-Doric E, et al. Assessment of climate change impact on the malaria vector Anopheles hyrcanus, West Nile disease, and incidence of melanoma in the Vojvodina Province (Serbia) using data from a regional climate model. PLoS One. 2020;15(1):e0227679.

[65] Nissan H, Ukawuba I, Thomson M. Climate-proofing a malaria eradication strategy. Malar J. 2021;20(1):190.

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[70] Weyant C, Brandeau ML, Burke M, Lobell DB, Bendavid E, Basu S. Anticipated burden and mitigation of carbon-dioxide-induced nutritional deficiencies and related diseases: A simulation modeling study. PLoS Med. 2018;15(7):e1002586.

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[72] Piovezan-Borges AC, Valente-Neto F, Tadei WP, Hamada N, Roque FO. Simulated climate change, but not predation risk, accelerates Aedes aegypti emergence in a microcosm experiment in western Amazonia. PLoS One. 2020;15(10):e0241070.

[73] Fu R, Yin L, Li W, Arias PA, Dickinson RE, Huang L, et al. Increased dry-season length over southern Amazonia in recent decades and its implication for future climate

**13**

*Introductory Chapter: Malaria Elimination - A Challenge with Multiple Emerging Ecosocial…*

*DOI: http://dx.doi.org/10.5772/intechopen.98579*

projection. Proc Natl Acad Sci U S A.

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2013;110(45):18110-18115.

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especialmente 2021

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comunidades vulnerables. https://www. paho.org/es/noticias/6-7-2020-opsinsta-paises-seguir-lucha-contramalaria-tiempos-covid-19*Introductory Chapter: Malaria Elimination - A Challenge with Multiple Emerging Ecosocial… DOI: http://dx.doi.org/10.5772/intechopen.98579*

projection. Proc Natl Acad Sci U S A. 2013;110(45):18110-18115.

*Current Topics and Emerging Issues in Malaria Elimination*

[67] Santalla E, Cordoba V, Blanco G. Greenhouse gas emissions from the waste sector in Argentina in businessas-usual and mitigation scenarios. J Air

[68] Ceccarelli S, Rabinovich JE. Global Climate Change Effects on Venezuela's Vulnerability to Chagas Disease is Linked to the Geographic Distribution of Five Triatomine Species. J Med Entomol. 2015;52(6):1333-1343.

[69] Fe-Goncalves LM, Araujo JDA, Santos C, Val AL, Almeida-Val VMF. How will farmed populations of freshwater fish deal with the extreme climate scenario in 2100? Transcriptional responses of Colossoma macropomum from two Brazilian climate regions. J Therm Biol.

[70] Weyant C, Brandeau ML, Burke M,

[71] Hamilton SE, Lovette J. Ecuador's mangrove forest carbon stocks: a spatiotemporal analysis of living carbon holdings and their depletion since the advent of commercial aquaculture. PLoS

Valente-Neto F, Tadei WP, Hamada N, Roque FO. Simulated climate change, but not predation risk, accelerates Aedes aegypti emergence in a microcosm experiment in western Amazonia. PLoS

Lobell DB, Bendavid E, Basu S. Anticipated burden and mitigation of carbon-dioxide-induced nutritional deficiencies and related diseases: A simulation modeling study. PLoS Med.

Waste Manag Assoc. 2013;63(8):909-917.

2020;89:102487.

2018;15(7):e1002586.

One. 2015;10(3):e0118880.

[72] Piovezan-Borges AC,

One. 2020;15(10):e0241070.

[73] Fu R, Yin L, Li W, Arias PA,

dry-season length over southern Amazonia in recent decades and its implication for future climate

Dickinson RE, Huang L, et al. Increased

distribution. Proc Natl Acad Sci U S A.

Manguin S, Patil AP, Temperley WH, Gething PW, et al. The dominant Anopheles vectors of human malaria in

distribution maps and bionomic precis.

[61] Midekisa A, Beyene B, Mihretie A, Bayabil E, Wimberly MC. Seasonal associations of climatic drivers and malaria in the highlands of Ethiopia.

[62] Brugueras S, Fernandez-Martinez B, Martinez-de la Puente J, Figuerola J, Porro TM, Rius C, et al. Environmental drivers, climate change and emergent diseases transmitted by mosquitoes and their vectors in southern Europe: A systematic review. Environ Res.

[63] Fischer L, Gultekin N, Kaelin MB,

[64] Mihailovic DT, Petric D, Petrovic T, Hrnjakovic-Cvjetkovic I, Djurdjevic V, Nikolic-Doric E, et al. Assessment of climate change impact on the malaria vector Anopheles hyrcanus, West Nile disease, and incidence of melanoma in the Vojvodina Province (Serbia) using data from a regional climate model. PLoS One. 2020;15(1):e0227679.

[65] Nissan H, Ukawuba I, Thomson M. Climate-proofing a malaria eradication strategy. Malar J. 2021;20(1):190.

underperforming. Glob Health Action.

[66] Verner G, Schutte S, Knop J, Sankoh O, Sauerborn R. Health in climate change research from 1990 to

2014: positive trend, but still

Fehr J, Schlagenhauf P. Rising temperature and its impact on receptivity to malaria transmission in Europe: A systematic review. Travel Med

Infect Dis. 2020;36:101815.

2014;111(9):3286-3291.

[60] Sinka ME, Rubio-Palis Y,

the Americas: occurrence data,

Parasit Vectors. 2010;3:72.

Parasit Vectors. 2015;8:339.

2020;191:110038.

**12**

2016;9:30723.

[74] Suárez JA, Carreño L, Paniz-Mondolfi AE, et al. Infectious diseases, social, economic and political crises, anthropogenic disasters and beyond: Venezuela 2019–implications for public health and travel medicine. Rev Panam Enf Infecc. 2018;1(2):73-93.

[75] PAHO. OPS insta a los países a seguir lucha contra malaria en tiempos de COVID-19, especialmente en comunidades vulnerables. https://www. paho.org/es/noticias/6-7-2020-opsinsta-paises-seguir-lucha-contramalaria-tiempos-covid-19 especialmente 2021

**15**

strains [7].

**Chapter 2**

**Abstract**

**1. Introduction**

treatment [4–6].

Point-of-Care Strategies Applied

*Alexandre Dias Tavares Costa, Anna Caroline Campos Aguiar,* 

Rapid and specific diagnosis of malaria remains one of the main strategies to fight the disease. The diagnosis is made primarily by the simple and low-cost thick drop technique, considered the gold standard test. However, the requirement for good quality microscopes and well-trained personnel often lead to inaccurate diagnosis, especially in cases of mixed infections or low parasitemia. Although PCR-based tests can help in these situations, this technique requires large and sensitive equipments, being unsuitable for point of care (POC) settings. A myriad of POC diagnostic tests have being developed in the last years, relying on molecular methods but also on novel strategies. New platforms, miniaturization techniques, and multiplexing possibilities promise great potential to improve disease diagnostics through fast and accurate detection of cases, even at remote places. Here, we will address the main POC strategies developed for the diagnosis of malaria,

Malaria is one of the deadliest diseases of poverty. It is estimated that malaria causes 228 million illnesses and 405 thousands deaths each year. Among the sick, children aged under 5 years are the most vulnerable group affected by malaria; in 2018, they accounted for 67% (272 000) of all malaria deaths worldwide [1].

In many countries where malaria is endemic, a lack of access to adequate diagnostic services leads to poor health outcomes for fever patients, as well as poor surveillance of infections and outbreaks, and treatment monitoring [2].

To make matters worse, the appearance of antimalarial resistant parasites including artemisinin derivatives pose a major public health threat [3]. In addition, drugs such as the artemisinin-derivatives are more expensive, leading to an increased demand for patient evaluation by accurate diagnostic tests before

Therefore, it has grown in the last years a general agreement that new diagnostic tests are needed for remote areas in malaria-endemic countries. However, the new tests must show improved performance over existing techniques, so that adequate distribution of anti-malarial drugs can effectively target the disease and its outbreaks, contributing to the reduction of generation of drug-resistant parasite

*Angelina Moraes Silva and Dhelio Batista Pereira*

highlighting their strengths and weakness as POC applications.

**Keywords:** point-of-care, diagnosis, malaria

to Malaria Diagnosis

#### **Chapter 2**
