Hrev_master [Healthcare in Low-resource Settings 2016; 4:5755] [page 5] Striving toward malaria elimination and the necessity to be persistent in our efforts Saurabh R. Shrivastava, Prateek S. Shrivastava, Jegadeesh Ramasamy Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, India Across the world, malaria continues to remain a major cause of public health concern as even now 50% of the world’s total population is at potential risk of malaria.1 Out of the 106 nations which were facing the challenge of malaria at the start of the current century, recent estimates suggest that almost 57 and 18 of them have achieved 75 and 50-75% reduc- tion in the incidence of malaria, respectively.2 However, the African region alone accounts for 88% of the total malaria cases and 90% of the overall deaths in the year 2015.3 Moreover, owing to the implementation of targeted approach a significant decline in both the global incidence by more than one-third, and mortality rates by three-fifth (0.83 million deaths in 2000 versus 0.43 million deaths in 2015) in the span of last 15 years has been accomplished.2,3 Further, population groups of under-five children, antenatal mothers and susceptible persons going to the malaria endemic regions are extremely vulnerable to the disease.1 The recent estimates reflect that a 65% decline in the malarial death rates has been observed among the under-five year chil- dren age-group on the global scale.1,2 In addition, an expenditure of millions of dollars has been saved, especially with regard to the management of the patients since 2000.2 Also, an excess of 6 million deaths across the world and more than 650 million cases of malaria (African region alone) have been pre- vented in the last 15 years.3 Most of the current trends reflect that significant improvement has been achieved towards the ultimate goal of malaria elimination.4,5 In-fact, the internation- al stakeholders were even successful in accom- plishing the proposed malaria target under the Millennium Development Goal - 6.3,4 Although, many factors have played their part in ensuring an improvement, the predom- inant share of the achieved success goes to the sustained level of political commitment, tech- nical assistance from the World Health Organization (WHO), and financial support from the earmarked international agency.3-5 However, among the implemented measures, three low-cost strategies have delivered maxi- mum output, namely insecticide-treated mos- quito nets (maximum contribution in financial savings), artemisinin-based combination ther- apies (highly effective treatment regimen for falciparum malaria) and indoor residual spray- ing.2,3 Further, a significant rise in the inci- dence of rapid diagnostic testing for malaria has also been reported from heterogeneous settings.1,4 However, even now, many challenges persist and there is a great need to address all of them.1,3,5 These include high caseload and death rates, localization of maximum number of cases from some of the high-burden nations, a slow rate of decline in the inci- dence/death rates of malaria compared to the global trends, shortcomings in the health care system, inaccessibility of the services (like mosquito nets or indoor residual spraying), emergence of drug resistance and insecticide resistance, and poor involvement of the com- munity stakeholders.1,3,5,6 Finally, a newer strat- egy has been adopted by the WHO member states to reduce the global malaria incidence and mortality by at least 90%, eliminate malar- ia from 35 nations, and to prevent the re-emer- gence of the disease in malaria free nations by the year 2030.1,3 To conclude, now the goal is set, we have access to effective measures which have deliv- ered results, but the challenge is to implement the same for a longer duration of time. Thus, the need of the hour is to have a strong leader- ship at different levels, constant motivation of the health workers, strategic involvement of the community, and up-scaling of the financial support. References 1. WHO. World malaria report 2015. Geneva, Switzerland: WHO; 2015. 2. WHO. Malaria. Available from: http://who.int/mediacentre/factsheets/fs09 4/en/ 3. WHO. Achieving the malaria MDG target: reversing the incidence of malaria 2000- 2015. Geneva, Switzerland: WHO; 2015. 4. Chanda E, Ameneshewa B, Angula HA, et al. Strengthening tactical planning and operational frameworks for vector control: the roadmap for malaria elimination in Namibia. Malaria J 2015;14:302. 5. Hsiang MS, Gosling RD. Striding toward malaria elimination in China. Am J Trop Med Hyg 2015;93:203-4. 6. Whittaker M, Smith C. Reimagining malaria: five reasons to strengthen com- munity engagement in the lead up to malaria elimination. Malaria J 2015;14:410. Healthcare in Low-resource Settings 2016; volume 4:5755 Correspondence: Saurabh RamBihariLal Shrivastava, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Thiruporur-Guduvancherry main road, 603108 Kancheepuram, India. Tel./Fax: +91.988.422.7224. E-mail: drshrishri2008@gmail.com Contributions: SRS, conception and design, draft- ing of the article, review of literature, guarantor; PRS, drafting the article, review of the literature, critically revising for important intellectual con- tent; JR, general supervision of the research, overall guidance in writing the manuscript. Conflict of interest: the authors declare no poten- tial conflict of interest. Key words: Malaria; Insecticide-treated nets; World Health Organization. Received for publication: 18 January 2016. Accepted for publication: 6 February 2016. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright S.R. Shrivastava et al., 2016 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2016; 4:5755 doi:10.4081/hls.2016.5755 Non co mmerc ial us e o nly