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( Brooke et al., 2002 ). It is difficult to imagine any modern malaria control/
elimination program without ITN and/or IRS, so the very limited number
of insecticides needs to be managed in such a way (e.g. alternation) to mini-
mize the evolution of resistance in vector mosquitoes.
8.3. Better Diagnostic Devices
Even though the biology of the man-mosquito-parasite triad cannot be
changed, it is possible that new tools might shift the balance in favour of
malaria elimination. High on the list of desirable items for malaria elimi-
nation are improved diagnostic tests especially for low parasitaemias and
non-falciparum species ( Harris et al., 2010 ).Vivax malaria does not have the
falciparum protein HRP-2, which is the basis of most malaria rapid detec-
tion tests ( Ly et al., 2010 ). As a consequence, vivax detection using RDT
depends on other proteins such as lactic acid dehydrogenase and vivax
detection is less sensitive than HRP-2-based tests for falciparum malaria
( Senn et al., 2011 ; Ashton et al., 2010 ; Ashley et al., 2009 ). As malaria pro-
grams evolve from controlling malaria disease burden towards the elimi-
nation of the parasite, finding the increasingly few infected persons and
adequately treating those often asymptomatic persons will become increas-
ingly important. The microscopic examination of stained blood smears still
remains the best way to quickly find low-level parasitaemias. New technol-
ogy will hopefully change this century-old paradigm, but to date, that has
not happened despite the invention and on-going improvement of immu-
nochromatographic detection strips.
For the first time in at least a generation, malaria elimination is firmly
on the world development pathway as not only a desirable goal but also a
program for global implementation ( Moonen et al., 2010 ; Feachem and
Sabot, 2008 ). Although the context of such discussions usually implies
that the main concern is falciparum malaria in Africa, vivax remains the
most prevalent parasite with the widest geographic range. Vivax will also
be the most difficult parasite to eliminate because of hypnozoites causing
relapses long after initial infection. The main strategy for malaria elimina-
tion is control in areas of high endemicity and progressive elimination from
the current borders of malaria transmission. Those countries that will be
eliminating malaria in the foreseeable future, with the possible exception
of Haiti, are all dealing with vivax malaria ( Tatem et al., 2010 ). Presence
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