Table Of ContentB. K. Tyagi
Desert
Malaria
An Emerging Malaria Paradigm and Its
Global Impact on Disease Elimination
Desert Malaria
B. K. Tyagi
Desert Malaria
An Emerging Malaria Paradigm and Its
Global Impact on Disease Elimination
B.K.Tyagi
VITUniversity
Vellore,India
ISBN978-981-19-7692-6 ISBN978-981-19-7693-3 (eBook)
https://doi.org/10.1007/978-981-19-7693-3
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Dedicated to
My parents and teachers who have always
taught me
to follow the principle of work:
Transliteration:
Karmanye vadhika raste, Ma phaleshu
kadachana Ma karma phala he tur bhuh, ma
te sangotsva karmanye
Translation:
You have a right to ‘Karma’ (actions) but
never to any Fruits thereof. You should never
be motivated by the results of your actions,
nor should there be any attachment in not
doing your prescribed activities.
Foreword
Taking cognizance of the World Malaria Report 2021 it looks like malaria will be
knocked off from most parts of world very soon. There are, however, certain
ecotypes where malariated mobile and hard-to-approach populations need special
attention, such as those in the malaria-prone deserts of the world, especially the
Sahara, the Middle East/West Asia, and the Great Indian Thar Desert whose
malariogenic scenario is fast changing under the impact of climate change as well
asanthropization,andcanaffecttheneighbouringregionswheresuccessfulmalaria
eliminationcampaignshavebeeninprogress.Theglobaldataonmorbimortalityisa
big alert sign in this direction: there were an estimated 241 million cases in 2020,
comparedto227millioncasesin2019,withmalariadeathsin2020havingincreased
to6,27,000globally—a12%increaseoverthatin2019!
AfterAfricancontinent,itistheSouth-EastAsianregion,includingIndiawhich
shoulderstheheaviestburdenofmalariaincidence,thatposesthegreatestthreatof
malariaburdentopeopleintheregionwhichhasrecentlywitnessedsomecountries
havingbeendeclaredmalaria-freebytheWorldHealthOrganization.India,too,has
made a great progress in reducing the malaria cases and resolutely developed ‘the
NationalFrameworkforMalariaEliminationinIndia2016–2030’whichwillneed
to take into consideration with equal alacrity all the various different malaria
ecotypes or paradigms including the distantly malariogenic Thar Desert. Accord-
ingly, the future elimination roadmaps will also need to factor in contemporary
challenges, including the impact of climate change on vector chorogeography,
human migration, rapid urbanization, and expansion of irrigated agriculture.
Leveragingadvancedcontroltechnologiesaidedbyarobustsurveillancesystemto
intensifymalariaelimination,thetimeseemstobejustripetotacklemalaria;from
grassroot action to holistic policy interventions and effective delivery of services,
without letting emerging malaria paradigms such as, for example, ‘the Desert
Malaria’disappearfromthesightwhileexecutingthe‘NationalStrategicPlanfor
MalariaElimination’(2017–22).
DuringthepastonedecadeIndiahassucceededinreducingthemalariaburdena
great deal(69%).India wasalso theonlyhigh-endemicnationtoseeadecreaseof
17.6% in 2019 compared to 2018. Further, when numbers of malaria cases are
comparedbetween2019and2020itwasrevealedthattheoverallnumberofmalaria
cases recorded in 2020 was 1,57,284 as compared to the number of cases in 2019
vviiii
viii Foreword
being2,86,091,whichisayear-on-yeardecreaseofapproximately45%.Yet,there
is no reason for ecstatic celebration for there are many challenges ahead, not to
mention the ongoing pandemic which has apparently disrupted other health
programmes across the world, and India is no exception; the reduction in malaria
casesduringthepastseveralmonthscouldbepotentiallycorrelatedwiththeunder-
reportingofcases,ononehand,andtheinabilitytotimelyaddress‘mobileandhard
toapproach populations’inregionssuchas, forexample, thearid environmentsof
theTharDesert,ontheother.Eventually,grassrootactioninvolvingassignificantly
indiscernible risk as that of the desert malaria is critical to combat a disease like
malaria.Tacklingthedesertmalaria,inadditiontoholisticpolicyinterventionsand
effectivedeliveryofservicesinendemicareas,wouldbevitalinhelpingachievethe
goalofamalaria-freeIndiaby2030.
Ontheglobalfront,duecognizanceshouldbetakenofthefactthatdesertmalaria
hasimmensepotentialtoimpactthesuccessfuldiseaseeliminationcampaignsinthe
borderingareas/regionsorcountries,andundertheirreversibleClimateChangethe
situationwillonlyworsenwiththeexpandinggeographicalreachofthedangerous
invasive mosquito, like Anopheles stephensi, and the parasite, Plasmodium
falciparum. Currently desert environments intervened by Climate Change and
anthropizationarebecomingconducivetomalariaexacerbation.
IwishProf.B.K.Tyagi’sbook,DesertMalariaagreatsuccess.Thebookisan
innovative and unique treatment, and yet so vital for our understanding about the
complexitiesassociatedwiththemalariaeliminationinfuture.Ifurtherwishthatall
thosewhoarepersonallyorinstitutionallyinvolvedinthedriveagainstmalaria,such
as policy makers, programme implementers, disease managers, academicians, and
researchers alike, will find this book a useful reference in their endeavours to
eliminatethediseasefromthefaceoftheEarthonceforall!
ParasitologyDepartment,UniversitiMalaya IndraVythilingam
KualaLumpur,Malaysia28thApril,2022
Preface
Thedecisiontowriteabookonmalariaindeserts,howeverinnovative,exigent,and
thought-provoking, was highly challenging and unconventional. The disease is
inherently associated with water—in variety and abundance—as a prerequisite,
anddesertsarebutchronicallywater-deficient,besidesotherenvironmentalfeatures
generallyinimicaltothedevelopment,growth,andsurvivalofboththePlasmodium
parasites of human malaria and their anopheline mosquito vectors. The fact, how-
ever,isthatdeserts’inhospitableandinimicalaridenvironmentstheworldoverare
fast transforming under the impact of climate change and/or anthropization, and
becoming home for continued malaria exacerbation and epidemics so much that
antimalaria campaigns elsewhere could be put to danger of reversal by increased
malaria cases. The threat of ‘Desert Malaria’ (Tyagi 1995) is indeed very real.
Therefore, highlighting malariological significance of deserts has proved a path-
breakingendeavour,tosaytheleast!Itis,ofcourse,common thinkingthatdeserts
arenottheplaceswheremalariaexists.Ifnotseriouslyattended,the‘DesertMalaria’
may become a good reason to ultimately undermine the global efforts to eliminate
malariainatimeboundmannerinthenearfuture.
Globally,accordingto theWorld Malaria Report 2021, there were anestimated
241 million cases in 2020, increasing from 227 million in 2019. During the same
timemalariadeathsincreasedby12%globallyin2020,incomparisonto2019,toan
estimated 6,27,000. For India, the numbers are grim. In 2020, the South-East Asia
Region(SEAR)had5millionestimatedcases.Threecountriesaccountedfor99.7%
oftheestimatedcasesintheregion,withIndiabeingthelargestcontributor(82.5%).
Indiaalsoaccountedfor82%ofallmalariadeathsintheSEAR.Malariacontrolisa
global issue and the World Health Organization through its member states is
committed to eliminate the disease from the face of the Earth. The WHO Global
MalariaProgramme(GMP)isresponsibleforcoordinatingWHO'sglobaleffortsto
controlandeliminatemalaria.Itsworkisguidedbythe‘GlobalTechnicalStrategy
for Malaria 2016–2030’ adopted by the World Health Assembly in May 2015 and
updatedin2021.AsfarastheWHOSEARegion,inwhichIndiaisalsoincluded,it
isnoteworthythattheislandnationofSriLankawasrecentlycertifiedmalaria-free
in 2015, and another country Timor-Leste is in the line of WHO Certification for
malaria-free having reported consistently zero malaria cases in 2018 and 2019.
Outside the WHO SEA Region, China was also most recently declared malaria-
ix
x Preface
freein2021.IndiahasrecentlypreparedaNationalStrategicFrameworkofMalaria
Elimination2016–2030whereinthenorthwesternxericregionoftheTharDesertis
also includedon thebasis ofrecent experiences. Thus,it ismore than crystal clear
that the desert/xeric environments bearing countries with potential for malaria
conflagration, like those in the African Continent and India, face rather greater
challenges to eliminate malaria due largely to a continuous reinforcement of cases
fromalessorinfrequentlysurveyedregionforreasonsapparent.Therealpotential
ofthedesertmalariaissofarnotfullycomprehended,anditisdoubtedifanygreat
successineliminatingmalaria wouldbeachievablewithout growing aufaitinthis
crucialecosystem.
‘Desert Malaria’, a new coinage in the realms of malariology, is an emerging
malaria paradigm, having been reported for the first time in the Thar Desert,
northwestern India. Its global impact on disease elimination carries a unique, yet
mostsignificantepidemiological,valueatatimewhenthemalariaendemiccountries
acrosstheworldarestrugglingtotheskinoftheirteethagainsttheman'soldestand
deadliest predator, the mosquito, and the centuries-old infection it transmits,
i.e.malaria,whichiswoefullyneglectedindesertsduetotheirhostilephysiography
and inclement environment, on one hand, and, more importantly, the traditional
beliefthatthedesertecosystemhasonlyverylowandunstablepotentialtoexacer-
bate malaria! Generally it is witnessed that countries with endemic malaria invari-
ably lay their entire focus for vector and disease control/elimination on the well-
knownepidemiologicalparadigmssuchas,forexample,tribalmalaria,ruralmalaria,
urban malaria, industrial malaria, irrigation malaria, forest malaria, border malaria,
etc.,andthedesertic,xeric,and/oraridenvironmentsareoftenneglectedepidemio-
logically,albeithighpotentialforoutbreaksconflagratoryenoughtoescalatedisease
burdenalloveragainintheneighbouringareas!
Desertenvironments(includingdesertic/xericandaridlands)constitutethemost
widespread terrestrial biome on Earth covering about 33% of the land areas of the
world,andarehometoover20%oftheworld'spopulation.Thebookbringsupthe
significanceoftheemergingnewmalariaparadigm—TheDesertMalaria,intotality,
thatis,alsobyhighlightingthesignificanceofboththe‘desertfringe’andthe‘desert
oasis’.Malariologically,ifnotappreciatedfortheirepidemiologicalpotential,these
desertscanbecomedifficulthabitatsformalariamanagement.Thedesertmalariais,
therefore,anintegralconstituentoftheglobaldiseaseepidemiologyandcontrol.
Thebookunfoldsthehistoryofmalariavis-à-visdesertecosystems,followedby
disease exacerbation due to multiple factors chiefly comprising anthropogenic
interference.Thebookrevealshowinrecenttimes increaseintrade,transportation
(of all kinds), and migration as well as the cyclic droughts in the world’s xeric
ecosystems,ononehand,andtheimpendingclimatechangeandanthropization,on
theotherhand,haveledtowideanddistantspreadofboththevectorsandthedisease
intothevaststretchesofdeserts.Italsoinformsonreasonsbehindtheemergenceof
the deadly malaria parasite, Plasmodium falciparum, in the desert ecosystem fol-
lowingfaultycanalizedirrigation.Thisisforthefirsttimethatallthethreedifferent
typesofdiseaseparadigms,viz.,(1)DesertMalariaperse,(2)DesertOasisMalaria,
Preface xi
and (3)Desert Fringe Malaria, have been treated in one volume, with fundamental
differencesintheireco-bio-socialimpactsinconjunctionwithmalariologicalsignif-
icance. It is hoped that this book, written authoritatively, on Desert Malaria: an
emergingmalariaparadigmanditsglobalimpactondiseaseelimination,willadd
newknowledgeonmalaria,anddesertswouldbegiventheirdueshareofthinking
abouteliminatingmalariainIndiaandtheworldalike.
Vellore,India B.K.Tyagi
30thApril,2022
