Global challenges of changing epidemiological patterns of malaria.

In the absence of secular climatic changes, the global challenges of changing epidemiological patterns of malaria have to be induced by man, i.e. by a disturbance of the equilibrium between man, vector and the parasite in an environment conducive to the natural transmission of the pathogen. There are many ways of attempting such a disturbance, from the use of personal protection to the use of diagnostic and remedial antiplasmodial treatment, up to the application of vector control measures for the elimination of breeding places, larviciding and the use of intradomestic insecticides. This will be done by looking at the parasites responsible for the specific infection, and considering the various arthropod hosts and the human hosts, before the comprehensive treatment of the environmental features. This will be followed by a section on the quantitative epidemiology. The various tools of intervention and their relative efficacy precede the section on common denominators of previously malarious countries having achieved and maintained malaria-free status. Similarly, the reasons for failing the declared goal of eliminating malaria sets the new scene for the global challenges ahead of us in the endeavour of future attempts at eliminating malaria.