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Background: Malaria is still a priority public health problem of Nepal where about 84% of the population are at risk. The aim of this paper is to highlight the past and present malaria situation in this country and its challenges for long-term malaria elimination strategies.
Methods: Malariometric indicator data of Nepal recorded through routine surveillance of health facilities for the years between 1963 and 2012 were compiled. Trends and differences in malaria indicator data were analysed.
Results: The trend of confirmed malaria cases in Nepal between 1963 and 2012 shows fluctuation, with a peak in 1985 when the number exceeded 42,321, representing the highest malaria case-load ever recorded in Nepal. This was followed by a steep declining trend of malaria with some major outbreaks. Nepal has made significant progress in controlling malaria transmission over the past decade: total confirmed malaria cases declined by 84% (12,750 in 2002 vs 2,092 in 2012), and there was only one reported death in 2012. Based on the evaluation of the National Malaria Control Programme in 2010, Nepal recently adopted a long-term malaria elimination strategy for the years 2011–2026 with the ambitious vision of a malaria-free Nepal by 2026. However, there has been an increasing trend of Plasmodium falciparum and imported malaria proportions in the last decade. Furthermore, the analysis of malariometric indicators of 31 malaria-risk districts between 2004 and 2012 shows a statistically significant reduction in the incidence of confirmed malaria and of Plasmodium vivax, but not in the incidence of P. falciparum and clinically suspected malaria.
Conclusions: Based on the achievements the country has made over the last decade, Nepal is preparing to move towards malaria elimination by 2026. However, considerable challenges lie ahead. These include especially, the need to improve access to diagnostic facilities to confirm clinically suspected cases and their treatment, the development of resistance in parasites and vectors, climate change, and increasing numbers of imported cases from a porous border with India. Therefore, caution is needed before the country embarks towards malaria elimination.
A majority of the plant species that are introduced into new ranges either do not become established, or become naturalized yet do not attain high densities and are thus considered ecologically and economically unproblematic. The factors that limit these relatively “benign” species are not well studied. The biotic resistance hypothesis predicts that herbivores, pathogens and competition reduce growth and reproduction of individual plants and so suppress population growth of non-native species. We explored the effect of insect herbivory and surrounding vegetation on growth and fitness of the non-native biennial plant Verbascum thapsus (common mullein) in Colorado, USA. Mullein is widespread in its introduced North American range, yet is infrequently considered a management concern because populations are often ephemeral and restricted to disturbed sites. To evaluate the impact of insect herbivores on mullein performance, we reduced herbivory using an insecticide treatment and compared sprayed plants to those exposed to ambient levels of herbivory. Reducing herbivory increased survival from rosette to reproduction by 7%, from 70–77%. Of plants that survived, reducing herbivory increased plant area in the first year and plant height, the length of the reproductive spike, and seed set during the second year. Reducing herbivory also had a marked effect on plant fitness, increasing seed set by 50%, from about 48,000 seeds per plant under ambient herbivory to about 98,000 per plant under reduced herbivory. Our findings also highlight that the relationship between herbivory and performance is complex. Among plants exposed to ambient herbivory, we observed a positive relationship between damage and performance, suggesting that, as predicted by the plant vigor hypothesis, insect herbivores choose the largest plants for feeding when their choice is not restricted by insecticide treatment. In contrast to the strong effects of experimentally reduced herbivory, we found that cover of other plants surrounding our focal plants explained relatively little variation in performance outcomes. Overall, we found that herbivore-induced impacts on individual plant performance and seed set are substantial, and thus may help prevent this naturalized species from becoming dominant in undisturbed recipient communities.