Malaria intervention scale-up in Africa: effectiveness predictions for health programme planning tools, based on dynamic transmission modelling

Malaria Journal

Research

Eline Korenromp¹  Matthew Hamilton²  Carel Pretorius²  Guy Mahiané²  Thomas A. Smith³  Olivier J. T. Briët³  Richard Cibulskis⁴  Jeremy Lauer⁵ 

[1] Avenir Health, Geneva, Switzerland;Avenir Health, Glastonbury, USA;Swiss Tropical and Public Health Institute, Basel, Switzerland;University of Basel, Basel, Switzerland;World Health Organization Global Malaria Programme, Geneva, Switzerland;World Health Organization Health Systems Governance and Financing dept., Geneva, Switzerland;

关键词: Malaria;    Prevention;    Treatment;    Vector control;    Mortality;    Morbidity;    Health impact;    Insecticide-treated mosquito nets;    Indoor residual spraying;    Programme planning;    Modelling;   

DOI  :  10.1186/s12936-016-1461-9

 received in 2016-05-07, accepted in 2016-07-29,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundScale-up of malaria prevention and treatment needs to continue to further important gains made in the past decade, but national strategies and budget allocations are not always evidence-based. Statistical models were developed summarizing dynamically simulated relations between increases in coverage and intervention impact, to inform a malaria module in the Spectrum health programme planning tool.MethodsThe dynamic Plasmodiumfalciparum transmission model OpenMalaria was used to simulate health effects of scale-up of insecticide-treated net (ITN) usage, indoor residual spraying (IRS), management of uncomplicated malaria cases (CM) and seasonal malaria chemoprophylaxis (SMC) over a 10-year horizon, over a range of settings with stable endemic malaria. Generalized linear regression models (GLMs) were used to summarize determinants of impact across a range of sub-Sahara African settings.ResultsSelected (best) GLMs explained 94–97 % of variation in simulated post-intervention parasite infection prevalence, 86–97 % of variation in case incidence (three age groups, three 3-year horizons), and 74–95 % of variation in malaria mortality. For any given effective population coverage, CM and ITNs were predicted to avert most prevalent infections, cases and deaths, with lower impacts for IRS, and impacts of SMC limited to young children reached. Proportional impacts were larger at lower endemicity, and (except for SMC) largest in low-endemic settings with little seasonality. Incremental health impacts for a given coverage increase started to diminish noticeably at above ~40 % coverage, while in high-endemic settings, CM and ITNs acted in synergy by lowering endemicity. Vector control and CM, by reducing endemicity and acquired immunity, entail a partial rebound in malaria mortality among people above 5 years of age from around 5–7 years following scale-up. SMC does not reduce endemicity, but slightly shifts malaria to older ages by reducing immunity in child cohorts reached.ConclusionHealth improvements following malaria intervention scale-up vary with endemicity, seasonality, age and time. Statistical models can emulate epidemiological dynamics and inform strategic planning and target setting for malaria control.

【 授权许可】

CC BY   
© The Author(s) 2016