Abstract
Using an agent-based model of malaria, we present numerical evidence that in communities of individuals having an affinity varying within a broad range of values, disease transmission may increase up to 300%. Moreover, our findings provide new insight into how to combine different strategies for the prevention of malaria transmission. In particular, we uncover a relationship between the level of heterogeneity and the level of conventional and unconventional anti-malarial drug administration (ivermectin and gametocidal agents), which, when taken together, will define a control parameter, tuning between disease persistence and elimination. Finally, we also provide evidence that the entomological inoculation rate, as well as the product between parasite and sporozoite rates are both good indicators of malaria incidence in the presence of heterogeneity in disease transmission and may configure a possible improvement in that setting, upon classical standard measures such as the basic reproductive number.
Highlights
Since the turn of the century, world malaria annual incidence decreased from 14.6 cases per 100 human inhabitants, in 2000 [1], to 5.7 cases, in 2018 [2]
This improvement is the result of adequate public health policy involving preventive actions such as vector control, implementation of rapid diagnostic testing (RDT), drug administration of artemisinin combined therapy (ACT), widespread use of barrier protection measures such as long-lasting insecticide-treated bed nets (LLIN), and mixed barrier protection through vector control measures such as indoor insecticide residual spraying (IRS)
Our results show a consistent linear correlation between 30 year average malaria incidence and increasing levels of heterogeneity, suggesting that heterogeneity strongly promotes malaria transmission (Figure 2)
Summary
Since the turn of the century, world malaria annual incidence decreased from 14.6 cases per 100 human inhabitants (pHHI), in 2000 [1], to 5.7 cases, in 2018 [2]. In 1997, Woolhouse defined a specific model for the presence of heterogeneity in malaria transmission, naming it the 20/80 rule [16] This rule assumes that 80% of all mosquito bites will occur in 20% of the human population, being inspired by Wilfredo Pareto’s original work on the distribution of world wealth [17]. Some of the most important are the existence of hotspots, genetic propensity, migratory human behavior, and particular geophysical conditions Instead of considering these different factors separately, we will look at their collective effect in a small fraction of human individuals receiving the majority of mosquito bites. We will parameterize a sort of Pareto rule in its more modern formulation, according to Woolhouse [16]
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