Abstract
BackgroundIn malaria-endemic countries, malaria prevention and treatment are critical for child health. In the context of intervention scale-up and rapid changes in endemicity, projections of intervention impact and optimized program scale-up strategies need to take into account the consequent dynamics of transmission and immunity.MethodsThe new Spectrum-Malaria program planning tool was used to project health impacts of Insecticide-Treated mosquito Nets (ITNs) and effective management of uncomplicated malaria cases (CMU), among other interventions, on malaria infection prevalence, case incidence and mortality in children 0–4 years, 5–14 years of age and adults. Spectrum-Malaria uses statistical models fitted to simulations of the dynamic effects of increasing intervention coverage on these burdens as a function of baseline malaria endemicity, seasonality in transmission and malaria intervention coverage levels (estimated for years 2000 to 2015 by the World Health Organization and Malaria Atlas Project). Spectrum-Malaria projections of proportional reductions in under-five malaria mortality were compared with those of the Lives Saved Tool (LiST) for the Democratic Republic of the Congo and Zambia, for given (standardized) scenarios of ITN and/or CMU scale-up over 2016–2030.ResultsProportional mortality reductions over the first two years following scale-up of ITNs from near-zero baselines to moderately higher coverages align well between LiST and Spectrum-Malaria —as expected since both models were fitted to cluster-randomized ITN trials in moderate-to-high-endemic settings with 2-year durations. For further scale-up from moderately high ITN coverage to near-universal coverage (as currently relevant for strategic planning for many countries), Spectrum-Malaria predicts smaller additional ITN impacts than LiST, reflecting progressive saturation. For CMU, especially in the longer term (over 2022–2030) and for lower-endemic settings (like Zambia), Spectrum-Malaria projects larger proportional impacts, reflecting onward dynamic effects not fully captured by LiST.ConclusionsSpectrum-Malaria complements LiST by extending the scope of malaria interventions, program packages and health outcomes that can be evaluated for policy making and strategic planning within and beyond the perspective of child survival.
Highlights
In malaria-endemic countries, malaria prevention and treatment are critical for child health
We considered 51% and 70% usage to be similar to 77% and 98% of households owning one or more Insecticide-Treated mosquito Nets (ITNs), based on ratios between these metrics in Democratic Republic of the Congo (DRC), Zambia and other stable malaria-endemic African countries observed in national household surveys ([22,23,24] and Additional file 2), and we consider these standardized coverage values optimal for the purpose of comparing impact projections despite the different coverage metrics in the two models
Scaling-up ITN and Effective management o uncomplicated malaria cases (CMU) from 2015 coverage levels In both Lives Saved Tool (LiST) and Spectrum-Malaria, increasing CMU coverage from 10% to 40% has larger impact than increasing ITN coverage from 77% ownership or 51% usage to 98% ownership or 70% usage (Figure 1)
Summary
In malaria-endemic countries, malaria prevention and treatment are critical for child health. Between 2000 and 2015, malaria incidence rates fell 37% globally, and malaria mortality rates by 60%, with even greater declines in Africa, the highest-burden region [1]. This was likely a combined result of improved malaria control and other factors independent of interventions [2]. For malaria deaths in children under-5, in 2012 the World Health Organization (WHO) had estimated that malaria prevention intervention scale-up over 2001– 2010 had prevented 921,300 (uncertainty interval: 625,600–1,260,800) child deaths (or 8.2% of the number in 2000) due to malaria across 36 malaria-endemic countries in Africa [3]. Impacts of improved case management, as well as mortality and morbidity impacts in older children and adults, are less certain
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