Abstract
BackgroundThis paper examines how the cost-effectiveness of IRS varies depending on the severity of transmission and level of programme coverage and how efficiency could be improved by incorporating climate information into decision making for malaria control programmes as part of an integrated Malaria Early Warning and Response System (MEWS).MethodsA climate driven model of malaria transmission was used to simulate cost-effectiveness of alternative IRS coverage levels over six epidemic and non-epidemic years. Decision rules for a potential MEWS system that triggers different IRS coverage are described. The average and marginal cost per case averted with baseline IRS coverage (24%) and under varying IRS coverage levels (50%, 75% and 100%) were calculated.ResultsAverage cost-effectiveness of 24% coverage varies dramatically between years, from US$108 per case prevented in low transmission to US$0.42 in epidemic years. Similarly for higher coverage (24–100%) cost per case prevented is far higher in low than high transmission years ($108–$267 to $0.88–$2.26).DiscussionEfficiency and health benefit gains could be achieved by implementing MEWS that provides timely, accurate information. Evidence from southern Africa, (especially Botswana) supports this.ConclusionAdvance knowledge of transmission severity can help managers make coverage decisions which optimise resource use and exploit efficiency gains if a fully integrated MEWS is in place alongside a health system with sufficient flexibility to modify control plans in response to information. More countries and programmes should be supported to use the best available evidence and science to integrate climate informed MEWS into decision making within malaria control programmes.
Highlights
This paper examines how the cost-effectiveness of indoor residual spraying (IRS) varies depending on the severity of transmission and level of programme coverage and how efficiency could be improved by incorporating climate information into decision making for malaria control programmes as part of an integrated Malaria Early Warning and Response System (MEWS)
Cases occurring with no intervention Severity of transmission Years in this category Implied IRS Coverage Level
The present analysis assumes that the MEWS is accurate and that the information is available sufficiently early for programme managers to use it as a basis to make IRS programme coverage decisions
Summary
This paper examines how the cost-effectiveness of IRS varies depending on the severity of transmission and level of programme coverage and how efficiency could be improved by incorporating climate information into decision making for malaria control programmes as part of an integrated Malaria Early Warning and Response System (MEWS). Quantifying the burden of malaria remains a major challenge as many infections may be asymptomatic, inadequate diagnosis and reporting and the fact that a majority of febrile cases do not reach the formal health system make estimation imprecise. Less contentious is the fact that Africa (page number not for citation purposes). Malaria Journal 2008, 7:263 http://www.malariajournal.com/content/7/1/263 bears the brunt of the malaria burden, with estimates suggesting greater than 60% of the worlds clinical cases and more than 90% of the worlds malaria deaths [2]. The current goal of the Global Malaria Programme and the Roll Back Malaria Partnership is to "halve the malaria burden by 2010" by focussing on treatment, prevention and epidemic response[4]. Africa is not yet on track to achieve this goal [5]
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