Abstract
We develop an age-structured ODE model to investigate the role of intermittent preventive treatment (IPT) in averting malaria-induced mortality in children, and its related cost in promoting the spread of antimalarial drug resistance. IPT, a malaria control strategy in which a full curative dose of an antimalarial medication is administered to vulnerable asymptomatic individuals at specified intervals, has been shown to reduce malaria transmission and deaths in children and pregnant women. However, it can also promote drug resistance spread. Our mathematical model is used to explore IPT effects on drug resistance and deaths averted in holoendemic malaria regions. The model includes drug-sensitive and drug-resistant strains as well as human hosts and mosquitoes. The basic reproduction, and invasion reproduction numbers for both strains are derived. Numerical simulations show the individual and combined effects of IPT and treatment of symptomatic infections on the prevalence of both strains and the number of lives saved. Our results suggest that while IPT can indeed save lives, particularly in high transmission regions, certain combinations of drugs used for IPT and to treat symptomatic infection may result in more deaths when resistant parasite strains are circulating. Moreover, the half-lives of the treatment and IPT drugs used play an important role in the extent to which IPT may influence spread of the resistant strain. A sensitivity analysis indicates the model outcomes are most sensitive to the reduction factor of transmission for the resistant strain, rate of immunity loss, and the natural clearance rate of sensitive infections.
Highlights
Malaria continues to be a burden in many parts of the world, especially in the African continent
Our quantities of interest (QOI), or outputs, were number of children who died of malaria, number of adults who died of malaria, and the proportion of deaths that resulted from infection with the resistant strain
The drug and dosages used for symptomatic treatment of the resistant pathogen, may be partially effective depending on the value chosen for p
Summary
Malaria continues to be a burden in many parts of the world, especially in the African continent. An estimated 214 million new malaria cases (range 149–303 million) were reported worldwide in 2015, with Africa contributing the most, about 88%, followed by Southeast Asia and the Eastern Mediterranean region, each contributing 10% and 2%, respectively (World Health Organization 2015b). The estimated 2015 worldwide number of deaths was 438, 000, a decline from the 2012 estimates Of these deaths, 90% came from the African region, 7% from Southeast Asia, and 2% from the Eastern Mediterranean region (World Health Organization 2014a, b, 2015b). Malaria mortality rates are dropping (down by 60% worldwide between 2000 and 2015), many people still suffer the burdens of illness, infection, and death, with children under five more susceptible to these burdens. Strategies for reducing infection and disease burden in infants and children, groups bearing the highest burden of the disease, are increasingly urgent.
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