Abstract
Malaria and some other tropical diseases are currently targeted for elimination and eventually eradication. Since resources are limited, prioritisation of countries or areas for elimination is often necessary. However, this prioritisation is frequently conducted in an ad hoc manner. Lower transmission areas are usually targeted for elimination first, but for some areas this necessitates long and potentially expensive surveillance programs while transmission is eliminated from neighbouring higher transmission areas. We use a mathematical model to compare the implications of prioritisation choices in reducing overall burden and costs. We show that when the duration of the elimination program is independent of the transmission potential, burden is always reduced most by targeting high transmission areas first, but to reduce costs the optimal ordering depends on the actual transmission levels. In general, when overall transmission potential is low and the surveillance cost per secondary case compared to the cost per imported case is low, targeting the higher transmission area for elimination first is favoured.
Highlights
The Global Technical Strategy for Malaria 2016–2030, released by the World Health Organization (WHO) (World Health Organization, 2015), sets the current global goals for malaria control and elimination by 2030 as: (i) reducing the number of malaria cases and deaths globally by 90% as compared to 2015; and (ii) eliminating and preventing re-establishment of transmission in at least 35 countries where malaria transmission was ongoing in 2015
Targeting isolated islands and other areas with low transmission potential for malaria elimination may have value as tests of new technologies or systems; but in general it is unclear whether targeting low transmission areas is a better strategy than focusing those resources on eliminating malaria from higher transmission areas, especially when these lower transmission areas face risks of malaria importation from neighbouring higher transmission areas
This paper aims to provide a mathematical formulation to guide strategic thinking about how zones with different levels of disease burden should be targeted for elimination, on the assumptions that (i) malaria control is maintained in all areas; (ii) elimination is technically possible in all the areas being considered; (iii) but resources to intensify control programs to achieve elimination are limited to targeting one area at a time
Summary
The Global Technical Strategy for Malaria 2016–2030, released by the World Health Organization (WHO) (World Health Organization, 2015), sets the current global goals for malaria control and elimination by 2030 as: (i) reducing the number of malaria cases and deaths globally by 90% as compared to 2015; and (ii) eliminating and preventing re-establishment of transmission in at least 35 countries where malaria transmission was ongoing in 2015. There is a global health priority in eliminating foci of drug resistance in the Greater Mekong subregion (Gueye et al, 2014), and spatially progressive elimination may be rational where the risk of re-establishment of transmission is low (Lines et al, 2008; Smith et al, 2013), or where a small focus of transmission has a disproportionate economic importance. Targeting isolated islands and other areas with low transmission potential for malaria elimination may have value as tests of new technologies or systems; but in general it is unclear whether targeting low transmission areas is a better strategy than focusing those resources on eliminating malaria from higher transmission areas, especially when these lower transmission areas face risks of malaria importation from neighbouring higher transmission areas
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