Abstract
Rapid declines in malaria prevalence, cases, and deaths have been achieved globally during the past 15 years because of improved access to first-line treatment and vector control. We aimed to assess the intervention coverage needed to achieve further gains over the next 15 years. We used a mathematical model of the transmission of Plasmodium falciparum malaria to explore the potential effect on case incidence and malaria mortality rates from 2015 to 2030 of five different intervention scenarios: remaining at the intervention coverage levels of 2011-13 (Sustain), for which coverage comprises vector control and access to treatment; two scenarios of increased coverage to 80% (Accelerate 1) and 90% (Accelerate 2), with a switch from quinine to injectable artesunate for management of severe disease and seasonal malaria chemoprevention where recommended for both Accelerate scenarios, and rectal artesunate for pre-referral treatment at the community level added to Accelerate 2; a near-term innovation scenario (Innovate), which included longer-lasting insecticidal nets and expansion of seasonal malaria chemoprevention; and a reduction in coverage to 2006-08 levels (Reverse). We did the model simulations at the first administrative level (ie, state or province) for the 80 countries with sustained stable malaria transmission in 2010, accounting for variations in baseline endemicity, seasonality in transmission, vector species, and existing intervention coverage. To calculate the cases and deaths averted, we compared the total number of each under the five scenarios between 2015 and 2030 with the predicted number in 2015, accounting for population growth. With an increase to 80% coverage, we predicted a reduction in case incidence of 21% (95% credible intervals [CrI] 19-29) and a reduction in mortality rates of 40% (27-61) by 2030 compared with 2015 levels. Acceleration to 90% coverage and expansion of treatment at the community level was predicted to reduce case incidence by 59% (Crl 56-64) and mortality rates by 74% (67-82); with additional near-term innovation, incidence was predicted to decline by 74% (70-77) and mortality rates by 81% (76-87). These scenarios were predicted to lead to local elimination in 13 countries under the Accelerate 1 scenario, 20 under Accelerate 2, and 22 under Innovate by 2030, reducing the proportion of the population living in at-risk areas by 36% if elimination is defined at the first administrative unit. However, failing to maintain coverage levels of 2011-13 is predicted to raise case incidence by 76% (Crl 71-80) and mortality rates by 46% (39-51) by 2020. Our findings show that decreases in malaria transmission and burden can be accelerated over the next 15 years if the coverage of key interventions is increased. UK Medical Research Council, UK Department for International Development, the Bill & Melinda Gates Foundation, the Swiss Development Agency, and the US Agency for International Development.
Highlights
Rapid declines in malaria have been achieved globally during the past 15 years because of improved access to treatment and vector control
With an increase to 80% coverage, we predicted a reduction in case incidence of 21% (95% credible intervals [CrI] 19–29) and a reduction in mortality rates of 40% (27–61) by 2030 compared with 2015 levels
The estimated proportion of children younger than 5 years at risk from malaria who sleep under a bednet in sub-Saharan Africa has increased from less than 2% in 2005 to 68% in 2015,1 and the estimated proportion of patients with confirmed Plasmodium falciparum malaria receiving appropriate treatment increased from less than 1% in 2005 to 16% across countries in 2014.1,2 This increase www.thelancet.com/infection Vol 16 April 2016
Summary
Rapid declines in malaria have been achieved globally during the past 15 years because of improved access to treatment and vector control. Evidence before this study The previous global strategy for malaria outlined in the Global Malaria Action Plan (2008) set the goals of a 75% reduction in malaria incidence and near-zero deaths by 2015. New goals have been set as part of WHO’s Global Technical Strategy for Malaria 2016–30, endorsed by the World Health Assembly in May, 2015. To inform this goal setting, we reviewed the National Strategic Plans from all malaria-endemic countries and undertook a country-bycountry review of previous trends in malaria cases for the 59 countries with sufficiently complete and consistent data. We searched the scientific literature using PubMed with the search terms “projection OR mathematical model” AND “malaria OR falciparum OR plasmodium”, for English-language articles published between Jan 1, 2000, and Feb 6, 2015, but did not identify any modelling studies estimating the potential trajectories of Plasmodium falciparum malaria at a global level
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