Abstract
BackgroundScale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. This article presents a new modelling tool projecting malaria infection, cases and deaths to support impact evaluation, target setting and strategic planning.MethodsNested in the Spectrum suite of programme planning tools, the model includes historic estimates of case incidence and deaths in groups aged up to 4, 5–14, and 15+ years, and prevalence of Plasmodium falciparum infection (PfPR) among children 2–9 years, for 43 sub-Saharan African countries and their 602 provinces, from the WHO and malaria atlas project. Impacts over 2016–2030 are projected for insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and effective management of uncomplicated cases (CMU) and severe cases (CMS), using statistical functions fitted to proportional burden reductions simulated in the P. falciparum dynamic transmission model OpenMalaria.ResultsIn projections for Nigeria, ITNs, IRS, CMU, and CMS scale-up reduced health burdens in all age groups, with largest proportional and especially absolute reductions in children up to 4 years old. Impacts increased from 8 to 10 years following scale-up, reflecting dynamic effects. For scale-up of each intervention to 80% effective coverage, CMU had the largest impacts across all health outcomes, followed by ITNs and IRS; CMS and SMC conferred additional small but rapid mortality impacts.DiscussionSpectrum-Malaria’s user-friendly interface and intuitive display of baseline data and scenario projections holds promise to facilitate capacity building and policy dialogue in malaria programme prioritization. The module’s linking to the OneHealth Tool for costing will support use of the software for strategic budget allocation. In settings with moderately low coverage levels, such as Nigeria, improving case management and achieving universal coverage with ITNs could achieve considerable burden reductions. Projections remain to be refined and validated with local expert input data and actual policy scenarios.
Highlights
Scale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based
Simulated impacts for user-specified scale-up were statistically summarized for usage of insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and effective management of uncomplicated cases (CMU) and severe cases (CMS), as detailed in [16]
Impacts were projected for scale-up of ITNs, IRS, effective management of uncomplicated malaria cases (CMU), effective management of severe malaria cases (CMS) in turn, each to 80% national coverage by 2020, in linear scale-up from their 2015 baseline levels (Fig. 3a), relative to a projection with constant coverages for all interventions
Summary
Scale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. Effective malaria prevention and treatment interventions have been scaled-up substantially with increasing national and donor funding since the early 2000s. 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 improving socio-economic factors [2, 3]. To sustain these improvements, the World Health Organization (WHO) global technical strategy for malaria recommends further scale-up to universal coverage with suitable preventive and curative interventions [4]. While most countries focus on WHOrecommended proven effective interventions, national strategies and plans vary considerably in budget allocations across interventions, and rationales for mixes of interventions are often not explicit [5]
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