Abstract
Malaria-endemic countries have to decide how much of their limited resources for vector control to allocate toward implementing long-lasting insecticidal nets (LLINs) versus indoor residual spraying (IRS). To help the Mozambique Ministry of Health use an evidence-based approach to determine funding allocation toward various malaria control strategies, the Global Fund convened the Mozambique Modeling Working Group which then used JANUS, a software platform that includes integrated computational economic, operational, and clinical outcome models that can link with different transmission models (in this case, OpenMalaria) to determine the economic value of vector control strategies. Any increase in LLINs (from 80% baseline coverage) or IRS (from 80% baseline coverage) would be cost-effective (incremental cost-effectiveness ratios ≤ $114/disability-adjusted life year averted). However, LLIN coverage increases tend to be more cost-effective than similar IRS coverage increases, except where both pyrethroid resistance is high and LLIN usage is low. In high-transmission northern regions, increasing LLIN coverage would be more cost-effective than increasing IRS coverage. In medium-transmission central regions, changing from LLINs to IRS would be more costly and less effective. In low-transmission southern regions, LLINs were more costly and less effective than IRS, due to low LLIN usage. In regions where LLINs are more cost-effective than IRS, it is worth considering prioritizing LLIN coverage and use. However, IRS may have an important role in insecticide resistance management and epidemic control. Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology.
Highlights
In 2015, malaria resulted in an estimated 214 million cases and 438,000 deaths worldwide; 89% of these cases and 91% of these deaths occurred in sub-Saharan Africa.[1]
Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology
The dotted lines in each panel plot the number of annual new malaria episodes per 1,000 persons for the 3 years if the current malaria control strategies in Mozambique were maintained
Summary
In 2015, malaria resulted in an estimated 214 million cases and 438,000 deaths worldwide; 89% of these cases and 91% of these deaths occurred in sub-Saharan Africa.[1] To address this, the World Health Organization (WHO) has recommended that all persons at risk for malaria should be covered by at least one vector control intervention, either the use of insecticide-treated nets (or long-lasting insecticidal nets [LLINs]) or indoor residual spraying (IRS). Due to the cost of these interventions, most countries in which malaria is endemic have to decide how many resources to allocate toward vector control, and within their budget for vector control, whether to prioritize LLINs or IRS. In 2014, the country of Mozambique was in the midst of developing an application to the Global Fund to support its malaria control programs in which decisions needed to be made on what kinds of vector control would be implemented and where. Current epidemiologic data show that malaria is on the rise with reported cases increasing by 40% from 2013 to 2014, outpatient visits increasing by 5%, and deaths increasing by 10%.4
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