Malaria Epidemics Research Articles

Analysing trends and forecasting malaria epidemics in Madagascar using a sentinel surveillance network: a web-based application

BackgroundThe use of a malaria early warning system (MEWS) to trigger prompt public health interventions is a key step in adding value to the epidemiological data routinely collected by sentinel surveillance systems.MethodsThis study describes a system using various epidemic thresholds and a forecasting component with the support of new technologies to improve the performance of a sentinel MEWS. Malaria-related data from 21 sentinel sites collected by Short Message Service are automatically analysed to detect malaria trends and malaria outbreak alerts with automated feedback reports.ResultsRoll Back Malaria partners can, through a user-friendly web-based tool, visualize potential outbreaks and generate a forecasting model. The system already demonstrated its ability to detect malaria outbreaks in Madagascar in 2014.ConclusionThis approach aims to maximize the usefulness of a sentinel surveillance system to predict and detect epidemics in limited-resource environments.

Describing interaction effect between lagged rainfalls on malaria: an epidemiological study in south\u2013west China

BackgroundWhen discussing the relationship between meteorological factors and malaria, previous studies mainly focus on the interaction between different climatic factors, while the possible interaction within one particular climatic predictor at different lag periods has been largely neglected. In this study, this issue was investigated by exploring the interaction of lagged rainfalls and its impact on malaria epidemics, which is a typical example of those meteorological variables.MethodsThe weekly data of malaria cases and three climatic variables of 30 counties in southwest China from 2004 to 2009 were analysed with the varying coefficient-distributed lag non-linear model. The correlation patterns of the 6th, 9th and 12th week lags would vary over different rainfall levels at the 4th-week lag.ResultsThe non-linear patterns for rainfall at different rainfall levels are distinct from each other. In the low rainfall level at the 4th week lag, the increasing rainfall may promote the transmission of malaria. However, for the high rainfall level at the 4th week lag, evidence shows that the excessive rainfall decreases the risk of malaria.ConclusionThis study reports for the first time that the interaction effect between lagged rainfalls on malaria exists, and highlights the importance of integrating the interaction between lagged predictors in relevant studies, which could help to better understand and predict malaria transmission.

Spatiotemporal epidemic characteristics and risk factor analysis of malaria in Yunnan Province, China

BackgroundMalaria remains an important public health concern in China and is particularly serious in Yunnan, a China’s provincial region of high malaria burden with an incidence of 1.79/105 in 2012. This study aims to examine the epidemiologic profile and spatiotemporal aspects of epidemics of malaria, and to examine risk factors which may influence malaria epidemics in Yunnan Province.MethodsThe data of malaria cases in 2012 in 125 counties of Yunnan Province was used in this research. The epidemical characteristics of cases were revealed, and time and space clusters of malaria were detected by applying scan statistics method. In addition, we applied the geographically weighted regression (GWR) model in identifying underlying risk factors.ResultsThere was a total of 821 cases of malaria, and male patients accounted for 83.9% (689) of the total cases. The incidence in the group aged 20–30 years was the highest, at 3.00/105. The majority (84.1%) of malaria cases occurred in farmers and migrant workers, according to occupation statistics. On a space-time basis, epidemics of malaria of varying severity occurred in the summer and autumn months, and the high risk regions were mainly distributed in the southwest counties. Annual average temperature, annual cumulative rainfall, rice yield per square kilometer and proportion of rural employees mainly showed a positive association with the malaria incidence rate, according to the GWR model.ConclusionsMalaria continues to be one of serious public health issues in Yunnan Province, especially in border counties in southwestern Yunnan. Temperature, precipitation, rice cultivation and proportion of rural employees were positively associated with malaria incidence. Individuals, and disease prevention and control departments, should implement more stringent preventative strategies in locations with hot and humid environmental conditions to control malaria.

GIS-Based Model for Mapping Malaria Risk under Climate Change Case Study: Burundi

Malaria is one of the largest problems threatening global public health that is expected to increase in the future under climate change due to associated warming and wetter conditions. This will exacerbate disease burden in Burundi as one of sub-Saharan African countries, where 2 million cases of malaria were reported in 2015. This highlights the need for developing a methodology for mapping malaria risk under climate change and delineating those regions that may potentially experience malaria epidemics in the future. Malaria transmission and distribution are generally determined by a wide range of climatic, topographic and socioeconomic factors. The paper in hand is intended to map malaria risk in Burundi under climate change up to 2050. For this purpose, a GIS-based model was developed for mapping malaria as a function of various climatic and topographic determinants of malaria. The developed GIS-model was used in mapping malaria risk under current climatic conditions. Thereafter, the produced risk map was validated compared to malaria morbidity data in Burundi at health district level. Finally, the GIS-model was applied to map malaria risk in the future under RCPs 2.6 and 8.5 scenarios up to 2050. It was found that about 34.6% and 44% of Burundi land surface will be highly vulnerable to malaria risk by 2050 under RCPs 2.6 and 8.5 scenario, respectively. Also, it was noted that such highly vulnerable areas are distributed mainly in northern parts of the country. The suggested GIS-based model for mapping malaria risk under climate change can contribute largely to more informed decision-making and policy making process in terms of planning for intervention and control malaria risk. This in turn can support reducing disease burden and improving resilience to climate change.

Epidemiology of Plasmodium vivax Malaria in Peru.

Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s–2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005–2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P. vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P. falciparum and chloroquine–primaquine for P. vivax. Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P. vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine- and 8-aminoquinoline-resistant P. vivax. Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P. vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination.

Another Approach to Detect Malaria Epidemics and to Evaluate the Impact of Their Control Measures in Situation of Lack of Information

Another Approach to Detect Malaria Epidemics and to Evaluate the Impact of Their Control Measures in Situation of Lack of Information

Strategic Map for Hospital Management: Perspectives and Priorities

IntroductionIt seems certain that there will be more changes in the healthcare industry in the next 15 years then there has been in the past 15 years. Why? What is the source of change? First of all, healthcare institutions continue to face a turbulent, confusing, and often threatening environment. It means that one of the most well described source of the change is external (Luigi et al., 2014). Legislative and policy initiatives, changes in demographics, increasing prevalence of chronic diseases, changes in lifestyles, consumers' lack of trust in traditional health systems, demand for more sophisticated, convenient, transparent, affordable and personalized service as well as increasing costs on healthcare (as % to GDP) have great impact on healthcare institutions Rudawska & Pctlak, 2013). This trends are well described in literature, and continuously researched by organizations and institution like: PWC (2014, 2015), CDC (Bernstein et al., 2003), Premier Healthcare Alliance, individual scientists (Rudawska & Urbanczyk, 2014) and practitioners.But there are also other sources of change. Nowadays, healthcare institutions change in the way every organization does (Rudawska, 2013). One issue of this change is especially important for healthcare institutions because of their specificity. It is sustainable development. The concept of sustainable development represents a shift in understanding of humanity's place on the planet (Hopwood et al., 2005). Why it is so important for management of a healthcare institution? Mostly, because these organizations are predestinated to implement sustainable development in some parts world-wide. In some parts they are doing it already. The UN have identified 17 goals and 169 targets of sustainable development (UN, 2015). One of the main goals is to ensure healthy lives and promote well-being for all at all ages. Some of the targets are obvious: reduce the global maternal mortality ratio to less than 70 per 100,000 live births or preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births. But some of them need additional effort. In particular, the epidemics of AIDS, tuberculosis, malaria and tropical diseases; combating hepatitis, water-borne diseases and other communicable diseases by the end of 2030 or reduce by one third premature mortality from non-communicable diseases through prevention and treatment and also, promoting mental health and well-being. Summarizing, healthcare institutions in future should become more open for the society, and more cooperative in fulfilling these goals.For hospital management it becomes increasingly difficult to adapt to the pace of policy changes and reforms while balancing economical considerations, social responsibility to provide high-quality health care to the community served and, finally, ecological concerns (Glouberman, Mintzberg, 2001). In this context, hospital management focuses on understanding the interconnections on the macro level - between society and the ecosystem - and changing its strategy to optimize the outcomes for these systems.Sustainable development concept requires managing hospitals on three different fields using three different value systems. Economic aims requires economic calculation of revenues, costs, incomes and expanses. Social aims in hospital management requires considering social reflections i.e. impacts of various diseases on society (epidemiology). Ecologic aims requires also different calculation. Ecologic calculation is focused on hospital impact on the environment. It is connected with waste management, drugs usage, as well as bioethics issues (Fig. 1).Between economic, social and ecologic aspects here there is an obvious conflict. The main source of this conflict is the lack of resources, especially financial ones (Urbaniec, 2015). …

Indigenous environmental indicators for malaria: A district study in Zimbabwe

This paper discusses indigenous environmental indicators for the occurrence of malaria in ward 11, 15 and 18 of Gwanda district, Zimbabwe. The study was inspired by the successes of use of indigenous knowledge systems in community based early warning systems for natural disasters. To our knowledge, no study has examined the relationship between malaria epidemics and climatic factors in Gwanda district. The aim of the study was to determine the environmental indicators for the occurrence of malaria. Twenty eight key informants from the 3 wards were studied. Questionnaires, focus group discussions and PRA sessions were used to collect data. Content analysis was used to analyse the data. The local name for malaria was ‘uqhuqho’ literally meaning a fever. The disease is also called, “umkhuhlane wemiyane” and is derived from the association between malaria and mosquitoes. The findings of our study reveal that trends in malaria incidence are perceived to positively correlate with variations in both temperature and rainfall, although factors other than climate seem to play an important role too. Plant phenology and insects are the commonly used indicators in malaria prediction in the study villages. Other indicators for malaria prediction included the perceived noise emanating from mountains, referred to as “roaring of mountains” and certain behaviours exhibited by ostriches. The results of the present study highlight the importance of using climatic information in the analysis of malaria surveillance data, and this knowledge can be integrated into the conventional health system to develop a community based malaria forecasting system.

Assessment of Malaria Reporting and Epidemic Preparedness Systems in Health Facilities in Eldoret West District, Uasin Gishu County, Kenya.

The most important factor in reducing the impact of an epidemic is a timely response with implementation of effective control measures at the point of detection. This study sought to assess the malaria reporting and epidemic preparedness systems of health facilities in Eldoret West District, Kenya. A cross-sectional study design was adapted. A census technique was used to select all the forty five health facilities in the district comprising of government, mission and non-governmental facilities. An interviewer administered questionnaire was used for data collection and analysis done using Stata. Categorical variables were summarized as frequencies and corresponding percentages. The overall reporting rate was 91.7% for all the health facilities. Only 15 health facilities (33%) plotted malaria trend lines for number of cases of malaria. Malaria epidemics were reported within 24 hours in 22 health facilities but they lacked the appropriate supplies to respond to confirmed cases or epidemics. The overall malaria reporting completeness rate was above 90% implying that the malaria surveillance system was generally good. Concerted efforts by concerned stakeholders should ensure improvement of malaria epidemic preparedness system in all health facilities and provision of information to health personnel on malaria outbreak response strategies.

High-Resolution Plasmodium falciparum Malaria Risk Mapping in Mutasa District, Zimbabwe: Implications for Regaining Control.

In Zimbabwe, more than half of malaria cases are concentrated in Manicaland Province, where seasonal malaria epidemics occur despite intensified control strategies. The objectives of this study were to develop a prediction model based on environmental risk factors and obtain seasonal malaria risk maps for Mutasa District, one of the worst affected districts in Manicaland Province. From October 2012 to September 2015, 483 households were surveyed, and 104 individuals residing within 69 households had positive rapid diagnostic test results. Logistic regression was used to model the probability of household positivity as a function of the environmental covariates extracted from high-resolution remote sensing data sources. Model predictions and prediction standard errors were generated for the rainy and dry seasons. The resulting maps predicted elevated risk during the rainy season, particularly in low-lying areas bordering Mozambique. In contrast, the risk of malaria was low across the study area during the dry season with foci of malaria risk scattered along the northern and western peripheries of the study area. These findings underscore the need for strong cross-border malaria control initiatives to complement country-specific interventions.

Evaluation of epidemiological data of malaria between 2001-2011 in Sanliurfa, Turkey

Although Plasmodium vivax is the only cause of malaria cases detected in Turkey, an increase number of imported P.falciparum cases have begun to be observed recently. Sanliurfa is a province located at Southeastern region of Turkey where malaria is endemic and also one of the two largest malaria epidemics of Turkey was experienced with 84.345 cases in 1994. As this region has borders with countries like Iraq, Iran and Syria, cross border migration caused an increase in imported cases. In addition, climate change, alteration in temperature and humidity due to the Southeastern Anatolian Irrigation Project have led an increase in suitable breeding grounds for mosquitoes. Since new indigenous malaria cases, except imported ones are not detected in Sanliurfa nowadays, there is not enough data on the malaria epidemiology in this region including recent years. The aim of this study was to evaluate the epidemiological data in connection with malaria cases observed in Sanliurfa which is a critical region for this infection for a 11-year-period, between the years of 2001 to 2011, retrospectively. Data obtained from the Malaria Control Unit of the Communicable Diseases Division of Sanliurfa Provincial Health Directorate were analized in terms of frequency of the cases, distribution of the cases in years and months, demographical characteristics, the source and species distribution of the parasite and the locations of the disease. A total of 1.149.196 blood smear samples have been examined during 11-year-period as part of surveillance programme and 4394 (0.4%) of them were positive for Plasmodium spp. The agent was P.vivax in 99.9% (4391/4394) of the cases, while in three cases (0.07%) who were diagnosed after 2010, it was P.falciparum. Of the patients 2351 (53.5%) were male and 2043 (46.5%) were female (p> 0.05), whose age ranging from 3 months to 80 years (mean age: 19.21 ± 16.12 years). The frequencies of the cases according to the age groups 0-11 months, 1-4 years, 5-9 years, 10-14 years and 15 years were as follows; 2.5%, 15.1%, 18%, 13.9% and 50.5%, respectively. The detection of Plasmodium spp. in the samples examined in 2002 (1244/110.533; 1.1%) was the highest, and in 2011 (1/50.981; 0.002%) was the lowest. The distribution rates of 4394 cases according to the years between 2001 to 2011, were found as 25.4%, 28.3%, 17.8%, 10.9%, 8.9%, 5.6%, 1.4%, 1.4%, 0.2%, 0.009% and 0.02%, respectively. Of all cases, 80.6% were autochthonous and 19.4% were imported. Most of the cases were detected in Siverek county with a rate of 71.4%, followed by Ceylanpınar (13.5%) and Viranşehir (6.6%) counties. Although malaria cases were detected throughout the year in Sanliurfa in respect to the climate, the highest numbers were recorded in September (832/4394; 18.9%) and November (1054/4394; 24%). This study emphasized that malaria cases due to local transmission declined to zero in Sanliurfa like the recent situation in Turkey. However, P.falciparum malaria cases are being reported due to the travels to endemic countries or migrations from those countries. Effective malaria control attempts, within the scope of Malaria Elimination Programme implemented in Turkey, should be continued with the same stability without any abruption in Sanliurfa province where the disease had been endemic in the past.

Gender, Race, and Heterogeneous Effects of Epidemic Malaria on Human Capital and Income

AbstractThis article investigates the impact of exposure to a serious, unusual, and unforeseen malaria epidemic in northeast Brazil in 1938–40 on subsequent human capital attainment and income. Arguing the event was exogenous, the article exploits cohort and regional heterogeneity in exposure to identify effects. Results are consistent with differential mortality rates according to gender and socioeconomic status, such that heterogeneous selection and scarring effects are observed. Analyzing by gender alone, positive (selection) effects are found for men, and mixed (positive and negative) effects for women. Allowing for heterogeneity by race, selection effects persist for men. In contrast, positive (selection) effects are observed for nonwhite women, and negative (scarring) effects for white women. Results contribute to evidence suggesting that exposure to negative environmental shocks affects human capital attainment, while also suggesting it heterogeneously affects cohort composition.

Reduction in Malaria Incidence following Indoor Residual Spraying with Actellic 300 CS in a Setting with Pyrethroid Resistance: Mutasa District, Zimbabwe.

BackgroundMore than half of malaria cases in Zimbabwe are concentrated in Manicaland Province, where seasonal malaria epidemics occur despite intensified control strategies. Recently, high levels of pyrethroid and carbamate resistance were detected in Anopheles funestus, the major malaria vector in eastern Zimbabwe. In response, a single round of indoor residual spraying (IRS) using pirimiphos-methyl (an organophosphate) was implemented in four high burden districts of Manicaland Province from November 1, 2014 to December 19, 2014. The objective of this study was to evaluate the effect of this programmatic switch in insecticides on malaria morbidity reported from health care facilities in Mutasa District, one of the worst affected districts in Manicaland Province.MethodsThe number of weekly malaria cases for each health facility 24 months prior to the 2014 IRS campaign and in the subsequent high transmission season were obtained from passive case surveillance. Environmental variables were extracted from remote-sensing data sources and linked to each health care facility. Negative binomial regression was used to model the weekly number of malaria cases, adjusted for seasonality and environmental variables.ResultsFrom December 2012 to May 2015, 124,206 malaria cases were reported from 42 health care facilities in Mutasa District. Based on a higher burden of malaria, 20 out of 31 municipal wards were sprayed in the district. Overall, 87.3% of target structures were sprayed and 92.1% of the target population protected. During the 6 months after the 2014 IRS campaign, a period when transmission would have otherwise peaked, the incidence of malaria was 38% lower than the preceding 24 months at health facilities in the sprayed wards.ConclusionsPirimiphos-methyl had a measurable impact on malaria incidence and is an effective insecticide for the control of An. funestus in eastern Zimbabwe.

Mathematical Analysis of Ivermectin as a Malaria Control Method

Malaria epidemics are detrimental to the health of many people and economies of many countries. There 5 exist methods of malaria control, but the fight against the disease is far from being over. The history of 6 mathematical modeling of malaria spread is more than hundred years old. Recently, a model was proposed in 7 the literature that captures the dynamics of malaria transmission by taking into account the behavior and life 8 cycle of the mosquito and its interaction with the human population. We modify this model by including the 9 effect of an anti-parasitic medication, ivermectin, on several threshold parameters, which can determine the 10 spread of malaria. The modified model takes a form of a system of nonlinear ordinary differential equations. 11 We investigate this model using applied dynamical systems techniques. We were able to show that that exist 12 parameter regimes such that careful use of ivermectin can curtail the spread of malaria without harming the 13 mosquito population. Otherwise, the ivermectin either eradicates the mosquito population, or has little to 14 no effect on the spread of malaria. We suggest that ivermectin can be very effective when used as a malaria 15 control method in conjunction with other methods such as reduction of breeding sites. 16

Assessment of Integrated Disease Surveillance and Response Implementation in Special Health Facilities of Dawuro Zone

Background: Widespread epidemics of malaria, yellow fever, meningitis and Tuberculosis across the Sub-Saharan African in the 1990s were largely attributed to poor surveillance systems which were neither able to detect communicable diseases on time nor build up an effective response. Effective communicable disease control relies on effective response systems which are dependent upon effective disease surveillance. Integrated Disease Surveillance and Response strategy (IDSR) was adopted by the AFRO members of the World Health Organization (WHO) to improve surveillance activities. Objective: This study was conducted to assess IDSR implementation in selected Health Facilities of Dawuro zone. Settings and Design: Dawuro zone is located in Southwestern Ethiopia. It shares borders with the Gamo-Gofa zone in south, Wolayta zone in the east, Konta Special district in the west, Oromia region in North, Hadya and Kambata Tembaro Zones in North east. Based on the 2006 census, it has a population of 590,090. A cross-sectional facility based descriptive study was conducted. Materials and Methods: An interviewer administered questionnaire of an adapted from the WHO Protocol for the Assessment of National Communicable Disease Surveillance and Response systems was used. Data analysis was carried out using SPSS version 21. Results: All of the health facilities (38%) have any case definition for the priority diseases. About 43% of the health facilities had electricity. Only seven percent has standby generators, which were functional. All health centers had calculators and stationery available for data management while 36% had computers and but 28% have printers available. No form of data analysis was available in 93% of the health centers, analysis of data were however available in all 14 Health centers studied. A reporting system was available in 92% of health centers. There was no feedback from the region to the district health offices and Health centers, nor was there feedback from the national to the zone level. Conclusion and recommendation: The implementation of IDSR in Dawuro zone is moderate. Resources are insufficient and although some structures are present on ground like the presence of reporting mechanism, feedback is low from the higher to lower levels. Standard case definitions are not used in all health facilities for all priority diseases. Standard case definitions should be made available and used in all health facilities.

Climate change and malaria control: the importance of mitigation and a call to action

Malaria has remained an important target for global disease control efforts for decades. The streams of funds and, consequently, availability of effective interventions for the disease have resulted in considerable reduction in its burden, globally. Despite the relative success of such global efforts, malaria remains a significant threat in over a hundred countries, worldwide, leading to about one million deaths and hundreds of millions of hospital visits, annually. Many researchers and health commentators have argued that global warming, a consequence of climate change, could be linked – directly or indirectly – to the persistence as well as the re-emergence of malaria epidemics. Although the association between climate change and malaria spread is complex and remains a subject of controversy and debates, this paper argues that the spread and severity of malaria in several places and the increased incidences of the disease in some regions could indeed be associated with the effects and consequences of climate change. The paper maintains that the biology of the Plasmodium spp , the ecology of mosquitoes, and even the susceptibility of humans to malaria could all be affected directly/indirectly by extreme climatic events. Based on the growing body of evidence on this subject, this paper makes a call for all stakeholders to come to a consensus on the significance of climate change mitigation to malaria control, and offers some recommendations on the way forward.

A Study of Malaria Epidemic Model Using the Effect of Lost Immunity

A Study of Malaria Epidemic Model Using the Effect of Lost Immunity

Application of geographical information system and remote sensing in malaria research and control in South Africa: a review

This paper presents a review of numerous items of published literature on the use of spatial technology for malaria epidemiology in South Africa between 1930 and 2013. In particular, focus is on the use of statistical and mathematical models as well as geographic information science (GIS) and remote sensing (RS) technology for malaria research. First, the review takes cognisance of the use of predictive models to determine the association between climatic factors and malaria epidemics only in KwaZulu-Natal province. Similar studies in other endemic regions such as Limpopo and Mpumalanga provinces have not been reported in the literature. While the integration of GIS with remote sensing has the potential of identifying, characterising, and monitoring breeding habitats and mapping malaria risk areas in South Africa, studies on the application of spatial technology in malaria research and control in South Africa are inexhaustive and have not been reported in the literature. As a result, a critical robust mal...

From conceptual pluralism to practical agreement on policy: global responsibility for global health.

BackgroundAs the human cost of the global economic crisis becomes apparent the ongoing discussions surrounding the post-2015 global development framework continue at a frenzied pace. Given the scale and scope of increased globalization moving forward in a post-Millennium Development Goals era, to protect and realize health equity for all people, has never been more challenging or more important. The unprecedented nature of global interdependence underscores the importance of proposing policy solutions that advance realizing global responsibility for global health.DiscussionThis article argues for advancing global responsibility for global health through the creation of a Global Fund for Health. It suggests harnessing the power of the exceptional response to the combined epidemics of AIDS, TB and Malaria, embodied in the Global Fund to Fight AIDS, Tuberculosis and Malaria, to realize an expanded, reconceptualized Global Fund for Health. However this proposal creates both an analytical quandary embedded in conceptual pluralism and a practical dilemma for the scope and raison d’etre of a new Global Fund for Health. To address these issues we offer a logical framework for moving from conceptual pluralism in the theories supporting global responsibility for health to practical agreement on policy to realize this end. We examine how the innovations flowing from this exceptional response can be coupled with recent ideas and concepts, for example a global social protection floor, a Global Health Constitution or a Framework Convention for Global Health, that share the global responsibility logic that underpins a Global Fund for Health.ConclusionsThe 2014 Lancet Commission on Global Governance for Health Report asks whether a single global health protection fund would be better for global health than the current patchwork of global and national social transfers. We concur with this suggestion and argue that there is much room for practical agreement on a Global Fund for Health that moves from the conceptual level into policies and practice that advance global health. The issues of shared responsibility and mutual accountability feature widely in the post-2015 discussions and need to be addressed in a coherent manner. Our article argues why and how a Global Fund for Health effectuates this, thus advancing global responsibility for global health.

Predictability of epidemic malaria under non-stationary conditions with process-based models combining epidemiological updates and climate variability

BackgroundPrevious studies have demonstrated the feasibility of early-warning systems for epidemic malaria informed by climate variability. Whereas modelling approaches typically assume stationary conditions, epidemiological systems are characterized by changes in intervention measures over time, at scales typically longer than inter-epidemic periods. These trends in control efforts preclude simple application of early-warning systems validated by retrospective surveillance data; their effects are also difficult to distinguish from those of climate variability itself.MethodsRainfall-driven transmission models for falciparum and vivax malaria are fitted to long-term retrospective surveillance data from four districts in northwest India. Maximum-likelihood estimates (MLEs) of model parameters are obtained for each district via a recently introduced iterated filtering method for partially observed Markov processes. The resulting MLE model is then used to generate simulated yearly forecasts in two different ways, and these forecasts are compared with more recent (out-of-fit) data. In the first approach, initial conditions for generating the predictions are repeatedly updated on a yearly basis, based on the new epidemiological data and the inference method that naturally lends itself to this purpose, given its time-sequential application. In the second approach, the transmission parameters themselves are also updated by refitting the model over a moving window of time.ResultsApplication of these two approaches to examine the predictability of epidemic malaria in the different districts reveals differences in the effectiveness of intervention for the two parasites, and illustrates how the ‘failure’ of predictions can be informative to evaluate and quantify the effect of control efforts in the context of climate variability. The first approach performs adequately, and sometimes even better than the second one, when the climate remains the major driver of malaria dynamics, as found for Plasmodium vivax for which an effective clinical intervention is lacking. The second approach offers more skillful forecasts when the dynamics shift over time, as is the case of Plasmodium falciparum in recent years with declining incidence under improved control.ConclusionsPredictive systems for infectious diseases such as malaria, based on process-based models and climate variables, can be informative and applicable under non-stationary conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0937-3) contains supplementary material, which is available to authorized users.