The human and economic costs of maintaining elimination are also lower than those associated with achieving it, so it is desirable to reach elimination quickly. As the only stable result that avoids the burden of continued, intensive control efforts, it also limits or avoids acquired resistance in parasites and mosquitoes. Prudence and good strategy are necessary to balance up-front with ongoing costs for malaria control.Įlimination, however lengthy the journey may be, is the most important goal for all control programmes. Though effective interventions to stem transmission are relatively expensive, the cost of failing to control malaria is higher, both in lost health and in hindered economic growth. And this problem is getting more severe: spending per person at risk in the highest burden countries has reduced even further in the last three years, creating challenges for continued global progress towards malaria eradication. As GDP growth and malaria are negatively correlated, national malaria control programmes and their partners in endemic countries must manage effective malaria control within stringent budget constraints.
With 76% of the world’s entire malaria morbidity burden borne by just 13 nations, and malaria prevalence related to both micro and macrocroeconomic indicators of poverty, those countries most burdened tend also to be those least able to afford its suppression. Mass screening and treatment (MSAT) with highly sensitive rapid diagnostic tests may demonstrate a comparable trend while mass LLIN campaigns may similarly coordinate with MDA/MSAT. An effective synchronous treatment campaign has the potential to greatly augment the impact of indoor residual spraying. When co-timed, the rapid clearing of the host parasite reservoir via chemotherapy is protected from resurgence by the longer duration of the vector control. A mass treatment campaign is normally short-lived, especially in higher transmission settings. The strong synergies found for these control tools between the complementary interventions demonstrate a general feature of effective concurrent campaign-style vector and medical interventions. Openmalaria simulations of this medical control augmentation of an IRS campaign show an even stronger response with the same timing relationship. In the Ross–Macdonald model, the impact compared was roughly double the sequential interventions in most transmission settings. The added benefit of co-timed interventions was robust to differences in the models. Resultsīy modelling IRS and MDA together and varying their deployment times, a strong synergy was found when the administered interventions overlapped. The impact of each intervention strategy was measured through its ability to prevent host infections over time, and the effects were compared to the baseline case of deploying interventions in isolation. High coverage interventions are modelled in different transmission environments using two methods: a Ross–Macdonald model variant and openmalaria simulations. These synergistic benefits likely differ across settings depending on transmission intensity and its overall seasonal pattern. Recently, a strong timing-dependent synergy between an IRS campaign and a mass drug administration (MDA) was theoretically quantified. While possible synergies between IRS and long-lasting insecticide-treated nets (LLINs) have been investigated in multiple transmission settings, coordinated synergy between IRS and other mass medical distribution campaigns have not attracted much attention. One commonly used intervention in sub-Saharan Africa is indoor residual spraying (IRS), typically deployed through a mass campaign. Synergies between different control tools, in which more than additive benefit accrues from interventions used together, are of interest because they may be used to obtain savings or to maximize health impact per expenditure.
Control programmes for high burden countries are tasked with charting effective multi-year strategies for malaria control within significant resource constraints.
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