Reactive case detection could be a powerful tool in malaria elimination, as it selectively targets transmission pockets. However, field operations have yet to demonstrate under which conditions, if any, reactive case detection is best poised to push a region to elimination. This study uses mathematical modelling to assess how baseline transmission intensity and local interconnectedness affect the impact of reactive activities in the context of other possible intervention packages.
This article, published in Nature found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. Interventions have averted an estimated 663 (542–753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted).
Author: Battle KE, Bennett A, Bhatt S, Bisanzio D, Briet O, Cameron E, Cibulskis RE, Cohen JM, Dalrymple U, Eckhoff P, Eisele TP, Fergus CA, Gething PW, Griffin JT, Hay SI, Henry A, Lindgren F, Lynch M, Mappin B, Moyes CL, Murray CLJ, Penny MA, Smith DL, Smith TA, Weiss J, Wenger E, Yukich J
Publication date: September 2015
The primary aim of this study is to quantify the relative effectiveness of MDA and fMDA with DHAp against no mass treatment (standard of care) for reducing Plasmodium falciparum prevalence and incidence. Strengths of this trial include: a robust study design (CRCT); cross-sectional parasite surveys as well as a longitudinal cohort; and stratification of high and low transmission areas. Primary limitations include: statistical power to detect only a 50 % reduction in primary outcomes within high and low transmission strata; potential for contamination; and potential for misclassification of exposure.
The intervention [mass testing and treatment, MTAT] appears to be highly cost-effective relative to World Health Organization thresholds for malaria burden reduction in Zambia as compared to no MTAT. However, it was estimated that population-wide mass drug administration is likely to be more cost-effective for burden reduction and for transmission reduction compared to MTAT.
The findings [of this study] highlight the importance of increased community sensitization as part of mass treatment campaigns for improving campaign coverage and acceptance. Further, they suggest that communication channels between the Zambia Ministry of Health, National Malaria Control Centre and Medical Stores Limited may need to be improved so as to ensure there is consistent supply and management of commodities. Continued capacity building of CHWs and health facility supervisors is critical for a more effective programme and sustained progress towards malaria elimination.
When improved through comprehensive parasitologically confirmed case reporting, HMIS data can become a valuable tool for evaluating malaria program scale-up. Using this approach, this article provides further evidence that increased ITN coverage is associated with decreased malaria morbidity and use of health services for malaria illness in Zambia.
Author: Bennett A, Eisele TP, Hamainza B, Ingwe MM, Kamuliwo M, Keating J, Miller JM, Moonga HB, Smith TA, Steketee R, Vounatsou P, Yukich J
Publication date: November 2014
Source: Population health metrics