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HasapAla SM, Azrag RS, Awad OM. Cost effectiveness of malaria vector control activities in Sudan. Malar J 2024; 23:80. [PMID: 38491492 PMCID: PMC10943848 DOI: 10.1186/s12936-024-04900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Malaria vector control activities in Sudan rely largely on Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spray (IRS) and Larval Source Management (LSM). The present study attempted to determine cost effectiveness of inputs and operations of vector control interventions applied in different environmental settings in central and eastern Sudan, as well as their impact. METHODS The inputs utilized and cost of each vector control activity, operational achievements and impact of the applied malaria vector control activities; IRS, LLINs and LSM were determined for eight sites in Al Gazira state (central Sudan) and Al Gadarif state (eastern Sudan). Operational costs were obtained from data of the National Malaria Control Program in 2017. Impact was measured using entomological indicators for Anopheles mosquitoes. RESULTS The total cost per person per year was $1.6, $0.85, and $0.32 for IRS, LLINs and LSM, respectively. Coverage of vector control operations was 97%, 95.2% and 25-50% in IRS, LLINs and LSM, respectively. Vectorial capacity of malaria vectors showed statistically significant variations (P < 0.034) and ranged 0.294-0.65 in areas implemented LSM in comparison to 0.097-0.248 in areas applied IRS and LLINs, respectively. Both indoor and outdoor biting Anopheles mosquitoes showed noticeable increase that reached 3-12 folds in areas implemented LSM in comparison to areas implemented IRS and LLINs. Annual malaria prevalence was 13.1-21.1% in areas implemented LSM in comparison to 3.20%, 4.77% in areas implemented IRS and LLINs, respectively. CONCLUSION IRS and LLINs are cost effective control measures due to adequate inputs and organized process. However, the unit cost of LSM intervention per outcome and subsequently the impact is hugely affected by the low coverage. The very weak support for implementation of LSM which includes inputs resulted in weakness of its process and consequently its impact. Implementation of LSM by local government in urban settings is challenged by many factors the most important are maintenance of adequate stable level of funding, un-adequate number of well trained health workers, unstable political and administrative conditions and weak infrastructure. These challenges are critical for proper implementation of LSM and control of malaria in urban settings in Sudan.
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Affiliation(s)
- Sami M HasapAla
- Department of Environmental Health, Faculty of Public Health, Shendi University, Shendi, Sudan
| | - Rasha S Azrag
- Vector Genetics and Control Laboratory, Department of Zoology, Faculty of Science, University of Khartoum, Khartoum, Sudan.
| | - Osama M Awad
- Department of Environmental Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Moemenbellah-Fard MD, Hosseinizadeh ZS, Alipour H, Heiran R, Shahriari-Namadi M, Ghasemian A, Osanloo M. Comparative Effects of Elettaria cardamomum Essential Oil and Its Nanoliposomal State on Mortality of Anopheles stephensi Larvae. J Arthropod Borne Dis 2023; 17:371-382. [PMID: 38868673 PMCID: PMC11164617 DOI: 10.18502/jad.v17i4.15300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/24/2023] [Indexed: 06/14/2024] Open
Abstract
Background Malaria has remained the most dreadful vector-borne disease; hence, vector control is the most affordable and achievable approach to mitigate the disease burden. Due to the emergence of resistance and environmental pollution, herbal larvicides are considered an alternative to chemical types. Also, nanotechnology has been proposed as a promising solution to improve the efficiency of plant larvicides. This study aimed to develop an effective herbal larvicide. Methods The chemical composition of Elettaria cardamomum essential oil (EO) was first investigated. Nanoliposomes containing the EO were then prepared using the ethanol injection method. After that, the larvicidal efficacy of the EO and its liposomal state were compared against Anopheles stephensi in laboratory conditions. Results Alpha-terpinyl acetate (77.59%), eucalyptol (4.38%), nerolidol (2.96%), linalool (1.77%), and limonene (1.69%) were the five major compounds of the EO. Nanoliposomes containing the EO with a particle size of 73±5 nm and a zeta potential of -16.3±0.8 mV were prepared. Additionally, the ATR-FTIR analysis verified the successful loading of the EO into nanoliposomes. The larvicidal activity of nanoliposomes exhibited remarkable potency, with an LC50 value of 14.35 (10-18) μg/mL, significantly more potent than the non-formulated EO, which had an LC50 value of 33.47 (28-39) μg/mL against Anopheles stephensi larvae. Conclusion The nanoliposomes containing E. cardamomum EO showed promising efficacy against An. stephensi larvae. It could thus be considered for further application against other species of mosquitoes.
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Affiliation(s)
- Mohammad Djaefar Moemenbellah-Fard
- Research Center for Health Sciences, Institute of Health, Department of Biology and Control of Disease Vectors, School of Health, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
| | - Zahra-Sadat Hosseinizadeh
- Research Center for Health Sciences, Institute of Health, Department of Biology and Control of Disease Vectors, School of Health, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
| | - Hamzeh Alipour
- Research Center for Health Sciences, Institute of Health, Department of Biology and Control of Disease Vectors, School of Health, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
| | - Roghayeh Heiran
- Estahban Higher Education Center- Shiraz University, Estahban, Iran
| | - Marzieh Shahriari-Namadi
- Research Center for Health Sciences, Institute of Health, Department of Biology and Control of Disease Vectors, School of Health, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
| | - Abdolmajid Ghasemian
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mahmoud Osanloo
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Fasa University of Medical Sciences, Fasa, Iran
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Tiedje KE, Oduro AR, Bangre O, Amenga-Etego L, Dadzie SK, Appawu MA, Frempong K, Asoala V, Ruybal-Pésantez S, Narh CA, Deed SL, Argyropoulos DC, Ghansah A, Agyei SA, Segbaya S, Desewu K, Williams I, Simpson JA, Malm K, Pascual M, Koram KA, Day KP. Indoor residual spraying with a non-pyrethroid insecticide reduces the reservoir of Plasmodium falciparum in a high-transmission area in northern Ghana. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000285. [PMID: 35600674 PMCID: PMC9121889 DOI: 10.1371/journal.pgph.0000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
High-malaria burden countries in sub-Saharan Africa are shifting from malaria control towards elimination. Hence, there is need to gain a contemporary understanding of how indoor residual spraying (IRS) with non-pyrethroid insecticides when combined with long-lasting insecticidal nets (LLINs) impregnated with pyrethroid insecticides, contribute to the efforts of National Malaria Control Programmes to interrupt transmission and reduce the reservoir of Plasmodium falciparum infections across all ages. Using an interrupted time-series study design, four age-stratified malariometric surveys, each of ~2,000 participants, were undertaken pre- and post-IRS in Bongo District, Ghana. Following the application of three-rounds of IRS, P. falciparum transmission intensity declined, as measured by a >90% reduction in the monthly entomological inoculation rate. This decline was accompanied by reductions in parasitological parameters, with participants of all ages being significantly less likely to harbor P. falciparum infections at the end of the wet season post-IRS (aOR = 0.22 [95% CI: 0.19-0.26], p-value < 0.001). In addition, multiplicity of infection (MOI var ) was measured using a parasite fingerprinting tool, designed to capture within-host genome diversity. At the end of the wet season post-IRS, the prevalence of multi-genome infections declined from 75.6% to 54.1%. This study demonstrates that in areas characterized by high seasonal malaria transmission, IRS in combination with LLINs can significantly reduce the reservoir of P. falciparum infection. Nonetheless despite this success, 41.6% of the population, especially older children and adolescents, still harboured multi-genome infections. Given the persistence of this diverse reservoir across all ages, these data highlight the importance of sustaining vector control in combination with targeted chemotherapy to move high-transmission settings towards pre-elimination. This study also points to the benefits of molecular surveillance to ensure that incremental achievements are not lost and that the goals advocated for in the WHO's High Burden to High Impact strategy are realized.
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Affiliation(s)
- Kathryn E. Tiedje
- School of BioSciences, The University of Melbourne, at the Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity and Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
| | - Abraham R. Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Oscar Bangre
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
| | - Lucas Amenga-Etego
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
| | - Samuel K. Dadzie
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Maxwell A. Appawu
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Kwadwo Frempong
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Victor Asoala
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Shazia Ruybal-Pésantez
- School of BioSciences, The University of Melbourne, at the Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
| | - Charles A. Narh
- School of BioSciences, The University of Melbourne, at the Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Samantha L. Deed
- School of BioSciences, The University of Melbourne, at the Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity and Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
| | - Dionne C. Argyropoulos
- School of BioSciences, The University of Melbourne, at the Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity and Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
| | - Anita Ghansah
- Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Samuel A. Agyei
- AngloGold Ashanti (Ghana) Malaria Control Programme, Obuasi, Ghana
| | | | - Kwame Desewu
- AngloGold Ashanti (Ghana) Malaria Control Programme, Obuasi, Ghana
| | | | - Julie A. Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Keziah Malm
- Ghana National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Mercedes Pascual
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, United States of America
| | - Kwadwo A. Koram
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Karen P. Day
- School of BioSciences, The University of Melbourne, at the Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
- Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity and Bio21 Molecular Science and Biotechnology Institute, Melbourne, Australia
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Nguyen TT, Nguyen XX, Wilson-Barthes M, Sawada I, Muela J, Hausmann-Muela S, Pham TV, Van Nguyen H, Van Nguyen V, Tran DT, Gryseels C, D'Alessandro U, Grietens KP, Erhart A. Why using bed nets is a challenge among minority populations in Central Vietnam. Malar J 2022; 21:87. [PMID: 35292018 PMCID: PMC8922825 DOI: 10.1186/s12936-022-04114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite freely distributed insecticide-treated nets (ITNs) and health information campaigns to increase their use among populations at risk, malaria transmission persists in forested areas in Vietnam, especially among ethnic minority communities. A mixed-methods study was conducted in four villages of Ca Dong and M'nong ethnicity in Central Vietnam between 2009 and 2011 to assess factors limiting the uptake of ITNs. METHODS The mixed-methods research design consisted of a qualitative study to explore the context and barriers to ITN use, and a cross-sectional household survey (n = 141) to quantify factors for limited and appropriate net use. RESULTS The Ca Dong and M'nong's livelihood was dependent on swidden farming in the forest. Poverty-related factors, including the lack of beds, blankets, the practice of sleeping around the kitchen fire and deteriorated ITNs due to open housing structures, were reasons for alternative and non-use of ITNs. When household members stayed overnight in plot huts at fields, ITNs were even more unavailable and easily deteriorated. 72.5% of households reported having received one net for every two persons, and 82.2% of participants reported to have used ITNs the night before the survey. However, only 18.4% of participants were estimated to be effectively protected by ITNs after accounting for the availability of torn ITNs and the way ITNs were used, for example as blankets, at both village and fields. Multi-variable logistic regression showed the effect of four significant factors for appropriate ITN use: i) being female (AOR = 8.08; p = 0.009); ii) aware of mosquito bites as the sole cause of malaria (AOR = 7.43; p = 0.008); iii) not sleeping around the kitchen fire (AOR = 24.57; p = 0.001); and iv) having sufficient number of ITNs in the household (AOR = 21.69; p = 0.001). CONCLUSION This study showed how social factors rooted in poverty and swidden agriculture limited the effective use of ITNs, despite high coverage, among ethnic minority populations in Central Vietnam. An in-depth understanding of the local context is essential to develop specific indicators for measuring ITN use.
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Affiliation(s)
- Thuan Thi Nguyen
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. .,National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam.
| | - Xa Xuan Nguyen
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Marta Wilson-Barthes
- International Health Institute, Brown University School of Public Health, Providence, USA
| | - Ikumi Sawada
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
| | - Joan Muela
- University Ramon I Virgili, Tarragona, Spain.,Partners for Applied Social Sciences, PASS International, Tessenderlo, Belgium
| | | | - Thanh Vinh Pham
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Hong Van Nguyen
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | | | - Duong Thanh Tran
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Partners for Applied Social Sciences, PASS International, Tessenderlo, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Annette Erhart
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Tian H, Li N, Li Y, Kraemer MUG, Tan H, Liu Y, Li Y, Wang B, Wu P, Cazelles B, Lourenço J, Gao D, Sun D, Song W, Li Y, Pybus OG, Wang G, Dye C. Malaria elimination on Hainan Island despite climate change. COMMUNICATIONS MEDICINE 2022; 2:12. [PMID: 35603266 PMCID: PMC9053252 DOI: 10.1038/s43856-022-00073-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background Rigorous assessment of the effect of malaria control strategies on local malaria dynamics is a complex but vital step in informing future strategies to eliminate malaria. However, the interactions between climate forcing, mass drug administration, mosquito control and their effects on the incidence of malaria remain unclear. Methods Here, we analyze the effects of interventions on the transmission dynamics of malaria (Plasmodium vivax and Plasmodium falciparum) on Hainan Island, China, controlling for environmental factors. Mathematical models were fitted to epidemiological data, including confirmed cases and population-wide blood examinations, collected between 1995 and 2010, a period when malaria control interventions were rolled out with positive outcomes. Results Prior to the massive scale-up of interventions, malaria incidence shows both interannual variability and seasonality, as well as a strong correlation with climatic patterns linked to the El Nino Southern Oscillation. Based on our mechanistic model, we find that the reduction in malaria is likely due to the large scale rollout of insecticide-treated bed nets, which reduce the infections of P. vivax and P. falciparum malaria by 93.4% and 35.5%, respectively. Mass drug administration has a greater contribution in the control of P. falciparum (54.9%) than P. vivax (5.3%). In a comparison of interventions, indoor residual spraying makes a relatively minor contribution to malaria control (1.3%–9.6%). Conclusions Although malaria transmission on Hainan Island has been exacerbated by El Nino Southern Oscillation, control methods have eliminated both P. falciparum and P. vivax malaria from this part of China. Several malaria control strategies have been implemented on Hainan Island, China, and it is important to determine which of these have been effective to guide future efforts to control malaria. Here, we use mathematical and statistical methods to assess the effectiveness of control methods using data on malaria cases on Hainan, considering the impact of climate change simultaneously, since malaria transmission is affected by the climate. We observe time-related trends in malaria incidence and a strong relationship with climate before the large-scale rollout of malaria control interventions. We find that insecticide-treated bed nets are the most effective strategy in decreasing malaria incidence, while mass drug administration and indoor residual spraying also contribute to malaria control. Our findings provide evidence that a combination of strategies reduces the burden of malaria in affected regions. Tian et al. use mathematical modelling to estimate the impact of various interventions on malaria incidence on Hainan Island, also taking into account climate change. They find that although malaria transmission has been exacerbated by climate change, insecticide-treated bed nets and other interventions were effective in controlling the disease.
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Jo Y, Barthel N, Stierman E, Clifton K, Pak ES, Ezeiru S, Ekweremadu D, Onugu N, Ali Z, Egwu E, Akoh O, Uzunyayla O, Van Hulle S. The Potential of Digital Data Collection Tools for Long-lasting Insecticide-Treated Net Mass Campaigns in Nigeria: Formative Study. JMIR Form Res 2021; 5:e23648. [PMID: 34623310 PMCID: PMC8538022 DOI: 10.2196/23648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Nigeria has the world’s largest malaria burden, accounting for 27% of the world’s malaria cases and 23% of malaria mortality globally. This formative study describes the operational process of the mass distribution of long-lasting insecticide-treated nets (LLINs) during a campaign program in Nigeria. Objective This study aims to assess whether and how digital data collection and management tools can change current practices and help resolve major implementation issues. Methods Qualitative data on the technical features and operational processes of paper-based and information and communication technology (ICT)–based systems in the Edo and Kwara states from June 2 to 30, 2017, were collected on the basis of documented operation manuals, field observations, and informant interviews. During the LLIN campaign in Edo State, we recruited 6 local government area focal persons and monitors and documented daily review meetings during household mobilization (9 days) and net distribution (5 days) to understand the major program implementation issues associated with the following three aspects: logistic issues, technical issues, and demand creation. Each issue was categorized according to the expected degree (low, mid, and high) of change by the ICT system. Results The net campaign started with microplanning and training, followed by a month-long implementation process, which included household mobilization, net movement, net distribution, and end process monitoring. The ICT system can improve management and oversight issues related to data reporting and processes through user-centered interface design, built-in data quality control logic flow or algorithms, and workflow automation. These often require more than 50% of staff time and effort in the current paper-based practice. Compared with the current paper-based system, the real-time system is expected to reduce the time to payment compensation for health workers by about 20 days and produce summary campaign statistics for at least 20 to 30 days. Conclusions The ICT system can facilitate the measurement of population coverage beyond program coverage during an LLIN campaign with greater data reliability and timeliness, which are often compromised due to the limited workforce capacity in a paper-based system.
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Affiliation(s)
- Youngji Jo
- Boston Medical Center, Boston, MA, United States
| | | | | | | | - Esther Semee Pak
- Graduate Institute of International Development Studies, Geneva, Switzerland
| | | | | | | | - Zainab Ali
- Catholic Relief Services, Abuja, Nigeria
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Conteh L, Shuford K, Agboraw E, Kont M, Kolaczinski J, Patouillard E. Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1213-1222. [PMID: 34372987 PMCID: PMC8324482 DOI: 10.1016/j.jval.2021.01.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To systematically review the literature on the unit cost and cost-effectiveness of malaria control. METHODS Ten databases and gray literature sources were searched to identify evidence relevant to the period 2005 to 2018. Studies with primary financial or economic cost data from malaria endemic countries that took a provider, provider and household, or societal perspective were included. RESULTS We identified 103 costing studies. The majority of studies focused on individual rather than combined interventions, notably insecticide-treated bed nets and treatment, and commonly took a provider perspective. A third of all studies took place in 3 countries. The median provider economic cost of protecting 1 person per year ranged from $1.18 to $5.70 with vector control and from $0.53 to $5.97 with chemoprevention. The median provider economic cost per case diagnosed with rapid diagnostic tests was $6.06 and per case treated $9.31 or $89.93 depending on clinical severity. Other interventions did not share enough similarities to be summarized. Cost drivers were rarely reported. Cost-effectiveness of malaria control was reiterated, but care in methodological and reporting standards is required to enhance data transferability. CONCLUSIONS Important information that can support resource allocation was reviewed. Given the variability in methods and reporting, global efforts to follow existing standards are required for the evidence to be most useful outside their study context, supplemented by guidance on options for transferring existing data across settings.
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Affiliation(s)
- Lesong Conteh
- Department of Health Policy, London School of Economics and Political Science, London, England, UK; School of Public Health, Imperial College London, St Mary's Campus, Paddington, England, UK
| | - Kathryn Shuford
- Department of Health Policy, London School of Economics and Political Science, London, England, UK
| | - Efundem Agboraw
- Vector Biology, Liverpool School of Tropical Medicine, Liverpool, England, UK
| | - Mara Kont
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, Imperial College London, England, UK
| | - Jan Kolaczinski
- Department of the Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Edith Patouillard
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
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Pulkki-Brännström AM, Haghparast-Bidgoli H, Batura N, Colbourn T, Azad K, Banda F, Banda L, Borghi J, Fottrell E, Kim S, Makwenda C, Ojha AK, Prost A, Rosato M, Shaha SK, Sinha R, Costello A, Skordis J. Participatory learning and action cycles with women's groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability. Health Policy Plan 2021; 35:1280-1289. [PMID: 33085753 PMCID: PMC7886438 DOI: 10.1093/heapol/czaa081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range: $61-$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from $135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women's groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations.
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Affiliation(s)
- Anni-Maria Pulkki-Brännström
- Department of Epidemiology and Global Health, Umeå University, Umeå S-901 87, Sweden.,UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Hassan Haghparast-Bidgoli
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Neha Batura
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Tim Colbourn
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Kishwar Azad
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh
| | | | - Lumbani Banda
- Parent and Child Health Initiative (PACHI), Area 14 Plot 171, Lilongwe, Malawi
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Edward Fottrell
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Sungwook Kim
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Charles Makwenda
- Parent and Child Health Initiative (PACHI), Area 14 Plot 171, Lilongwe, Malawi
| | - Amit Kumar Ojha
- Ekjut, Plot no. - 556B, Potka Chakradharpur, West Singhbhum, Pin - 833102, Jharkhand, India
| | - Audrey Prost
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Mikey Rosato
- Women and Children First (UK), United House, North Road, London, N7 9DP, UK
| | - Sanjit Kumer Shaha
- Perinatal Care Project, Diabetic Association of Bangladesh, 122 Kazi Nazrul Islam Avenue, Dhaka 1000, Bangladesh
| | - Rajesh Sinha
- Ekjut, Plot no. - 556B, Potka Chakradharpur, West Singhbhum, Pin - 833102, Jharkhand, India
| | - Anthony Costello
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
| | - Jolene Skordis
- UCL Institute for Global Health, UCL (University College London), 30 Guilford Street, London, WC1N 1EH, UK
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Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020. Nat Commun 2021; 12:3589. [PMID: 34117240 PMCID: PMC8196080 DOI: 10.1038/s41467-021-23707-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/12/2021] [Indexed: 02/05/2023] Open
Abstract
Insecticide-treated nets (ITNs) are one of the most widespread and impactful malaria interventions in Africa, yet a spatially-resolved time series of ITN coverage has never been published. Using data from multiple sources, we generate high-resolution maps of ITN access, use, and nets-per-capita annually from 2000 to 2020 across the 40 highest-burden African countries. Our findings support several existing hypotheses: that use is high among those with access, that nets are discarded more quickly than official policy presumes, and that effectively distributing nets grows more difficult as coverage increases. The primary driving factors behind these findings are most likely strong cultural and social messaging around the importance of net use, low physical net durability, and a mixture of inherent commodity distribution challenges and less-than-optimal net allocation policies, respectively. These results can inform both policy decisions and downstream malaria analyses.
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10
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Keating J, Yukich JO, Miller JM, Scates S, Hamainza B, Eisele TP, Bennett A. Retrospective evaluation of the effectiveness of indoor residual spray with pirimiphos-methyl (Actellic) on malaria transmission in Zambia. Malar J 2021; 20:173. [PMID: 33794892 PMCID: PMC8017828 DOI: 10.1186/s12936-021-03710-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 03/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Widespread insecticide resistance to pyrethroids could thwart progress towards elimination. Recently, the World Health Organization has encouraged the use of non-pyrethroid insecticides to reduce the spread of insecticide resistance. An electronic tool for implementing and tracking coverage of IRS campaigns has recently been tested (mSpray), using satellite imagery to improve the accuracy and efficiency of the enumeration process. The purpose of this paper is to retrospectively analyse cross-sectional observational data to provide evidence of the epidemiological effectiveness of having introduced Actellic 300CS and the mSpray platform into IRS programmes across Zambia. Methods Health facility catchment areas in 40 high burden districts in 5 selected provinces were initially targeted for spraying. The mSpray platform was used in 7 districts in Luapula Province. An observational study design was used to assess the relationship between IRS exposure and confirmed malaria case incidence. A random effects Poisson model was used to quantify the effect of IRS (with and without use of the mSpray platform) on confirmed malaria case incidence over the period 2013–2017; analysis was restricted to the 4 provinces where IRS was conducted in each year 2014–2016. Results IRS was conducted in 283 health facility catchment areas from 2014 to 2016; 198 health facilities from the same provinces, that received no IRS during this period, served as a comparison. IRS appears to be associated with reduced confirmed malaria incidence; the incidence rate ratio (IRR) was lower in areas with IRS but without mSpray, compared to areas with no IRS (IRR = 0.91, 95% CI 0.84–0.98). Receiving IRS with mSpray significantly lowered confirmed case incidence (IRR = 0.75, 95% CI 0.66–0.86) compared to no IRS. IRS with mSpray resulted in lower incidence compared to IRS without mSpray (IRR = 0.83, 95% CI 0.72–0.95). Conclusions IRS using Actellic-CS appears to substantially reduce malaria incidence in Zambia. The use of the mSpray tool appears to improve the effectiveness of the IRS programme, possibly through improved population level coverage. The results of this study lend credence to the anecdotal evidence of the effectiveness of 3GIRS using Actellic, and the importance of exploring new platforms for improving effective population coverage of areas targeted for spraying.
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Affiliation(s)
- Joseph Keating
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2320, New Orleans, 70112, USA.
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2320, New Orleans, 70112, USA
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Elimination Centre, Chainama Hospital College Grounds, Lusaka, Zambia
| | - Sara Scates
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2320, New Orleans, 70112, USA
| | - Busiku Hamainza
- National Malaria Elimination Centre, Ministry of Health, Lusaka, Zambia
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2320, New Orleans, 70112, USA
| | - Adam Bennett
- Global Health Sciences, University of California, San Francisco, CA, USA
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11
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Alonso S, Chaccour CJ, Wagman J, Candrinho B, Muthoni R, Saifodine A, Saute F, Robertson M, Zulliger R. Cost and cost-effectiveness of indoor residual spraying with pirimiphos-methyl in a high malaria transmission district of Mozambique with high access to standard insecticide-treated nets. Malar J 2021; 20:143. [PMID: 33691706 PMCID: PMC7948350 DOI: 10.1186/s12936-021-03687-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As malaria cases increase in some of the highest burden countries, more strategic deployment of new and proven interventions must be evaluated to meet global malaria reduction goals. METHODS The cost and cost-effectiveness of indoor residual spraying (IRS) with pirimiphos-methyl (Actellic®300 CS) were assessed in a high transmission district (Mopeia) with high access to pyrethroid insecticide-treated nets (ITNs), compared to ITNs alone. The major mosquito vectors in the area were susceptible to primiphos-methyl, but resistant to pyrethoids. A decision analysis approach was followed to conduct deterministic and probabilistic sensitivity analyses in a theoretical cohort of 10,000 children under five years of age (U5) and 10,000 individuals of all ages, separately. Model parameters and distributions were based on prospectively collected cost and epidemiological data from a cluster-randomized control trial and a literature review. The primary analysis used health facility-malaria incidence, while community cohort incidence and cross-sectional prevalence rates were used in sensitivity analyses. Lifetime costs, malaria cases, deaths and disability-adjusted life-years (DALYs) were calculated to determine the incremental costs per DALY averted through IRS. RESULTS The average IRS cost per person protected was US$8.26 and 51% of the cost was insecticide. IRS averted 46,609 (95% CI 46,570-46,646) uncomplicated and 242 (95% CI 241-243) severe lifetime cases in a theoretical children U5 cohort, yielding an incremental cost-effectiveness ratio (ICER) of US$400 (95% CI 399-402) per DALY averted. In the all-age cohort, the ICER was higher: US$1,860 (95% CI 1,852-1,868) per DALY averted. Deterministic and probabilistic results were consistent. When adding the community protective effect of IRS, the cost per person protected decreased (US$7.06) and IRS was highly cost-effective in children U5 (ICER = US$312) and cost-effective in individuals of all ages (ICER = US$1,431), compared to ITNs alone. CONCLUSION This study provides robust evidence that IRS with pirimiphos-methyl can be cost-effective in high transmission regions with high pyrethroid ITN coverage where the major vector is susceptible to pirimiphos-methyl but resistant to pyrethroids. The finding that insecticide cost is the main driver of IRS costs highlights the need to reduce the insecticide price without jeopardizing effectiveness. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02910934 (Registered 22 September 2016). https://clinicaltrials.gov/ct2/show/NCT02910934?term=NCT02910934&draw=2&rank=1.
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Affiliation(s)
- Sergi Alonso
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12 8QQ, UK. .,Centro de Investigação Em Saúde de Manhiça, Maputo, Mozambique. .,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Carlos J Chaccour
- Centro de Investigação Em Saúde de Manhiça, Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Abuchahama Saifodine
- U.S. President's Malaria Initiative, US Agency for International Development, Maputo, Mozambique
| | - Francisco Saute
- Centro de Investigação Em Saúde de Manhiça, Maputo, Mozambique
| | | | - Rose Zulliger
- U.S. President's Malaria Initiative and Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
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12
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Chaccour C, Zulliger R, Wagman J, Casellas A, Nacima A, Elobolobo E, Savaio B, Saifodine A, Fornadel C, Richardson J, Candrinho B, Robertson M, Saute F. Incremental impact on malaria incidence following indoor residual spraying in a highly endemic area with high standard ITN access in Mozambique: results from a cluster-randomized study. Malar J 2021; 20:84. [PMID: 33568137 PMCID: PMC7877039 DOI: 10.1186/s12936-021-03611-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Attaining the goal of reducing the global malaria burden is threatened by recent setbacks in maintaining the effectiveness of vector control interventions partly due to the emergence of pyrethroid resistant vectors. One potential strategy to address these setbacks could be combining indoor residual spraying (IRS) with non-pyrethroids and standard insecticide-treated nets (ITNs). This study aimed to provide evidence on the incremental epidemiological benefit of using third-generation IRS product in a highly endemic area with high ITN ownership. Methods A cluster-randomized, open-label, parallel-arms, superiority trial was conducted in the Mopeia district in Zambezia, Mozambique from 2016 to 2018. The district had received mass distribution of alphacypermethrin ITNs two years before the trial and again mid-way. 86 clusters were defined, stratified and randomized to receive or not receive IRS with pirimiphos-methyl (Actellic®300 CS). Efficacy of adding IRS was assessed through malaria incidence in a cohort of children under five followed prospectively for two years, enhanced passive surveillance at health facilities and by community health workers, and yearly cross-sectional surveys at the peak of the transmission season. Findings A total of 1536 children were enrolled in the cohort. Children in the IRS arm experienced 4,801 cases (incidence rate of 3,532 per 10,000 children-month at risk) versus 5,758 cases in the no-IRS arm (incidence rate of 4,297 per 10,000 children-month at risk), resulting in a crude risk reduction of 18% and an incidence risk ratio of 0.82 (95% CI 0.79–0.86, p-value < 0.001). Facility and community passive surveillance showed a malaria incidence of 278 per 10,000 person-month in the IRS group (43,974 cases over 22 months) versus 358 (95% CI 355–360) per 10,000 person-month at risk in the no-IRS group (58,030 cases over 22 months), resulting in an incidence rate ratio of 0.65 (95% CI 0.60–0.71, p < 0.001). In the 2018 survey, prevalence in children under five in the IRS arm was significantly lower than in the no-IRS arm (OR 0.54, 95% CI, 0.31–0.92, p = 0.0241). Conclusion In a highly endemic area with high ITN access and emerging pyrethroid resistance, adding IRS with pirimiphos-methyl resulted in significant additional protection for children under five years of age. Trial registration: ClinicalTrials.gov identifier NCT02910934, registered 22 September 2016, https://clinicaltrials.gov/ct2/show/NCT02910934?term=NCT02910934&draw=2&rank=1.
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Affiliation(s)
- Carlos Chaccour
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.
| | - Rose Zulliger
- President's Malaria Initiative, US Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Amilcar Nacima
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Eldo Elobolobo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Abuchahama Saifodine
- President's Malaria Initiative, United States Agency for International Development, Maputo, Mozambique
| | | | | | | | | | - Francisco Saute
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
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Whiteman A, Loaiza JR, Yee DA, Poh KC, Watkins AS, Lucas KJ, Rapp TJ, Kline L, Ahmed A, Chen S, Delmelle E, Oguzie JU. Do socioeconomic factors drive Aedes mosquito vectors and their arboviral diseases? A systematic review of dengue, chikungunya, yellow fever, and Zika Virus. One Health 2020; 11:100188. [PMID: 33392378 PMCID: PMC7772681 DOI: 10.1016/j.onehlt.2020.100188] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/17/2022] Open
Abstract
As the threat of arboviral diseases continues to escalate worldwide, the question of, "What types of human communities are at the greatest risk of infection?" persists as a key gap in the existing knowledge of arboviral diseases transmission dynamics. Here, we comprehensively review the existing literature on the socioeconomic drivers of the most common Aedes mosquito-borne diseases and Aedes mosquito presence/abundance. We reviewed a total of 182 studies on dengue viruses (DENV), chikungunya virus (CHIKV), yellow fever virus (YFVV), Zika virus (ZIKV), and presence of Aedes mosquito vectors. In general, associations between socioeconomic conditions and both Aedes-borne diseases and Aedes mosquitoes are highly variable and often location-specific. Although 50% to 60% of studies found greater presence or prevalence of disease or vectors in areas with lower socioeconomic status, approximately half of the remaining studies found either positive or null associations. We discuss the possible causes of this lack of conclusiveness as well as the implications it holds for future research and prevention efforts.
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Affiliation(s)
- Ari Whiteman
- Smithsonian Tropical Research Institute, Panama City, Panama
| | - Jose R. Loaiza
- Smithsonian Tropical Research Institute, Panama City, Panama
- Instituto de Investigaciones Científicas & Servicios de Alta Tecnología, Edificio 219, Clayton PO 0843–01103, Ciudad del Saber, Panama
- Programa Centroamericano de Maestría en Entomología, Universidad de Panamá, Panama
| | - Donald A. Yee
- School of Biological, Environmental, & Earth Sciences, University of Southern Mississippi, Hattiesburg, MS, United States of America
| | - Karen C. Poh
- Department of Entomology, Pennsylvania State University, University Park, PA, United States of America
| | | | - Keira J. Lucas
- Collier Mosquito Control District, Naples, FL, United States of America
| | - Tyler J. Rapp
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Lillie Kline
- Woodward Academy, Atlanta, GA, United States of America
| | - Ayman Ahmed
- Institute of Endemic Diseases, University of Khartoum, Sudan
- World Reference Center for Emerging Viruses and Arboviruses, The Institute for Human Infections and Immunity, Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Shi Chen
- Public Health Sciences, University of North Carolina at Charlotte, United States of America
| | - Eric Delmelle
- Geography and Earth Sciences, University of North Carolina at Charlotte, United States of America
| | - Judith Uche Oguzie
- College of Natural Sciences Redeemer's University, Ede Osun State, Nigeria
- African Center of Excellence for Genomics of Infectious Diseases Redeemer's University Ede, Osun State, Nigeria
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14
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Yukich JO, Scott C, Silumbe K, Larson BA, Bennett A, Finn TP, Hamainza B, Conner RO, Porter TR, Keating J, Steketee RW, Eisele TP, Miller JM. Cost-Effectiveness of Focal Mass Drug Administration and Mass Drug Administration with Dihydroartemisinin-Piperaquine for Malaria Prevention in Southern Province, Zambia: Results of a Community-Randomized Controlled Trial. Am J Trop Med Hyg 2020; 103:46-53. [PMID: 32618249 PMCID: PMC7416981 DOI: 10.4269/ajtmh.19-0661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Community-wide administration of antimalarial drugs in therapeutic doses is a potential tool to prevent malaria infection and reduce the malaria parasite reservoir. To measure the effectiveness and cost of using the antimalarial drug combination dihydroartemisinin–piperaquine (DHAp) through different community-wide distribution strategies, Zambia’s National Malaria Control Centre conducted a three-armed community-randomized controlled trial. The trial arms were as follows: 1) standard of care (SoC) malaria interventions, 2) SoC plus focal mass drug administration (fMDA), and 3) SoC plus MDA. Mass drug administration consisted of offering all eligible individuals DHAP, irrespective of a rapid diagnostic test (RDT) result. Focal mass drug administration consisted of offering DHAP to all eligible individuals who resided in a household where anyone tested positive by RDT. Results indicate that the costs of fMDA and MDA per person targeted and reached are similar (US$9.01 versus US$8.49 per person, respectively, P = 0.87), but that MDA was superior in all cost-effectiveness measures, including cost per infection averted, cost per case averted, cost per death averted, and cost per disability-adjusted life year averted. Subsequent costing of the MDA intervention in a non-trial, operational setting yielded significantly lower costs per person reached (US$2.90). Mass drug administration with DHAp also met the WHO thresholds for “cost-effective interventions” in the Zambian setting in 90% of simulations conducted using a probabilistic sensitivity analysis based on trial costs, whereas fMDA met these criteria in approximately 50% of simulations. A sensitivity analysis using costs from operational deployment and trial effectiveness yielded improved cost-effectiveness estimates. Mass drug administration may be a cost-effective intervention in the Zambian context and can help reduce the parasite reservoir substantially. Mass drug administration was more cost-effective in relatively higher transmission settings. In all scenarios examined, the cost-effectiveness of MDA was superior to that of fMDA.
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Affiliation(s)
- Joshua O Yukich
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Callie Scott
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Seattle, Washington
| | | | - Bruce A Larson
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California
| | - Timothy P Finn
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Busiku Hamainza
- National Malaria Control Centre, Zambia Ministry of Health, Lusaka, Zambia
| | - Ruben O Conner
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Seattle, Washington
| | - Travis R Porter
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Joseph Keating
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Richard W Steketee
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Seattle, Washington
| | - Thomas P Eisele
- Department of Tropical Medicine, Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Cucchiaro G, Van Leeuwen J, Goodridge Y. Case Report: The Role of Spatial Repellant Devices to Prevent Malaria in Low-Income Countries. Am J Trop Med Hyg 2020; 102:1033-1036. [PMID: 32100683 DOI: 10.4269/ajtmh.19-0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Malaria is the leading cause of morbidity and mortality in Uganda. The role of spatial repellent devices in preventing malaria is controversial. The goal of this study was to evaluate the populations' acceptability of a newly designed insecticide diffuser. We distributed to three families living in southern Uganda a device commercially available, the VAPE® portable set. This spatial repellent device offers several advantages compared with other traditional products. It is powered by lithium batteries that guarantee 20 days of uninterrupted delivery of insecticide; it contains two insecticides: empenthrin and transfluthrin; and it is simple to use, one switch to turn it "on" and/or "off." It is odorless, and it can be placed anywhere in the living/sleeping area. People can also carry it outside the house. We planned to evaluate people's compliance with its usage, its reliability, and its overall costs. We conducted a 5-month survey. We distributed the devices to three households, one device per bedroom. Ten males and 11 females, with a mean age of 26 ± 16 (range 10-51) years, lived in these houses. The compliance with the use of the device and its acceptability were high. No side effects were reported. No individual contracted malaria during the 5-month period. The major obstacle we found was the timely delivery of the devices to the evaluation area and initial compliance with the instructions on how to use the device. Larger randomized studies are needed to clarify whether there is a role for this type of spatial repellent devices in the global efforts to prevent malaria.
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Affiliation(s)
- Giovanni Cucchiaro
- 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Yvette Goodridge
- 3Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
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16
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Scates SS, Finn TP, Wisniewski J, Dadi D, Mandike R, Khamis M, Greer G, Serbantez N, Segbaya S, Owusu P, Mihigo J, Gerberg L, Acosta A, Koenker H, Yukich J. Costs of insecticide-treated bed net distribution systems in sub-Saharan Africa. Malar J 2020; 19:105. [PMID: 32131834 PMCID: PMC7055111 DOI: 10.1186/s12936-020-03164-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) are one of the most cost-effective measures for preventing malaria. The World Health Organization recommends both large-scale mass distribution campaigns and continuous distributions (CD) as part of a multifaceted strategy to achieve and sustain universal access to ITNs. A combination of these strategies has been effective for scaling up ITN access. For policy makers to make informed decisions on how to efficiently implement CD or combined strategies, information on the costs and cost-effectiveness of these delivery systems is necessary, but relatively few published studies of the cost continuous distribution systems exist. Methods To address the gap in continuous distribution cost data, four types of delivery systems—CD through antenatal care services (ANC) and the expanded programme on immunization (EPI) (Ghana, Mali, and mainland Tanzania), CD through schools (Ghana and mainland Tanzania), and a combined community/health facility-based distribution (Zanzibar, Tanzania), as well as mass distributions (Mali)—were costed. Data on costs were collected retrospectively from financial and operational records, stakeholder interviews, and resource use surveys. Results Overall, from a full provider perspective, mass distributions and continuous systems delivered ITNs at overlapping economic costs per net distributed (mass distributions: 4.37–4.61 USD, CD channels: 3.56–9.90 USD), with two of the school-based systems and the mass distributions at the lower end of this range. From the perspective of international donors, the costs of the CD systems were, for the most part, less costly than the mass distributions (mass distributions: 4.34–4.55 USD, Ghana and Tanzania 2017 school-based: 3.30–3.69 USD, health facility-based: 3.90–4.55 USD, combined community/health facility 4.55 USD). The 2015 school-based distribution (7.30 USD) and 2016 health facility-based distribution (6.52 USD) programmes in Tanzania were an exception. Mass distributions were more heavily financed by donors, while CD relied more extensively on domestic resource contributions. Conclusions These results suggest that CD strategies can continue to deliver nets at a comparable cost to mass distributions, especially from the perspective of the donor.
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Affiliation(s)
- Sara S Scates
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Timothy P Finn
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Janna Wisniewski
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David Dadi
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Renata Mandike
- Tanzania National Malaria Control Programme, Dodoma, Tanzania
| | - Mwinyi Khamis
- Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania
| | - George Greer
- U.S. President's Malaria Initiative, US Agency for International Development, Dar es Salaam, Tanzania
| | - Naomi Serbantez
- U.S. President's Malaria Initiative, US Agency for International Development, Dar es Salaam, Tanzania
| | - Sylvester Segbaya
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Prince Owusu
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Jules Mihigo
- U.S. President's Malaria Initiative, US Agency for International Development, Bamako, Mali
| | - Lilia Gerberg
- U.S President's Malaria Initiative, U.S. Agency for International Development, Washington, D.C., USA
| | - Angela Acosta
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Hannah Koenker
- PMI VectorWorks Project, Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA
| | - Joshua Yukich
- PMI VectorWorks Project, Department of Tropical Medicine and the Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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17
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Runge M, Snow RW, Molteni F, Thawer S, Mohamed A, Mandike R, Giorgi E, Macharia PM, Smith TA, Lengeler C, Pothin E. Simulating the council-specific impact of anti-malaria interventions: A tool to support malaria strategic planning in Tanzania. PLoS One 2020; 15:e0228469. [PMID: 32074112 PMCID: PMC7029840 DOI: 10.1371/journal.pone.0228469] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/16/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The decision-making process for malaria control and elimination strategies has become more challenging. Interventions need to be targeted at council level to allow for changing malaria epidemiology and an increase in the number of possible interventions. Models of malaria dynamics can support this process by simulating potential impacts of multiple interventions in different settings and determining appropriate packages of interventions for meeting specific expected targets. METHODS The OpenMalaria model of malaria dynamics was calibrated for all 184 councils in mainland Tanzania using data from malaria indicator surveys, school parasitaemia surveys, entomological surveillance, and vector control deployment data. The simulations were run for different transmission intensities per region and five interventions, currently or potentially included in the National Malaria Strategic Plan, individually and in combination. The simulated prevalences were fitted to council specific prevalences derived from geostatistical models to obtain council specific predictions of the prevalence and number of cases between 2017 and 2020. The predictions were used to evaluate in silico the feasibility of the national target of reaching a prevalence of below 1% by 2020, and to suggest alternative intervention stratifications for the country. RESULTS The historical prevalence trend was fitted for each council with an agreement of 87% in 2016 (95%CI: 0.84-0.90) and an agreement of 90% for the historical trend (2003-2016) (95%CI: 0.87-0.93) The current national malaria strategy was expected to reduce the malaria prevalence between 2016 and 2020 on average by 23.8% (95% CI: 19.7%-27.9%) if current case management levels were maintained, and by 52.1% (95% CI: 48.8%-55.3%) if the case management were improved. Insecticide treated nets and case management were the most cost-effective interventions, expected to reduce the prevalence by 25.0% (95% CI: 19.7%-30.2) and to avert 37 million cases between 2017 and 2020. Mass drug administration was included in most councils in the stratification selected for meeting the national target at minimal costs, expected to reduce the prevalence by 77.5% (95%CI: 70.5%-84.5%) and to avert 102 million cases, with almost twice higher costs than those of the current national strategy. In summary, the model suggested that current interventions are not sufficient to reach the national aim of a prevalence of less than 1% by 2020 and a revised strategic plan needs to consider additional, more effective interventions, especially in high transmission areas and that the targets need to be revisited. CONCLUSION The methodology reported here is based on intensive interactions with the NMCP and provides a helpful tool for assessing the feasibility of country specific targets and for determining which intervention stratifications at sub-national level will have most impact. This country-led application could support strategic planning of malaria control in many other malaria endemic countries.
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Affiliation(s)
- Manuela Runge
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert W. Snow
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, England, United Kingodm
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Fabrizio Molteni
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- National Malaria Control Programme (NMCP), Dar es Salaam, Tanzania
| | - Sumaiyya Thawer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- National Malaria Control Programme (NMCP), Dar es Salaam, Tanzania
| | - Ally Mohamed
- National Malaria Control Programme (NMCP), Dar es Salaam, Tanzania
| | - Renata Mandike
- National Malaria Control Programme (NMCP), Dar es Salaam, Tanzania
| | - Emanuele Giorgi
- CHICAS, Lancaster Medical School, Lancaster University, Lancaster, England, United Kingodm
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Thomas A. Smith
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Clinton Health Access Initiative, Boston, Massachusetts, United States of America
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Systematic review and meta-analysis of the cost and cost-effectiveness of distributing insecticide-treated nets for the prevention of malaria. Acta Trop 2020; 202:105229. [PMID: 31669182 DOI: 10.1016/j.actatropica.2019.105229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
Insecticide-treated nets are one of two core vector control interventions recommended by the World Health Organization for deployment in malaria-endemic regions around the world, especially sub-Saharan Africa. Although there are many factors that influence the type of distribution strategy chosen, among the most important considerations for the type of distribution strategy chosen is cost, both in terms of total expenditure required and in terms of relative cost-effectiveness. This research attempted to inform these decisions by conducting a systematic review and meta-analysis of the literature on the cost and cost-effectiveness of ITN distribution. The analysis compared the relative cost and cost-effectiveness of distribution strategies. Findings suggest that mass campaigns have lower average distribution costs per net compared with continuous/health facility distribution or sale/vouchers, although the relationship between distribution channel and cost were not statistically significant in the multivariate regression models. Continuous/health facility distribution channels were found to be more cost-effective than mass campaigns for averting DALYs, death, and cases of malaria. Those who design and budget for malaria programs should base decisions about distribution channels more on operational and epidemiological considerations than on cost per net, as the costs per net between distribution channels are not statistically different.
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Hast MA, Chaponda M, Muleba M, Kabuya JB, Lupiya J, Kobayashi T, Shields T, Lessler J, Mulenga M, Stevenson JC, Norris DE, Moss WJ. The Impact of 3 Years of Targeted Indoor Residual Spraying With Pirimiphos-Methyl on Malaria Parasite Prevalence in a High-Transmission Area of Northern Zambia. Am J Epidemiol 2019; 188:2120-2130. [PMID: 31062839 DOI: 10.1093/aje/kwz107] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 01/06/2023] Open
Abstract
Malaria transmission in northern Zambia has increased in the past decade, despite malaria control activities. Evidence-based intervention strategies are needed to effectively reduce malaria transmission. Zambia's National Malaria Control Centre conducted targeted indoor residual spraying (IRS) in Nchelenge District, Luapula Province, from 2014 to 2016 using the organophosphate insecticide pirimiphos-methyl. An evaluation of the IRS campaign was conducted by the Southern Africa International Centers of Excellence for Malaria Research using actively detected malaria cases in bimonthly household surveys carried out from April 2012 to July 2017. Changes in malaria parasite prevalence after IRS were assessed by season using Poisson regression models with robust standard errors, controlling for clustering of participants in households and demographic, geographical, and climatological covariates. In targeted areas, parasite prevalence declined approximately 25% during the rainy season following IRS with pirimiphos-methyl but did not decline during the dry season or in the overall study area. Within targeted areas, parasite prevalence declined in unsprayed households, suggesting both direct and indirect effects of IRS. The moderate decrease in parasite prevalence within sprayed areas indicates that IRS with pirimiphos-methyl is an effective malaria control measure, but a more comprehensive package of interventions is needed to effectively reduce the malaria burden in this setting.
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Affiliation(s)
- Marisa A Hast
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - James Lupiya
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Timothy Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jennifer C Stevenson
- Department of Molecular Microbiology and Immunology and Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Macha, Zambia
| | - Douglas E Norris
- Department of Molecular Microbiology and Immunology and Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Molecular Microbiology and Immunology and Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Dambach P, Baernighausen T, Traoré I, Ouedraogo S, Sié A, Sauerborn R, Becker N, Louis VR. Reduction of malaria vector mosquitoes in a large-scale intervention trial in rural Burkina Faso using Bti based larval source management. Malar J 2019; 18:311. [PMID: 31521176 PMCID: PMC6744650 DOI: 10.1186/s12936-019-2951-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Malaria remains one of the most important causes of morbidity and death in sub-Saharan Africa. Along with early diagnosis and treatment of malaria cases and intermittent preventive treatment in pregnancy (IPTp), vector control is an important tool in the reduction of new cases. Alongside the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), targeting the vector larvae with biological larvicides, such as Bacillus thuringiensis israelensis (Bti) is gaining importance as a means of reducing the number of mosquito larvae before they emerge to their adult stage. This study presents data corroborating the entomological impact of such an intervention in a rural African environment. Methods The study extended over 2 years and researched the impact of biological larviciding with Bti on malaria mosquitoes that were caught indoors and outdoors of houses using light traps. The achieved reductions in female Anopheles mosquitoes were calculated for two different larviciding choices using a regression model. Results In villages that received selective treatment of the most productive breeding sites, the number of female Anopheles spp. dropped by 61% (95% CI 54–66%) compared to the pre-intervention period. In villages in which all breeding sites were treated, the number of female Anopheles spp. was reduced by 70% (95% CI 64–74%) compared to the pre-intervention period. Conclusion It was shown that malaria vector abundance can be dramatically reduced through larviciding of breeding habitats and that, in many geographical settings, they are a viable addition to current malaria control measures.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany.
| | - Till Baernighausen
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Issouf Traoré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Norbert Becker
- German Mosquito Control Association (KABS), 67346, Speyer, Germany
| | - Valérie R Louis
- Institute of Public Health, University Hospital Heidelberg, 69120, Heidelberg, Germany
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Derua YA, Kweka EJ, Kisinza WN, Githeko AK, Mosha FW. Bacterial larvicides used for malaria vector control in sub-Saharan Africa: review of their effectiveness and operational feasibility. Parasit Vectors 2019; 12:426. [PMID: 31470885 PMCID: PMC6716942 DOI: 10.1186/s13071-019-3683-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 08/23/2019] [Indexed: 12/19/2022] Open
Abstract
Several trials and reviews have outlined the potential role of larviciding for malaria control in sub-Saharan Africa (SSA) to supplement the core indoor insecticide-based interventions. It has been argued that widespread use of long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS) interventions in many parts of Africa result in many new areas with low and focal malaria transmission that can be targeted with larvicides. As some countries in SSA are making good progress in malaria control, larval source management, particularly with bacterial larvicides, could be included in the list of viable options to maintain the gains achieved while paving the way to malaria elimination. We conducted a review of published literature that investigated the application of bacterial larvicides, Bacillus thuringiensis var. israelensis (Bti) and/or Bacillus sphaericus (Bs) for malaria vector control in SSA. Data for the review were identified through PubMed, the extensive files of the authors and reference lists of relevant articles retrieved. A total of 56 relevant studies were identified and included in the review. The findings indicated that, at low application rates, bacterial larvicide products based on Bti and/or Bs were effective in controlling malaria vectors. The larvicide interventions were found to be feasible, accepted by the general community, safe to the non-target organisms and the costs compared fairly well with those of other vector control measures practiced in SSA. Our review suggests that larviciding should gain more ground as a tool for integrated malaria vector control due to the decline in malaria which creates more appropriate conditions for the intervention and to the recognition of limitations of insecticide-based vector control tools. The advancement of new technology for mapping landscapes and environments could moreover facilitate identification and targeting of the numerous larval habitats preferred by the African malaria vectors. To build sustainable anti-larval measures in SSA, there is a great need to build capacity in relevant specialties and develop organizational structures for governance and management of larval source management programmes.
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Affiliation(s)
- Yahya A Derua
- Kilimanjaro Christian Medical University College, Tumaini University Makumira, Moshi, Tanzania. .,National Institute for Medical Research, Amani Research Centre, Muheza, Tanga, Tanzania.
| | - Eliningaya J Kweka
- Division of Livestock and Human Diseases Vector Control, Tropical Pesticides Research Institute, Arusha, Tanzania.,Department of Medical Parasitology and Entomology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - William N Kisinza
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanga, Tanzania
| | - Andrew K Githeko
- Climate and Human Health Research Unit, Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Franklin W Mosha
- Kilimanjaro Christian Medical University College, Tumaini University Makumira, Moshi, Tanzania
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Barabadi H, Alizadeh Z, Rahimi MT, Barac A, Maraolo AE, Robertson LJ, Masjedi A, Shahrivar F, Ahmadpour E. Nanobiotechnology as an emerging approach to combat malaria: A systematic review. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 18:221-233. [DOI: 10.1016/j.nano.2019.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 12/11/2022]
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Tompkins AM, Colón‐González FJ, Di Giuseppe F, Namanya DB. Dynamical Malaria Forecasts Are Skillful at Regional and Local Scales in Uganda up to 4 Months Ahead. GEOHEALTH 2019; 3:58-66. [PMID: 32159031 PMCID: PMC7038892 DOI: 10.1029/2018gh000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/02/2018] [Accepted: 01/04/2019] [Indexed: 06/10/2023]
Abstract
Malaria forecasts from dynamical systems have never been attempted at the health district or local clinic catchment scale, and so their usefulness for public health preparedness and response at the local level is fundamentally unknown. A pilot preoperational forecasting system is introduced in which the European Centre for Medium Range Weather Forecasts ensemble prediction system and seasonal climate forecasts of temperature and rainfall are used to drive the uncalibrated dynamical malaria model VECTRI to predict anomalies in transmission intensity 4 months ahead. It is demonstrated that the system has statistically significant skill at a number of sentinel sites in Uganda with high-quality data. Skill is also found at approximately 50% of the Ugandan health districts despite inherent uncertainties of unconfirmed health reports. A cost-loss economic analysis at three example sentinel sites indicates that the forecast system can have a positive economic benefit across a broad range of intermediate cost-loss ratios and frequency of transmission anomalies. We argue that such an analysis is a necessary first step in the attempt to translate climate-driven malaria information to policy-relevant decisions.
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Affiliation(s)
- Adrian M. Tompkins
- Earth System PhysicsAbdus Salam International Centre for Theoretical PhysicsTriesteItaly
| | - Felipe J. Colón‐González
- School of Environmental SciencesUniversity of East AngliaNorwichUK
- Tyndall Centre for Climate Change ResearchUniversity of East AngliaNorwichUK
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Stelmach R, Colaço R, Lalji S, McFarland D, Reithinger R. Cost-Effectiveness of Indoor Residual Spraying of Households with Insecticide for Malaria Prevention and Control in Tanzania. Am J Trop Med Hyg 2018; 99:627-637. [PMID: 30014819 PMCID: PMC6169190 DOI: 10.4269/ajtmh.17-0537] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 05/17/2018] [Indexed: 10/28/2022] Open
Abstract
Using a decision-tree approach, we examined the cost-effectiveness of indoor residual spraying (IRS) of households with insecticide combined with insecticide-treated bed net (ITN) distribution (IRS + ITN), compared with ITN distribution alone in the programmatic context of mainland Tanzania. The primary outcome of our model was the expected economic cost to society per case of malaria averted in children ≤ 5 years of age. Indoor residual spraying of households with insecticide data came from a program implemented in northwest Tanzania from 2008 to 2012; all other data originated from the published literature. Through sensitivity and scenario analyses, the model also examined the effects of variations in insecticide resistance, malaria prevalence, and different IRS modalities. In the base case, IRS + ITN is expected to be more expensive and more effective than the ITN-only intervention (incremental cost-effectiveness ratio [ICER]: $152.36). The number of IRS rounds, IRS insecticide costs, ITN use, malaria prevalence, and the probability that a child develops symptoms following infection drove the interventions' cost-effectiveness. Compared with universal spraying, targeted spraying is expected to lead to a higher number of malaria cases per person targeted (0.211-0.256 versus 0.050-0.076), but the incremental cost per case of malaria averted is expected to be lower (ICER: $41.70). In a scenario of increasing pyrethroid resistance, the incremental expected cost per case of malaria averted is expected to increase compared with the base case (ICER: $192.12). Tanzania should pursue universal IRS only in those regions that report high malaria prevalence. If the cost per case of malaria averted of universal IRS exceeds the willingness to pay, targeted spraying could provide an alternative, but may result in higher malaria prevalence.
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Affiliation(s)
- Rachel Stelmach
- RTI International, Washington, District of Columbia
- IMA World Health, Dar es Salaam, Tanzania
| | | | - Shabbir Lalji
- RTI International, Dar es Salaam, Tanzania
- IMA World Health, Dar es Salaam, Tanzania
| | | | - Richard Reithinger
- RTI International, Washington, District of Columbia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Stuck L, Lutambi A, Chacky F, Schaettle P, Kramer K, Mandike R, Nathan R, Yukich J. Can school-based distribution be used to maintain coverage of long-lasting insecticide treated bed nets: evidence from a large scale programme in southern Tanzania? Health Policy Plan 2018; 32:980-989. [PMID: 28444184 DOI: 10.1093/heapol/czx028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 11/13/2022] Open
Abstract
Many sub-Saharan African countries have achieved substantial gains in insecticide treated bednet coverage since 2005. The Tanzania National Malaria Control Programme identified school-based net distribution as one potential 'keep-up' strategy for the purpose of maintaining long-lasting insecticidal net (LLIN) coverage after a nationwide mass campaign in 2011. The School Net Programme (SNP) was implemented in three regions of southern Tanzania and distributed one LLIN to each enrolled child attending schools in primary grades (standards) 1, 3, 5 and 7, and secondary grades (forms) 2 and 4 in 2013 and again with slightly modified eligibility criteria in 2014 and 2015. Household surveys in the programme area as well as in a control area were conducted after each of the SNP distributions to measure ownership and use of long-lasting insecticide treated nets. Ownership of at least one LLIN after the first distribution was 76.1% (95% CI 70.8-80.7) in the intervention area and 78.6% (95% CI 74.4-82.3) in the control area. After the second distribution, ownership of at least one LLIN had dropped significantly in the control area to 65.4% (95% CI 59.5-71.0) in 2015 (P < 0.001), while coverage in the intervention area was maintained at 79.3% (95% CI 75.4 × 82.6). Ownership of at least one LLIN in intervention area remained stable following the second round of net distribution. During the same period LLIN ownership, especially of enough nets to ensure all household member access, fell significantly in the control area. These results demonstrate that the SNP may be sufficient to maintain stable LLIN coverage following a mass distribution of LLINs.
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Affiliation(s)
- Logan Stuck
- Department of Tropical Medicine, Centre for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Frank Chacky
- National Malaria Control Programme, Dar es Salaam, Tanzania
| | - Paul Schaettle
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Karen Kramer
- National Malaria Control Programme and Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Renata Mandike
- National Malaria Control Programme, Dar es Salaam, Tanzania
| | - Rose Nathan
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Joshua Yukich
- Department of Tropical Medicine, center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Storey JD, Babalola SO, Ricotta EE, Fox KA, Toso M, Lewicky N, Koenker H. Associations between ideational variables and bed net use in Madagascar, Mali, and Nigeria. BMC Public Health 2018; 18:484. [PMID: 29642883 PMCID: PMC5896159 DOI: 10.1186/s12889-018-5372-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts. Methods Sampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use. Results In all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative). Conclusion This research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control.
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Affiliation(s)
- J Douglas Storey
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA.
| | - Stella O Babalola
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Emily E Ricotta
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Kathleen A Fox
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Michael Toso
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Nan Lewicky
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
| | - Hannah Koenker
- Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD, 21202, USA
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A Meta-Regression Analysis of the Effectiveness of Mosquito Nets for Malaria Control: The Value of Long-Lasting Insecticide Nets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030546. [PMID: 29562673 PMCID: PMC5877091 DOI: 10.3390/ijerph15030546] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 11/16/2022]
Abstract
Long-lasting insecticidal nets (LLINs) have been widely used as an effective alternative to conventional insecticide-treated nets (ITNs) for over a decade. Due to the growing number of field trials and interventions reporting the effectiveness of LLINs in controlling malaria, there is a need to systematically review the literature on LLINs and ITNs to examine the relative effectiveness and characteristics of both insecticide nettings. A systematic review of over 2000 scholarly articles published since the year 2000 was conducted. The odds ratios (ORs) of insecticidal net effectiveness in reducing malaria were recorded. The final dataset included 26 articles for meta-regression analysis, with a sample size of 154 subgroup observations. While there is substantial heterogeneity in study characteristics and effect size, we found that the overall OR for reducing malaria by LLIN use was 0.44 (95% CI = 0.41–0.48, p < 0.01) indicating a risk reduction of 56%, while ITNs were slightly less effective with an OR of 0.59 (95% CI = 0.57–0.61, p <0.01). A meta-regression model confirms that LLINs are significantly more effective than ITNs in the prevention of malaria, when controlling for other covariates. For both types of nets, protective efficacy was greater in high transmission areas when nets were used for an extended period. However, cross-sectional studies may overestimate the effect of the nets. The results surprisingly suggest that nets are less effective in protecting children under the age of five, which may be due to differences in child behavior or inadequate coverage. Compared to a previous meta-analysis, insecticide-treated nets appear to have improved their efficacy despite the risks of insecticide resistance. These findings have practical implications for policymakers seeking effective malaria control strategies.
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Howard N, Guinness L, Rowland M, Durrani N, Hansen KS. Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic. PLoS Negl Trop Dis 2017; 11:e0005935. [PMID: 29059179 PMCID: PMC5695615 DOI: 10.1371/journal.pntd.0005935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/02/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Financing of malaria control for displaced populations is limited in scope and duration, making cost-effectiveness analyses relevant but difficult. This study analyses cost-effectiveness of adding prevention through targeted indoor residual spraying (IRS) to case management in Afghan refugee settlements in Pakistan during a prolonged malaria epidemic. Methods/Findings An intervention study design was selected, taking a societal perspective. Provider and household costs of vector control and case management were collected from provider records and community survey. Health outcomes (e.g. cases and DALYs averted) were derived and incremental cost-effectiveness ratios (ICERs) for cases prevented and DALYs averted calculated. Population, treatment cost, women’s time, days of productivity lost, case fatality rate, cases prevented, and DALY assumptions were tested in sensitivity analysis. Malaria incidence peaked at 44/1,000 population in year 2, declining to 14/1,000 in year 5. In total, 370,000 malaria cases, 80% vivax, were diagnosed and treated and an estimated 67,988 vivax cases and 18,578 falciparum and mixed cases prevented. Mean annual programme cost per capita was US$0.56. The additional cost of including IRS over five years per case prevented was US$39; US$50 for vivax (US$43 in years 1–3, US$80 in years 4–5) and US$182 for falciparum (US$139 in years 1–3 and US$680 in years 4–5). Per DALY averted this was US$266 (US$220 in years 1–3 and US$486 in years 4–5) and thus ‘highly cost-effective’ or cost-effective using WHO and comparison thresholds. Conclusions Adding IRS was cost-effective in this moderate endemicity, low mortality setting. It was more cost-effective when transmission was highest, becoming less so as transmission reduced. Because vivax was three times more common than falciparum and the case fatality rate was low, cost-effectiveness estimations for cases prevented appear reliable and more definitive for vivax malaria. We conducted a cost-effectiveness analysis of adding malaria prevention to routine malaria diagnosis and treatment in Afghan refugee settlements in Pakistan during a five-year malaria epidemic. We found that malaria incidence peaked at 44 per 1,000 in year 2 and declined to 14 per 1,000 in year 5, with an average annual programme cost per capita of US$0.56 in 2015 currency. Cost per case prevented averaged US$88 (US$111 for vivax, US$442 for falciparum), per death prevented averaged US$316,734, and per DALY averted averaged US$601. The additional cost of including IRS over five years per case prevented was US$39 (US$50 for vivax and US$182 for falciparum malaria case prevented) and per DALY averted was US$266. While our cost-effectiveness results were relatively high, when compared with internationally recognised cost-effectiveness thresholds both prevention and case management were highly cost-effective, indicating the relevance of an integrated approach for epidemic malaria control and global malaria elimination.
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Affiliation(s)
- Natasha Howard
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Rowland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- HealthNet-TPO, Peshawar, Pakistan
| | | | - Kristian S. Hansen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Kilian A, Woods Schnurr L, Matova T, Selby RA, Lokko K, Blaufuss S, Gbanya MZ, Allan R, Koenker H, Swaka M, Greer G, Fotheringham M, Gerberg L, Lynch M. Evaluation of a continuous community-based ITN distribution pilot in Lainya County, South Sudan 2012-2013. Malar J 2017; 16:363. [PMID: 28893263 PMCID: PMC5594500 DOI: 10.1186/s12936-017-2020-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Continuous distribution of insecticide-treated nets (ITNs) has now been accepted as one way of sustaining ITN universal coverage. Community-based channels offer an interesting means of delivering ITNs to households to sustain universal ITN coverage. The objective of this study was to provide proof of concept for this channel. Methods A 9-month, community-based, distribution pilot was implemented beginning 1 year after a mass campaign in Lainya County, South Sudan from 2012 to 2013. Following social mobilization, community members could request an ITN from a net coupon holder. Eligibility criteria included having lost an ITN, giving birth outside of the health facility, or not having enough ITNs for all household members. After verification, households could exchange the coupon for an ITN at a distribution point. The evaluation was a pre/post design using representative household surveys with two-stage cluster sampling and a sample size of 600 households per survey. Results At endline, 78% of respondents were aware of the scheme and 89% of those also received an ITN through community-based distribution. Population access to ITNs nearly doubled, from 38% at baseline to 66% after the pilot. Household ownership of any ITN and enough ITNs (1 for 2 people) also increased significantly, from 66 to 82% and 19 to 46%, respectively. Community-based distribution was the only source of ITNs for 53.4% of households. The proportion of the population using an ITN last night increased from 22.7% at baseline to 53.9% at endline. A logistic regression model indicates that although behaviour change communication was positively associated with an increase in ITN use, access to enough nets was the greatest determinant of use. Conclusions ITN access and use improved significantly in the study area during the pilot, coming close to universal coverage targets. This pilot serves as proof of concept for the community-based distribution methodology implemented as a mechanism to sustain ITN universal coverage. Longer periods of implementation should be evaluated to determine whether community-based distribution can successfully maintain ITN coverage beyond the short term, and reach all wealth quintiles equitably. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-2020-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Albert Kilian
- Malaria Consortium, London, UK. .,Tropical Health LLP, Montagut, Spain.
| | | | | | - Richmond Ato Selby
- Malaria Consortium, London, UK.,Johns Hopkins University Center for Communication Programs, Baltimore, USA
| | - Kojo Lokko
- Johns Hopkins University Center for Communication Programs, Baltimore, USA
| | - Sean Blaufuss
- Johns Hopkins University Center for Communication Programs, Baltimore, USA
| | | | | | - Hannah Koenker
- Johns Hopkins University Center for Communication Programs, Baltimore, USA
| | - Martin Swaka
- President's Malaria Initiative, U.S. Agency for International Development, Washington D.C., USA
| | - George Greer
- President's Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, Tanzania
| | - Megan Fotheringham
- President's Malaria Initiative, U.S. Agency for International Development, Washington D.C., USA
| | - Lilia Gerberg
- President's Malaria Initiative, U.S. Agency for International Development, Washington D.C., USA
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Gunda R, Chimbari MJ. Cost-effectiveness analysis of malaria interventions using disability adjusted life years: a systematic review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:10. [PMID: 28680367 PMCID: PMC5494144 DOI: 10.1186/s12962-017-0072-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malaria continues to be a public health problem despite past and on-going control efforts. For sustenance of control efforts to achieve the malaria elimination goal, it is important that the most cost-effective interventions are employed. This paper reviews studies on cost-effectiveness of malaria interventions using disability-adjusted life years. METHODS A review of literature was conducted through a literature search of international peer-reviewed journals as well as grey literature. Searches were conducted through Medline (PubMed), EMBASE and Google Scholar search engines. The searches included articles published in English for the period from 1996 to 2016. The inclusion criteria for the study were type of malaria intervention, year of publication and cost-effectiveness ratio in terms of cost per DALY averted. We included 40 studies which specifically used the DALY metric in cost-effectiveness analysis (CEA) of malaria interventions. RESULTS The majority of the reviewed studies (75%) were done using data from African settings with the majority of the interventions (60.0%) targeting all age categories. Interventions included case treatment, prophylaxis, vector control, insecticide treated nets, early detection, environmental management, diagnosis and educational programmes. Sulfadoxine-pyrimethamine was the most common drug of choice in malaria prophylaxis, while artemisinin-based combination therapies were the most common drugs for case treatment. Based on guidelines for CEA, most interventions proved cost-effective in terms of cost per DALYs averted for each intervention. CONCLUSION The DALY metric is a useful tool for determining the cost-effectiveness of malaria interventions. This paper demonstrates the importance of CEA in informing decisions made by policy makers.
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Affiliation(s)
- Resign Gunda
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, 4001 South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard Campus, Durban, 4001 South Africa
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Kim D, Brown Z, Anderson R, Mutero C, Miranda ML, Wiener J, Kramer R. The Value of Information in Decision-Analytic Modeling for Malaria Vector Control in East Africa. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:231-244. [PMID: 27008340 PMCID: PMC6011226 DOI: 10.1111/risa.12606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
Abstract
Decision analysis tools and mathematical modeling are increasingly emphasized in malaria control programs worldwide to improve resource allocation and address ongoing challenges with sustainability. However, such tools require substantial scientific evidence, which is costly to acquire. The value of information (VOI) has been proposed as a metric for gauging the value of reduced model uncertainty. We apply this concept to an evidenced-based Malaria Decision Analysis Support Tool (MDAST) designed for application in East Africa. In developing MDAST, substantial gaps in the scientific evidence base were identified regarding insecticide resistance in malaria vector control and the effectiveness of alternative mosquito control approaches, including larviciding. We identify four entomological parameters in the model (two for insecticide resistance and two for larviciding) that involve high levels of uncertainty and to which outputs in MDAST are sensitive. We estimate and compare a VOI for combinations of these parameters in evaluating three policy alternatives relative to a status quo policy. We find having perfect information on the uncertain parameters could improve program net benefits by up to 5-21%, with the highest VOI associated with jointly eliminating uncertainty about reproductive speed of malaria-transmitting mosquitoes and initial efficacy of larviciding at reducing the emergence of new adult mosquitoes. Future research on parameter uncertainty in decision analysis of malaria control policy should investigate the VOI with respect to other aspects of malaria transmission (such as antimalarial resistance), the costs of reducing uncertainty in these parameters, and the extent to which imperfect information about these parameters can improve payoffs.
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Affiliation(s)
- Dohyeong Kim
- School of Economic, Political and Policy Sciences, The University of Texas at Dallas, TX, USA
| | - Zachary Brown
- Department of Agricultural and Resource Economics, North Carolina State University, NC, USA
| | | | - Clifford Mutero
- University of Pretoria, Pretoria, South Africa
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | | | - Jonathan Wiener
- Duke University Law School and Sanford School of Public Policy, Duke University, NC, USA
| | - Randall Kramer
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, NC, USA
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Rahman R, Lesser A, Mboera L, Kramer R. Cost of microbial larviciding for malaria control in rural Tanzania. Trop Med Int Health 2016; 21:1468-1475. [PMID: 27500959 DOI: 10.1111/tmi.12767] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Microbial larviciding may be a potential supplement to conventional malaria vector control measures, but scant information on its relative implementation costs and effectiveness, especially in rural areas, is an impediment to expanding its uptake. We perform a costing analysis of a seasonal microbial larviciding programme in rural Tanzania. METHODS We evaluated the financial and economic costs from the perspective of the public provider of a 3-month, community-based larviciding intervention implemented in twelve villages in the Mvomero District of Tanzania in 2012-2013. Cost data were collected from financial reports and invoices and through discussion with programme administrators. Sensitivity analysis explored the robustness of our results to varying key parameters. RESULTS Over the 2-year study period, approximately 6873 breeding sites were treated with larvicide. The average annual economic costs of the larviciding intervention in rural Tanzania are estimated at 2014 US$ 1.44 per person protected per year (pppy), US$ 6.18 per household and US$ 4481.88 per village, with the larvicide and staffing accounting for 14% and 58% of total costs, respectively. CONCLUSIONS We found the costs pppy of implementing a seasonal larviciding programme in rural Tanzania to be comparable to the costs of other larviciding programmes in urban Tanzania and rural Kenya. Further research should evaluate the cost-effectiveness of larviciding relative to, and in combination with, other vector control strategies in rural settings.
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Affiliation(s)
- Rifat Rahman
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Adriane Lesser
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Leonard Mboera
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Randall Kramer
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Nicholas School of the Environment, Duke University, Durham, NC, USA
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Larson BA, Ngoma T, Silumbe K, Rutagwera MRI, Hamainza B, Winters AM, Miller JM, Scott CA. A framework for evaluating the costs of malaria elimination interventions: an application to reactive case detection in Southern Province of Zambia, 2014. Malar J 2016; 15:408. [PMID: 27515533 PMCID: PMC4982323 DOI: 10.1186/s12936-016-1457-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/29/2016] [Indexed: 11/20/2022] Open
Abstract
Background This paper summarizes a framework for evaluating the costs of malaria elimination interventions and applies this approach to one key component of the elimination strategy—reactive case detection (RCD)—implemented through 173 health facilities across 10 districts in Southern Province of Zambia during 2014. Methods The primary unit of analysis is the health facility catchment area (HFCA). A five-step approach was followed to estimate implementation costs: organize preliminary information; estimate basic unit costs; estimate activity unit costs; estimate and organize final unit cost database; and create the final costing database (one row of data per HFCA). By working through a specific application, the overall logic of the analysis and details of each step are presented. An electronic annex also provides all details of the analysis. Because population varies substantially across HFCAs, all results are reported per 1000 population in HFCAs. Results During 2014, 38.9 households per HFCA were visited for RCD services; 166.8 individuals were tested and 32.3 tested positive and were treated. The mean annual cost per HFCA was $1177 (median = $923, IQR $651–$1417). Variation in costs was driven by the number of CHWs and passive cases detected. CHW-related costs and data review meetings accounted for the largest share of costs. Rapid diagnostic tests and drugs accounted for less than 10 % of total costs. Conclusions The framework presented here follows standard methods in applied costing of public health interventions (combining ingredients- and activity-based costing approaches into one final cost analysis). Through an application to a specific programme implemented in Zambia in 2014, the details of how to apply such methods to an actual programme are presented. Such details are not typically presented in existing costing analyses but are required for applied analysts working with national malaria control programmes and other organizations to complete such analyses as part of routine programme implementation. Obtaining data and information for implementing the approach remains complicated, in part because analysts from one organization may not have easy access to information from another organization. This basic approach is transparent and easily applied to other malaria elimination interventions being implemented in sub-Saharan Africa and elsewhere. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1457-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bruce A Larson
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 80211, USA.
| | - Thandiwe Ngoma
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia
| | - Kafula Silumbe
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia
| | - Marie-Reine I Rutagwera
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia
| | - Busiku Hamainza
- Ministry of Health, National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, P.O. Box 32509, Lusaka, Zambia
| | - Anna M Winters
- Akros, Cresta Golfview Grounds, Great East Road, Unit 5, Lusaka, Zambia.,University of Montana School of Public and Community Health Sciences, Missoula, MT, USA
| | - John M Miller
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds, Great East Road, Lusaka, Zambia
| | - Callie A Scott
- PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA
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Dambach P, Schleicher M, Stahl HC, Traoré I, Becker N, Kaiser A, Sié A, Sauerborn R. Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso. Malar J 2016; 15:380. [PMID: 27449023 PMCID: PMC4957841 DOI: 10.1186/s12936-016-1438-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022] Open
Abstract
Background The key tools in malaria control are early diagnosis and treatment of cases as well as vector control. Current strategies for malaria vector control in sub-Saharan Africa are largely based on long-lasting insecticide-treated nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). An additional tool in the fight against malaria vectors, larval source management (LSM), has not been used in sub-Saharan Africa on a wider scale since the abandonment of environmental spraying of DDT. Increasing concerns about limitations of LLINs and IRS and encouraging results from large larvicide-based LSM trials make a strong case for using biological larviciding as a complementary tool to existing control measures. Arguments that are often quoted against such a combined approach are the alleged high implementation costs of LSM. This study makes the first step to test this argument. The implementation costs of larval source management based on Bacillus thuringiensis israelensis (Bti) (strain AM65-52) spraying under different implementation scenarios were analysed in a rural health district in Burkina Faso. Methods The analysis draws on detailed cost data gathered during a large-scale LSM intervention between 2013 and 2015. All 127 villages in the study setup were assigned to two treatment arms and one control group. Treatment either implied exhaustive spraying of all available water collections or targeted spraying of the 50 % most productive larval sources via remote-sensing derived and entomologically validated risk maps. Based on the cost reports from both intervention arms, the per capita programme costs were calculated under the assumption of covering the whole district with either intervention scenario. Cost calculations have been generalized by providing an adaptable cost formula. In addition, this study assesses the sensitivity of per capita programme costs with respect to changes in the underlying cost components. Results The average annual per capita costs of exhaustive larviciding with Bti during the main malaria transmission period (June–October) in the Nouna health district were calculated to be US$ 1.05. When targeted spraying of the 50 % most productive larval sources is used instead, average annual per capita costs decrease by 27 % to US$ 0.77. Additionally, a high sensitivity of per capita programme costs against changes in total surface of potential larval sources and the number of spraying repetitions was found. Discussion The per capita costs for larval source management interventions with Bti are roughly a third of the annual per capita expenditures for anti-malarial drugs and those for LLINs in Burkina Faso which are US$ 3.80 and 3.00, respectively. The average LSM costs compare to those of IRS and LLINs for sub-Saharan Africa. The authors argue that in such a setting LSM based on Bti spraying is within the range of affordable anti-malarial strategies and, consequently, should deserve more attention in practice. Future research includes a cost-benefit calculation, based on entomological and epidemiological data collected during the research project. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1438-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Dambach
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
| | | | | | - Issouf Traoré
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Norbert Becker
- German Mosquito Control Association (KABS), Speyer, Germany.,Centre for Organismal Studies, University of Heidelberg, Heidelberg, Germany
| | - Achim Kaiser
- German Mosquito Control Association (KABS), Speyer, Germany
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Nonvignon J, Aryeetey GC, Issah S, Ansah P, Malm KL, Ofosu W, Tagoe T, Agyemang SA, Aikins M. Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana. Malar J 2016; 15:367. [PMID: 27423900 PMCID: PMC4947302 DOI: 10.1186/s12936-016-1418-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022] Open
Abstract
Background In Ghana, malaria is endemic and perennial (with significant seasonal variations in the three Northern Regions), accounting for 33 % of all deaths among children under 5 years old, with prevalence rates in children under-five ranging from 11 % in Greater Accra to 40 % in Northern Region. Ghana adopted the WHO-recommended Seasonal Malaria Chemoprevention (SMC) strategy with a trial in the Upper West Region in 2015. The objective of this study was to estimate the cost-effectiveness of seasonal malaria chemoprevention. Methods Costs were analysed from provider and societal perspectives and are reported in 2015 US$. Data on resource use (direct and indirect costs) of the SMC intervention were collected from intervention records and a survey in all districts and at regional level. Additional numbers of malaria cases and deaths averted by the intervention were estimated based on prevalence data obtained from an SMC effectiveness study in the region. Incremental cost-effectiveness ratios (ICERs) were estimated for the districts and region. Sensitivity analyses were conducted to test the robustness of the ICERs. Results The total financial cost of the intervention was US$1,142,040.80. The total economic cost was estimated to be US$7.96 million and US$2.66 million from the societal and provider perspectives, respectively. The additional numbers of cases estimated to be averted by the intervention were 24,881 and 808, respectively. The economic cost per child dosed was US$67.35 from societal perspective and US$22.53 from the provider perspective. The economic cost per additional case averted was US$107.06 from the provider perspective and US$319.96 from the societal perspective. The economic cost per additional child death averted by the intervention was US$3298.36 from the provider perspective and US$9858.02 from the societal perspective. The financial cost per the SMC intervention delivered to a child under-five was US$9.66. The ICERs were sensitive to mortality rate used. Conclusions The SMC intervention is economically beneficial in reducing morbidity in children under-5 years and presents a viable approach to improving under-five health in Ghana.
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Affiliation(s)
- Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Genevieve Cecilia Aryeetey
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Shamwill Issah
- UK Department for International Development, Accra, Ghana
| | - Patrick Ansah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Keziah L Malm
- National Malaria Control Programme, Ghana Health Service, Accra, Ghana
| | - Winfred Ofosu
- Upper West Regional Health Directorate, Ghana Health Service, Wa, Ghana
| | - Titus Tagoe
- Upper West Regional Health Directorate, Ghana Health Service, Wa, Ghana
| | - Samuel Agyei Agyemang
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana
| | - Moses Aikins
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, P. O. Box LG13, Legon, Ghana.
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Pega F, Wilson N. A Systematic Review of Health Economic Analyses of Housing Improvement Interventions and Insecticide-Treated Bednets in the Home. PLoS One 2016; 11:e0151812. [PMID: 27249419 PMCID: PMC4889137 DOI: 10.1371/journal.pone.0151812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 01/18/2016] [Indexed: 11/25/2022] Open
Abstract
Background Housing improvements have considerable potential for improving health. So does the provision of insecticide-treated bednets for malaria prevention. Therefore we aimed to conduct updated systematic reviews of health economic analyses in both these intervention domains. Methods and findings The search strategy included economic analyses of housing improvement interventions and use of insecticide-treated bednets for community-dwelling, healthy populations (published between 1 January 2000 and 15 April 2014). We searched the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, EMBASE, and three health economics databases. Thirty-five economic analyses of seven types of intervention fulfilled the inclusion criteria. Most included studies adopted a health sector perspective and were cost-effectiveness analyses using decision analytic modeling or conducted alongside trials. The overall quality of the studies was generally likely to be adequate for informing policy-making (albeit with limitations in some areas). There was fairly consistent evidence for the cost-effectiveness/favorable cost-benefit of removing indoor lead to prevent lead poisoning and sequelae, and retrofitting insulation to prevent lung disease. But the value of assessing and improving home safety and providing smoke alarms to prevent injuries was more mixed and the economic evidence was inconclusive or insufficient for: home ventilation to prevent lung disease, installing heaters to prevent lung disease and regulating tap water temperatures to prevent scalding. Few studies (n = 4) considered health equity. The 12 studies of providing insecticide-treated bednets or hammocks to prevent malaria found these interventions to be moderately to highly cost-effective. Conclusions This systematic review provides updated evidence that several housing improvement interventions (such as removing indoor lead and retrofitting insulation) and also the provision of insecticide-treated bednets are cost-effective interventions. Nevertheless, for some interventions additional analyses are required to better clarify their health economic and health equity value.
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Affiliation(s)
- Frank Pega
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand
- * E-mail:
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand
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Abstract
Plasmodium knowlesi a simian malaria parasite is currently affecting humans in Southeast Asia. Malaysia has reported the most number of cases and P. knowlesi is the predominant species occurring in humans. The vectors of P. knowlesi belong to the Leucosphyrus group of Anopheles mosquitoes. These are generally described as forest-dwelling mosquitoes. With deforestation and changes in land-use, some species have become predominant in farms and villages. However, knowledge on the distribution of these vectors in the country is sparse. From a public health point of view it is important to know the vectors, so that risk factors towards knowlesi malaria can be identified and control measures instituted where possible. Here, we review what is known about the knowlesi malaria vectors and ascertain the gaps in knowledge, so that future studies could concentrate on this paucity of data in-order to address this zoonotic problem.
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Demombynes G, Trommlerová SK. What has driven the decline of infant mortality in Kenya in the 2000s? ECONOMICS AND HUMAN BIOLOGY 2016; 21:17-32. [PMID: 26707059 DOI: 10.1016/j.ehb.2015.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
Substantial declines in early childhood mortality have taken place in many countries in Sub-Saharan Africa. Kenya's infant mortality rate fell by 7.6 percent per year between 2003 and 2008, the fastest rate of decline among the 20 countries in the region for which recent Demographic and Health Survey (DHS) data are available. The average rate of decline across all 20 countries was 3.6 percent per year. Among the possible causes of the observed decline in Kenya is a large-scale campaign to distribute insecticide-treated bednets (ITN) which started in 2004. A Oaxaca-Blinder decomposition using DHS data shows that the increased ownership of bednets in endemic malaria zones explains 79 percent of the decline in infant mortality. Although the Oaxaca-Blinder method cannot identify causal effects, given the wide evidence basis showing that ITN usage can reduce malaria prevalence and the huge surge in ITN ownership in Kenya, it is likely that the decomposition results reflect at least in part a causal effect. The widespread ownership of ITNs in areas of Kenya where malaria is rare suggests that better targeting of ITN provision could improve the cost-effectiveness of such programs.
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Faraj C, Yukich J, Adlaoui EB, Wahabi R, Mnzava AP, Kaddaf M, El Idrissi AL, Ameur B, Kleinschmidt I. Effectiveness and Cost of Insecticide-Treated Bed Nets and Indoor Residual Spraying for the Control of Cutaneous Leishmaniasis: A Cluster-Randomized Control Trial in Morocco. Am J Trop Med Hyg 2016; 94:679-685. [PMID: 26811431 PMCID: PMC4775907 DOI: 10.4269/ajtmh.14-0510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/19/2015] [Indexed: 11/08/2022] Open
Abstract
Cutaneous leishmaniasis (CL) remains an important public health problem in Morocco. A cluster-randomized trial was conducted with the following three study arms: 1) long-lasting insecticide-treated nets (LLINs) plus standard of care environmental management (SoC-EM), 2) indoor residual spraying (IRS) with α-cypermethrin plus SoC-EM, and 3) SoC-EM alone. Incidence of new CL cases by passive and active case detection, sandfly abundance, and cost and cost-effectiveness was compared between study arms over 5 years. Incidence of CL and sandfly abundance were significantly lower in the IRS arm compared with SoC-EM (CL incidence rate ratio = 0.32, 95% confidence interval [CI] = 0.15–0.69, P = 0.005 and sandfly abundance ratio = 0.39, 95% CI = 0.18–0.85, P = 0.022). Reductions in the LLIN arm of the study were not significant, possibly due to poor compliance. IRS was effective and more cost-effective for the prevention of CL in Morocco.
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Affiliation(s)
| | - Joshua Yukich
- *Address correspondence to Joshua Yukich, Tulane University School of Public Health and Tropical Medicine, Department of Tropical Medicine, 1440 Canal Street, Suite 2300, New Orleans, LA 70112-2715. E-mail:
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Penny MA, Verity R, Bever CA, Sauboin C, Galactionova K, Flasche S, White MT, Wenger EA, Van de Velde N, Pemberton-Ross P, Griffin JT, Smith TA, Eckhoff PA, Muhib F, Jit M, Ghani AC. Public health impact and cost-effectiveness of the RTS,S/AS01 malaria vaccine: a systematic comparison of predictions from four mathematical models. Lancet 2016; 387:367-375. [PMID: 26549466 PMCID: PMC4723722 DOI: 10.1016/s0140-6736(15)00725-4] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The phase 3 trial of the RTS,S/AS01 malaria vaccine candidate showed modest efficacy of the vaccine against Plasmodium falciparum malaria, but was not powered to assess mortality endpoints. Impact projections and cost-effectiveness estimates for longer timeframes than the trial follow-up and across a range of settings are needed to inform policy recommendations. We aimed to assess the public health impact and cost-effectiveness of routine use of the RTS,S/AS01 vaccine in African settings. METHODS We compared four malaria transmission models and their predictions to assess vaccine cost-effectiveness and impact. We used trial data for follow-up of 32 months or longer to parameterise vaccine protection in the group aged 5-17 months. Estimates of cases, deaths, and disability-adjusted life-years (DALYs) averted were calculated over a 15 year time horizon for a range of levels of Plasmodium falciparum parasite prevalence in 2-10 year olds (PfPR2-10; range 3-65%). We considered two vaccine schedules: three doses at ages 6, 7·5, and 9 months (three-dose schedule, 90% coverage) and including a fourth dose at age 27 months (four-dose schedule, 72% coverage). We estimated cost-effectiveness in the presence of existing malaria interventions for vaccine prices of US$2-10 per dose. FINDINGS In regions with a PfPR2-10 of 10-65%, RTS,S/AS01 is predicted to avert a median of 93,940 (range 20,490-126,540) clinical cases and 394 (127-708) deaths for the three-dose schedule, or 116,480 (31,450-160,410) clinical cases and 484 (189-859) deaths for the four-dose schedule, per 100,000 fully vaccinated children. A positive impact is also predicted at a PfPR2-10 of 5-10%, but there is little impact at a prevalence of lower than 3%. At $5 per dose and a PfPR2-10 of 10-65%, we estimated a median incremental cost-effectiveness ratio compared with current interventions of $30 (range 18-211) per clinical case averted and $80 (44-279) per DALY averted for the three-dose schedule, and of $25 (16-222) and $87 (48-244), respectively, for the four-dose schedule. Higher ICERs were estimated at low PfPR2-10 levels. INTERPRETATION We predict a significant public health impact and high cost-effectiveness of the RTS,S/AS01 vaccine across a wide range of settings. Decisions about implementation will need to consider levels of malaria burden, the cost-effectiveness and coverage of other malaria interventions, health priorities, financing, and the capacity of the health system to deliver the vaccine. FUNDING PATH Malaria Vaccine Initiative; Bill & Melinda Gates Foundation; Global Good Fund; Medical Research Council; UK Department for International Development; GAVI, the Vaccine Alliance; WHO.
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Affiliation(s)
- Melissa A Penny
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Robert Verity
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
| | | | | | - Katya Galactionova
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael T White
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
| | | | | | - Peter Pemberton-Ross
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Jamie T Griffin
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
| | - Thomas A Smith
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | | | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
| | - Azra C Ghani
- Medical Research Council Centre for Outbreak Analysis and Modelling, Imperial College London, London, UK
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Deressa W, Loha E, Balkew M, Hailu A, Gari T, Kenea O, Overgaard HJ, Gebremichael T, Robberstad B, Lindtjørn B. Combining long-lasting insecticidal nets and indoor residual spraying for malaria prevention in Ethiopia: study protocol for a cluster randomized controlled trial. Trials 2016; 17:20. [PMID: 26758744 PMCID: PMC4711025 DOI: 10.1186/s13063-016-1154-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are the main malaria prevention interventions in Ethiopia. There is conflicting evidence that the combined application of both interventions is better than either LLINs or IRS used alone. This trial aims to investigate whether the combination of LLINs (PermaNet 2.0, Vestergaard Frandsen, Lausanne, Switzerland) with IRS using propoxur will enhance the protective benefits and cost-effectiveness of the interventions against malaria and its effect on mosquito behavior, as compared to each intervention alone. METHODS/DESIGN This 2 x 2 factorial cluster randomized controlled trial is being carried out in the Adami Tullu district in south-central Ethiopia for about 116 weeks from September 2014 to December 2016. The trial is based on four arms: LLINs + IRS, LLINs alone, IRS alone and control. Villages (or clusters) will be the unit of randomization. The sample size includes 44 clusters per arm, with each cluster comprised of approximately 35 households (about 175 people). Prior to intervention, all households in the LLINs + IRS and LLINs alone arms will be provided with LLINs free of charge. Households in the LLINs + IRS and IRS alone arms will be sprayed with carbamate propoxur once a year just before the main malaria transmission season throughout the investigation. The primary outcome of this trial will be a malaria incidence based on the results of the rapid diagnostic tests in patients with a fever or history of fever attending health posts by passive case detection. Community-based surveys will be conducted each year to assess anemia among children 5-59 months old. In addition, community-based malaria prevalence surveys will be conducted each year on a representative sample of households during the main transmission season. The cost-effectiveness of the interventions and entomological studies will be simultaneously conducted. Analysis will be based on an intention-to-treat principle. DISCUSSION This trial aims to provide evidence on the combined use of LLINs and IRS for malaria prevention by answering the following research questions: Can the combined use of LLINs and IRS significantly reduce the incidence of malaria compared with the use of either LLINs or IRS alone? And is the reduced incidence justifiable compared to the added costs? Will the combined use of LLINs and IRS reduce vector density, infection, longevity and the entomological inoculation rate? These data are crucial in order to maximize the impact of vector control interventions on the morbidity and mortality of malaria. TRIAL REGISTRATION PACTR201411000882128 (8 September 2014).
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Affiliation(s)
- Wakgari Deressa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Eskindir Loha
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
| | - Meshesha Balkew
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Alemayehu Hailu
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
- Center for International Health, University of Bergen, Bergen, Norway.
| | - Taye Gari
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
- Center for International Health, University of Bergen, Bergen, Norway.
| | - Oljira Kenea
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Hans J Overgaard
- Norwegian University of Life Sciences, Ås, Norway.
- Institut de Recherche pour le Développement (IRD), Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), Montpellier, France.
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand.
| | - Teshome Gebremichael
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Bjarne Robberstad
- Center for International Health, University of Bergen, Bergen, Norway.
| | - Bernt Lindtjørn
- Center for International Health, University of Bergen, Bergen, Norway.
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Sun DW, Du JW, Wang GZ, Li YC, He CH, Xue RD, Wang SQ, Hu XM. A Cost-Effectiveness Analysis of Plasmodium falciparum Malaria Elimination in Hainan Province, 2002-2012. Am J Trop Med Hyg 2015; 93:1240-8. [PMID: 26438030 PMCID: PMC4674241 DOI: 10.4269/ajtmh.14-0486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/06/2015] [Indexed: 01/01/2023] Open
Abstract
In Hainan Province, China, great achievements in elimination of falciparum malaria have been made since 2010. There have been no locally acquired falciparum malaria cases since that time. The cost-effectiveness of elimination of falciparum malaria has been analyzed in Hainan Province. There were 4,422 falciparum malaria cases reported from 2002 to 2012, more cases occurred in males than in females. From 2002 to 2012, a total of 98.5 disability-adjusted life years (DALYs) were reported because of falciparum malaria. Populations in the age ranges of 15-25 and 30-44 years had higher incidences and DALYs than other age groups. From 2002 to 2012, malaria-related costs for salaries of staff, funds from the provincial government, national government, and the GFATM were US$3.02, US$2.24, US$1.44, and US$5.08 million, respectively. An estimated 9,504 falciparum malaria cases were averted during the period 2003-2012. The estimated cost per falciparum malaria case averted was US$116.5. The falciparum malaria elimination program in Hainan was highly effective and successful. However, funding for maintenance is still needed because of imported cases.
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Affiliation(s)
- Ding-Wei Sun
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
| | - Jian-Wei Du
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
| | - Guang-Ze Wang
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
| | - Yu-Chun Li
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
| | - Chang-Hua He
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
| | - Rui-De Xue
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
| | - Shan-Qing Wang
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
| | - Xi-Min Hu
- Department of Parasitic Control and Prevention, Hainan Provincial Center for Disease Control and Prevention, Haikou, People's Republic of China; Anastasia Mosquito Control District, St. Augustine, Florida
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Kruger T, Sibanda MM, Focke WW, Bornman MS, de Jager C. Acceptability and effectiveness of a monofilament, polyethylene insecticide-treated wall lining for malaria control after six months in dwellings in Vhembe District, Limpopo Province, South Africa. Malar J 2015; 14:485. [PMID: 26628275 PMCID: PMC4667516 DOI: 10.1186/s12936-015-1005-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND South Africa uses indoor residual spraying (IRS) for vector control in its malaria control programme (MCP). Insecticide-treated wall linings (ITWLs) offer possible advantages over IRS and long-lasting, insecticide-treated nets (LLINs). This study assessed the user acceptability and perceived effectiveness, and the durability, including efficacy through bioassays, of a newly developed, monofilament polyethylene ITWL. METHODS Four ITWL formulations/treatments, two incorporated with deltamethrin and two with alpha-cypermethrin in concentrations ranging from 0.29 to 0.85 wt%, and untreated linings were randomly installed on the inner walls of traditional mud huts (n = 20) and modern brick houses (n = 20) in a community village in Vhembe District, Limpopo Province. The linings were exposed to conditions within these dwellings over 6 months. Data were collected monthly through questionnaires and entomological residual efficacy analysis of ITWL, as part of durability testing, was done bimonthly using WHO prescribed bioassays. RESULTS Monofilament polyethylene ITWLs were successfully installed in traditional sleeping huts and in bedrooms of modern type brick houses. ITWL remained intact throughout the entire 6 months of the study. Participants did not express any dissatisfaction towards the linings although two participants indicated the product should be fitted at a lower level for better results. User perceived effectiveness was very high with participants reporting observed mortality of mosquitoes and other nuisance insects. This perception coincided with results obtained through residual efficacy bioassays where a 100 % knockdown and mortality of mosquitoes was recorded throughout the trial period. Acceptability regarding appearance, including colour, position and attachment method, was also satisfactory with some participants citing the lining as decorative. All participants opted to keep ITWL and residual long-term efficacy will be determined annually for a further 3 years. CONCLUSIONS The newly developed ITWLs are highly accepted amongst participants in an unsprayed section of a village in a malaria-endemic area. The perceived effectiveness that coincides with results obtained through bioassays and acceptance of the overall appearance of ITWL will be evaluated over a longer term to determine sustainability. With further developing and testing, this ITWL has the potential to become a sustainable and safer alternative vector control method.
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Affiliation(s)
- Taneshka Kruger
- University of Pretoria Centre for Sustainable Malaria Control (UP CSMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X323, Pretoria, 0001, South Africa.
| | - Mthokozisi M Sibanda
- UP CSMC, Chemical Engineering, Institute of Applied Materials, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa.
| | - Walter W Focke
- UP CSMC, Chemical Engineering, Institute of Applied Materials, University of Pretoria, Private Bag X20, Hatfield, 0028, South Africa.
| | - Maria S Bornman
- University of Pretoria Centre for Sustainable Malaria Control (UP CSMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X323, Pretoria, 0001, South Africa.
| | - Christiaan de Jager
- University of Pretoria Centre for Sustainable Malaria Control (UP CSMC), School of Health Systems and Public Health, University of Pretoria, Private Bag X323, Pretoria, 0001, South Africa.
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Parham PE, Hughes DA. Climate influences on the cost-effectiveness of vector-based interventions against malaria in elimination scenarios. Philos Trans R Soc Lond B Biol Sci 2015; 370:rstb.2013.0557. [PMID: 25688017 DOI: 10.1098/rstb.2013.0557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite the dependence of mosquito population dynamics on environmental conditions, the associated impact of climate and climate change on present and future malaria remains an area of ongoing debate and uncertainty. Here, we develop a novel integration of mosquito, transmission and economic modelling to assess whether the cost-effectiveness of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) against Plasmodium falciparum transmission by Anopheles gambiae s.s. mosquitoes depends on climatic conditions in low endemicity scenarios. We find that although temperature and rainfall affect the cost-effectiveness of IRS and/or LLIN scale-up, whether this is sufficient to influence policy depends on local endemicity, existing interventions, host immune response to infection and the emergence rate of insecticide resistance. For the scenarios considered, IRS is found to be more cost-effective than LLINs for the same level of scale-up, and both are more cost-effective at lower mean precipitation and higher variability in precipitation and temperature. We also find that the dependence of peak transmission on mean temperature translates into optimal temperatures for vector-based intervention cost-effectiveness. Further cost-effectiveness analysis that accounts for country-specific epidemiological and environmental heterogeneities is required to assess optimal intervention scale-up for elimination and better understand future transmission trends under climate change.
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Affiliation(s)
- Paul E Parham
- Department of Public Health and Policy, University of Liverpool, London, EC2A 1AG, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ, UK
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Shahandeh K, Basseri HR, Majdzadeh R, Sadeghi R, Safari R, Shojaeizadeh D. Health Workers Adjustment for Elimination of Malaria in a Low Endemic Area. Int J Prev Med 2015; 6:105. [PMID: 26644905 PMCID: PMC4671174 DOI: 10.4103/2008-7802.169022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 04/30/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Malaria elimination efforts face with substantial challenges and the role of health workers in address this challenge, particularly advocates and mobilizes communities. The aim of the study was to explore perceptions of health workers in relation to eliminating malaria in order to better understand the level their involvement in malaria elimination efforts. A qualitative approach was adopted based on key informant interviews with 26 health workers who working at community-level in malaria low endemic areas, southern Iran. METHODS Data were collected through key informant interviews. Data were analyzed using thematic content analysis. RESULTS Findings reveal that the majority of participants concerned with the imported malaria cases, without to address an effective solution to the issue. Health workers had positive perceptions on their basic knowledge and opinions in relation to their field work with emphases to integrate methods. Participants expressed willingness to contribute to malaria elimination effort. They also emphasized on continuous training, resource mobilization, and support. In addition, their perceptions on malaria elimination policy such as sustained financial investment to achieve elimination and integrated management of vector control were rather negative. CONCLUSIONS A mechanism should be considered that allow the health workers to feedback positively on their quality of their practice to health providers.
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Affiliation(s)
- Khandan Shahandeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Basseri
- Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safari
- Department of Communicable Diseases, Hormozgan Province Health Center, Hormozgan University of Medical Sciences, Bandar Abass, Iran
| | - Davoud Shojaeizadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Wong ML, Chua TH, Leong CS, Khaw LT, Fornace K, Wan-Sulaiman WY, William T, Drakeley C, Ferguson HM, Vythilingam I. Seasonal and Spatial Dynamics of the Primary Vector of Plasmodium knowlesi within a Major Transmission Focus in Sabah, Malaysia. PLoS Negl Trop Dis 2015; 9:e0004135. [PMID: 26448052 PMCID: PMC4598189 DOI: 10.1371/journal.pntd.0004135] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background The simian malaria parasite Plasmodium knowlesi is emerging as a public health problem in Southeast Asia, particularly in Malaysian Borneo where it now accounts for the greatest burden of malaria cases and deaths. Control is hindered by limited understanding of the ecology of potential vector species. Methodology/Principal Findings We conducted a one year longitudinal study of P. knowlesi vectors in three sites within an endemic area of Sabah, Malaysia. All mosquitoes were captured using human landing catch. Anopheles mosquitoes were dissected to determine, oocyst, sporozoites and parous rate. Anopheles balabacensis is confirmed as the primary vector of. P. knowlesi (using nested PCR) in Sabah for the first time. Vector densities were significantly higher and more seasonally variable in the village than forest or small scale farming site. However An. balabacensis survival and P. knowlesi infection rates were highest in forest and small scale farm sites. Anopheles balabacensis mostly bites humans outdoors in the early evening between 1800 to 2000hrs. Conclusions/Significance This study indicates transmission is unlikely to be prevented by bednets. This combined with its high vectorial capacity poses a threat to malaria elimination programmes within the region. The first natural infection of Plasmodium knowlesi was reported 40 years ago. At that time it was perceived that the infection would not affect humans. However, now P. knowlesi is the predominant malaria species (38% of the cases) infecting people in Malaysia and is a notable obstacle to malaria elimination in the country. Plasmodium knowlesi has also been reported from all countries in Southeast Asia with the exception of Lao PDR and Timor Leste. In Sabah, Malaysian Borneo cases of human P. knowlesi are increasing. Thus, a comprehensive understanding of the bionomics of the vectors is required so as to enable proper control strategies. Here, we conducted a longitudinal study in Kudat district, Sabah, to determine and characterize the vectors of P. knowlesi within this transmission foci. Anopheles balabacensis was the predominant mosquito in all study sites and is confirmed as vector for P. knowlesi and other simian malaria parasites. The peak biting time was in the early part of the evening between1800 to 2000. Thus, breaking the chain of transmission is an extremely challenging task for the malaria elimination programme.
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Affiliation(s)
- Meng L. Wong
- Parasitology Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tock H. Chua
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Sabah Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Cherng S. Leong
- Parasitology Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Loke T. Khaw
- Parasitology Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kimberly Fornace
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Chris Drakeley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Heather M. Ferguson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Scotland, United Kingdom
| | - Indra Vythilingam
- Parasitology Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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Silumbe K, Yukich JO, Hamainza B, Bennett A, Earle D, Kamuliwo M, Steketee RW, Eisele TP, Miller JM. Costs and cost-effectiveness of a large-scale mass testing and treatment intervention for malaria in Southern Province, Zambia. Malar J 2015; 14:211. [PMID: 25985992 PMCID: PMC4490652 DOI: 10.1186/s12936-015-0722-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/05/2015] [Indexed: 11/17/2022] Open
Abstract
Background A cluster, randomized, control trial of three dry-season rounds of a mass testing and treatment intervention (MTAT) using rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) was conducted in four districts in Southern Province, Zambia. Methods Data were collected on the costs and logistics of the intervention and paired with effectiveness estimated from a community randomized control trial for the purpose of conducting a provider perspective cost-effectiveness analysis of MTAT vs no MTAT (Standard of Care). Results Dry-season MTAT in this setting did not reduce malaria transmission sufficiently to permit transition to a case-investigation strategy to then pursue malaria elimination, however, the intervention did substantially reduce malaria illness and was a highly cost-effective intervention for malaria burden reduction in this moderate transmission area. The cost per RDT administered was estimated to be USD4.39 (range: USD1.62-13.96) while the cost per AL treatment administered was estimated to be USD34.74 (range: USD3.87-3,835). The net cost per disability adjusted life year averted (incremental cost-effectiveness ratio) was estimated to be USD804. Conclusions The intervention 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.
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Affiliation(s)
- Kafula Silumbe
- Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia.
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | | | - Adam Bennett
- Malaria Elimination Initiative, University of California San Francisco, San Francisco, USA.
| | - Duncan Earle
- Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia.
| | | | - Richard W Steketee
- Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia.
| | - Thomas P Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - John M Miller
- Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia.
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Santatiwongchai B, Chantarastapornchit V, Wilkinson T, Thiboonboon K, Rattanavipapong W, Walker DG, Chalkidou K, Teerawattananon Y. Methodological variation in economic evaluations conducted in low- and middle-income countries: information for reference case development. PLoS One 2015; 10:e0123853. [PMID: 25950443 PMCID: PMC4423853 DOI: 10.1371/journal.pone.0123853] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/1969] [Accepted: 07/20/1969] [Indexed: 11/18/2022] Open
Abstract
Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to inform a methodological standardisation workstream at the Bill and Melinda Gates Foundation (BMGF) and assesses BMGF-funded cost-per-DALY economic evaluations in four programme areas (malaria, tuberculosis, HIV/AIDS and vaccines) in terms of variation in methodology, use of evidence, and quality of reporting. The findings suggest that there is room for improvement in the three areas of assessment, and support the case for the introduction of a standardised methodology or reference case by the BMGF. The findings are also instructive for all institutions that fund economic evaluations in LMICs and who have a desire to improve the ability of economic evaluations to inform resource allocation decisions.
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Affiliation(s)
| | | | - Thomas Wilkinson
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
| | | | | | - Damian G Walker
- Global Health Program, Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Kalipso Chalkidou
- NICE International, National Institute for Health and Care Excellence, London, United Kingdom
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49
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West PA, Protopopoff N, Wright A, Kivaju Z, Tigererwa R, Mosha FW, Kisinza W, Rowland M, Kleinschmidt I. Enhanced protection against malaria by indoor residual spraying in addition to insecticide treated nets: is it dependent on transmission intensity or net usage? PLoS One 2015; 10:e0115661. [PMID: 25811379 PMCID: PMC4374910 DOI: 10.1371/journal.pone.0115661] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/03/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Insecticide treated nets (ITNs) and indoor residual spraying (IRS) are effective vector control tools that protect against malaria. There is conflicting evidence regarding whether using ITNs and IRS in combination provides additional benefit over using either of these methods alone. This study investigated factors that may modify the effect of the combined use of IRS and ITNs compared to using ITNs alone on malaria infection prevalence. METHODS Secondary analysis was carried out on data from a cluster randomised trial in north-west Tanzania. 50 clusters received ITNs from a universal coverage campaign; of these 25 were randomly allocated to additionally receive two rounds of IRS in 2012. In cross-sectional household surveys children 0.5-14 years old were tested for Plasmodium falciparum infections (PfPR) two, six and ten months after the first IRS round. RESULTS IRS protected those sleeping under nets (OR = 0.38, 95%CI 0.26-0.57) and those who did not (OR = 0.43, 95%CI 0.29-0.63). The protective effect of IRS was not modified by community level ITN use (ITN use<50%, OR = 0.39, 95%CI 0.26-0.59; ITN use> = 50%, OR = 0.46, 95%CI 0.28-0.74). The additional protection from IRS was similar in low (<10% PfPR, OR = 0.38, 95%CI 0.19-0.75) and high transmission areas (≥10% PfPR, OR = 0.34, 95%CI 0.18-0.67). ITN use was protective at the individual-level regardless of whether the village had been sprayed (OR = 0.83, 95%CI 0.70-0.98). Living in a sprayed village was protective regardless of whether the individual slept under an ITN last night (OR = 0.41, 95%CI 0.29-0.58). INTERPRETATION Implementing IRS in addition to ITNs was beneficial for individuals from villages with a wide range of transmission intensities and net utilisation levels. Net users received additional protection from IRS. ITNs were providing some individual protection, even in this area with high levels of pyrethroid insecticide resistance. These results demonstrate that there is a supplementary benefit of IRS even when ITNs are effective. TRIAL REGISTRATION ClinicalTrials.gov NCT01697852.
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Affiliation(s)
- Philippa A. West
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Natacha Protopopoff
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alexandra Wright
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zuhura Kivaju
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | | | - Franklin W. Mosha
- Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
| | - William Kisinza
- National Institute for Medical Research, Amani Medical Research Centre, Muheza, Tanzania
| | - Mark Rowland
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Immo Kleinschmidt
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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50
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Ricotta EE, Boulay M, Ainslie R, Babalola S, Fotheringham M, Koenker H, Lynch M. The use of mediation analysis to assess the effects of a behaviour change communication strategy on bed net ideation and household universal coverage in Tanzania. Malar J 2015; 14:15. [PMID: 25603882 PMCID: PMC4308934 DOI: 10.1186/s12936-014-0531-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/22/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND SBCC campaigns are designed to act on cognitive, social and emotional factors at the individual or community level. The combination of these factors, referred to as 'ideation', play a role in determining behaviour by reinforcing and confirming decisions about a particular health topic. This study introduces ideation theory and mediation analysis as a way to evaluate the impact of a malaria SBCC campaign in Tanzania, to determine whether exposure to a communication programme influenced universal coverage through mediating ideational variables. METHODS A household survey in three districts where community change agents (CCAs) were active was conducted to collect information on ITN use, number of ITNs in the household, and perceptions about ITN use and ownership. Variables relating to attitudes and beliefs were combined to make 'net ideation'. Using an ideational framework, a mediation analysis was conducted to see the impact exposure to a CCA only, mass media and community (M & C) messaging only, or exposure to both, had on household universal coverage, through the mediating variable net ideation. RESULTS All three levels of exposure (CCA, M & C messaging, or exposure to both) were significantly associated with increased net ideation (CCA: 0.283, 95% CI: 0.136-0.429, p-value: <0.001; M & C: 0.128, 95% CI: 0.032-0.334, p-value: 0.018; both: 0.376, 95% CI: 0.170-0.580, p-value: <0.001). Net ideation also significantly increased the odds of having universal coverage (CCAOR: 1.265, 95% CI: 1.118-1.433, p-value: <0.001; M & COR: 1.264, 95% CI: 1.117-1.432, p-value: <0.001, bothOR: 1.260, 95% CI: 1.114-1.428, p-value: <0.001). There were no significant direct effects between any exposure and universal coverage when controlling for net ideation. CONCLUSIONS The results of this study indicate that mediation analysis is an applicable new tool to assess SBCC campaigns. Ideation as a mediator of the effects of communication exposure on household universal coverage has implications for designing SBCC to support both mass and continuous distribution efforts, since both heavily rely on consumer participation to obtain and maintain ITNs. Such systems can be strengthened by SBCC programming, generating demand through improving social norms about net ownership and use, perceived benefits of nets, and other behavioural constructs.
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Affiliation(s)
- Emily E Ricotta
- />Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, Baltimore, MD 21202 USA
| | - Marc Boulay
- />Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, Baltimore, MD 21202 USA
| | - Robert Ainslie
- />Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, Baltimore, MD 21202 USA
| | - Stella Babalola
- />Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, Baltimore, MD 21202 USA
| | - Megan Fotheringham
- />President’s Malaria Initiative, US Agency for International Development, Washington, DC USA
| | - Hannah Koenker
- />Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, Baltimore, MD 21202 USA
| | - Matthew Lynch
- />Johns Hopkins Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, 111 Market Place Suite 310, Baltimore, MD 21202 USA
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