Authors

P G Walker¹; J T Griffin¹; N M Ferguson¹; A C Ghani¹;  ¹ Imperial College London

Discussion

Reducing the burden of malaria is a global priority but financial constraints require resources to be allocated rationally to maximise impact.We combined a dynamical model capturing heterogeneity in malaria transmission across Africa with financial data for key malaria interventions to estimate the most efficient ordering of malaria interventions to reduce malaria burden and transmission. We found the optimal package in a setting depends on whether disease reduction or elimination is the target. Long-lasting insecticide-treated nets are generally the most cost-effective first intervention to achieve either goal, with seasonal malaria chemoprevention or indoor-residual spraying added second depending on seasonality and vector species. These interventions are estimated to reduce transmission to <0.001 case per person-year in 43·4% (40·0%-49·0%) of the population at risk in Africa. Adding three annual rounds of mass drug administration (MDA) increased this to 90·9% (86·9%-94·6%). Further optimisation can be achieved by targeting policies at the provincial (sub-national) level, achieving an estimated 32·1% (29·6%-34·5%) cost saving relative to country-wide policies. Nevertheless we predict only 26 (22-29) of 41 countries could reduce transmission to these levels with these tools. These results show the cost-benefits of carefully tailoring interventions to local ecology but also highlight that novel interventions are necessary for malaria eradication.