Prioritizing the scale-up of interventions for malaria control and elimination

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Title: Prioritizing the scale-up of interventions for malaria control and elimination
Authors: Winskill, P
Walker, PG
Cibulskis, RE
Ghani, AC
Item Type: Journal Article
Abstract: Background A core set of intervention and treatment options are recommended by the World Health Organization for use against falciparum malaria. These are treatment, long-lasting insecticide-treated bed nets, indoor residual spraying, and chemoprevention options. Both domestic and foreign aid funding for these tools is limited. When faced with budget restrictions, the introduction and scale-up of intervention and treatment options must be prioritized. Methods Estimates of the cost and impact of different interventions were combined with a mathematical model of malaria transmission to estimate the most cost-effective prioritization of interventions. The incremental cost effectiveness ratio was used to select between scaling coverage of current interventions or the introduction of an additional intervention tool. Results Prevention, in the form of vector control, is highly cost effective and scale-up is prioritized in all scenarios. Prevention reduces malaria burden and therefore allows treatment to be implemented in a more cost-effective manner by reducing the strain on the health system. The chemoprevention measures (seasonal malaria chemoprevention and intermittent preventive treatment in infants) are additional tools that, provided sufficient funding, are implemented alongside treatment scale-up. Future tools, such as RTS,S vaccine, have impact in areas of higher transmission but were introduced later than core interventions. Conclusions In a programme that is budget restricted, it is essential that investment in available tools be effectively prioritized to maximize impact for a given investment. The cornerstones of malaria control: vector control and treatment, remain vital, but questions of when to scale and when to introduce other interventions must be rigorously assessed. This quantitative analysis considers the scale-up or core interventions to inform decision making in this area.
Issue Date: 8-Apr-2019
Date of Acceptance: 29-Mar-2019
ISSN: 1475-2875
Publisher: BioMed Central
Journal / Book Title: Malaria Journal
Volume: 18
Issue: 1
Copyright Statement: © 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Bill & Melinda Gates Foundation
Medical Research Council (MRC)
Funder's Grant Number: OPP1068440
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Tropical Medicine
Plasmodium falciparum
1108 Medical Microbiology
Publication Status: Published
Open Access location:
Article Number: 122
Online Publication Date: 2019-04-08
Appears in Collections:Epidemiology, Public Health and Primary Care

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