The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015
Open accessAbstract
Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015, and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542–753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies. In this study, the authors present an analysis of the malaria burden in sub-Saharan Africa between 2000 and 2015, and quantify the effects of the interventions that have been implemented to combat the disease; they find that the prevalence of Plasmodium falciparum infection has been reduced by 50% since 2000 and the incidence of clinical disease by 40%, and that interventions have averted approximately 663 million clinical cases since 2000, with insecticide-treated bed nets being the largest contributor. In one of the largest public health campaigns in history, a concerted malaria control campaign has been under way in sub-Saharan Africa for the past 15 years. Billions of dollars have been invested to provide interventions such as bed nets and antimalarial drugs but the overall effect on malaria burden remains unclear. This study uses field data from 30,000 population clusters in a sophisticated space–time modelling framework to quantify the changing Plasmodium falciparum risk (a 40% decline in case incidence since 2000) and the role of malaria interventions (around 700 million cases averted). Although below target levels, the current campaign has substantially reduced the incidence of malaria across the continent. Continued success will depend upon increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance.
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LLINs and IRS are effective strategies for controlling malaria but can only operate indoors.
“LLINs and IRS are effective strategies controlling malaria but unfortunately they can only operate indoors [41, 42].”
From Entomological indicators of malaria transmission prior to a cluster-randomized controlled trial of a 'lethal house lure' intervention in central Côte d'Ivoire (2022) · cites this paper as [42]
The Discussion reports that insecticide-treated nets (ITNs) had the largest effect and indoor residual spraying (IRS) made an important contribution to reducing malaria prevalence and incidence. The paper identifies IRS as indoor spraying, but the passages do not establish the stronger claim that both interventions can only operate indoors. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe combination of LLINs and IRS has proven effective in different parts of Africa, and IRS provides more flexibility in the choice of insecticides against insecticide-resistant mosquitoes than LLINs.
“The combination of LLINs and IRS has proven effective in different parts of Africa, and IRS provides more flexibility in the choice of insecticides against insecticide-resistant mosquitoes than LLINs [6, 7].”
From Characterization and abundance of malaria vectors in Sakassou, Central Côte d'Ivoire (2025) · cites this paper as [6]
The Discussion (page unavailable) reports that insecticide-treated nets had a large effect across Africa and that indoor residual spraying (IRS) contributed to reductions where implemented at scale. Extended Data Figure 4 maps the combined effect of nets, treatment, and IRS, but does not establish the effectiveness of nets and IRS specifically as a pair. The paper also does not compare their flexibility in choosing insecticides against resistant mosquitoes. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe degree of mortality concentration estimated for enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, and tuberculosis reflects substantial global progress in reducing mortality from these causes over the study period, underscoring the success of several public health campaigns, global commitments, and improvements in communicable-disease programmes.
“The degree of mortality concentration estimated by this study for enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, and tuberculosis reflects substantial global progress in reducing mortality from these causes over the study period, underscoring the success of several public health campaigns, global commitments, and improvements in communicable-disease programmes.28,”
From Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [30]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredVector control tools like long-lasting insecticide treated nets (LLINs) and indoor residual spraying (IRS) have played a key role in the reduction of malaria transmission in Sub-Saharan Africa.
“Over the last two decades, vector control tools like long-lasting insecticide treated nets (LLINs) and indoor residual spraying (IRS) have played a key role in the reduction of malaria transmission in SSA [4, 5].”
From Spatial temporal distribution of Anopheles mosquitoes in different ecological zones of Ghana (2026) · cites this paper as [4]
The Discussion and ‘Attributable effect of malaria control interventions’ section report that insecticide-treated nets (ITNs) and indoor residual spraying (IRS) contributed to reduced malaria infection prevalence across Africa. The paper does not distinguish long-lasting nets (LLINs) from other ITNs, and its analysis covers 2000–2015 rather than the full two decades stated in the citing sentence. Page numbers are not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredWidescale implementation of core vector control (long-lasting insecticidal nets and indoor residual spraying) has contributed to substantial reductions in the burden of malaria.
“Widescale implementation of core vector control—specifically long-lasting insecticidal nets and indoor residual spraying—has contributed to substantial reductions in the burden of malaria.1, 2”
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- Authors
- Bhatt, S., Weiss, D. J., Cameron, E., Bisanzio, D., Mappin, B., Dalrymple, U., Battle, K. E., Moyes, C. L., Henry, A., Eckhoff, P. A., Wenger, E. A., Briët, O., Penny, M. A., Smith, T. A., Bennett, A., Yukich, J., Eisele, T. P., Griffin, J. T., Fergus, C. A., Lynch, M., Lindgren, F., Cohen, J. M., Murray, C. L. J., Smith, D. L., Hay, S. I., Cibulskis, R. E., & Gething, P. W.
- Affiliations
- University of Oxford (GB)
- Intellectual Ventures (United States) (US)
- Swiss Tropical and Public Health Institute (CH)
- University of California, San Francisco (US)
- Tulane University (US)
- Imperial College London (GB)
- World Health Organization (CH)
- University of Bath (GB)
- Clinton Health Access Initiative (US)
- University of Washington (US)
- National Institutes of Health (US)
- Corresponding author
- Gething, P. W.
- ORCID
- Venue
- Nature
- Published
- 2015-09-16
- Volume
- 526
- Issue
- 7572
- Pages
- 207-211
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- PMC
- PMC4820050
- OpenAlex
- W1729017034
- Cited by
- 3,225
- References
- 22
- Citations by year
- 2026: 211 · 2025: 277 · 2024: 329 · 2023: 298 · 2022: 343 · 2021: 397 · 2020: 401 · 2019: 271 · 2018: 248 · 2017: 239 · 2016: 185 · 2015: 20 · 2012: 1
- FWCI
- 247.73
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Nature (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure (University of Bath) (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- The University of Bath Online Publications Store (The University of Bath) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- World Health Organization
- Wellcome Trust (095066)
- Medical Research Council (MR/K00669X/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Social Sciences › Arts and Humanities › History › History of Medicine and Tropical Health
- Keywords
- malaria control, Plasmodium falciparum, sub-Saharan Africa, insecticide-treated nets, clinical malaria incidence, malaria prevalence, spatio-temporal modeling, malaria burden, antimalarial drugs, insecticide resistance
- MeSH terms
- Africa, Animals, Antimalarials, Child, Child, Preschool, Drug Resistance, Humans, Insecticides, Plasmodium falciparum, Incidence, Prevalence, Databases, Factual, Malaria, Falciparum, Risk Assessment, Endemic Diseases, Insecticide-Treated Bednets
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