Cited by 3,225Malaria Research and ControlBird parasitology and diseasesHistory of Medicine and Tropical Health

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The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015

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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.·2015·Nature

DOI 10.1038/nature15535PMC PMC4820050

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Abstract

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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“Resolving the problem posed by outdoor transmission of malaria has become critical [34, 40] LLINs and IRS are effective strategies controlling malaria but unfortunately they can only operate indoors [41, 42].”
Background

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: Bhatt, S.
Weiss, D. J.
Cameron, E.
Bisanzio, D.
Mappin, B.
Dalrymple, U.
Battle, K. E.
Moyes, C. L.
Eckhoff, P. A.
Wenger, E. A.
Briët, O.
Penny, M. A.
Smith, T. A.
Bennett, A.
Yukich, J.
Eisele, T. P.
Fergus, C. A.
Lynch, M.
Lindgren, F.
Cohen, J. M.
Smith, D. L.
Hay, S. I.
Gething, P. W.
Venue: Nature
Publisher: Springer Science and Business Media LLC
Published: 2015-09-16
Volume: 526
Issue: 7572
Pages: 207-211
ISSN: 0028-0836 (ISSN-L)
1476-4687
DOI: 10.1038/nature15535
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
FWCI: 247.73
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
www.springer.com/tdm (tdm)
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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The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015

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