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Cited by 595Malaria Research and ControlMathematical and Theoretical Epidemiology and Ecology ModelsMosquito-borne diseases and control

Reducing Plasmodium falciparum Malaria Transmission in Africa: A Model-Based Evaluation of Intervention Strategies

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Griffin, Jamie T., Hollingsworth, T. Deirdre, Okell, Lucy C., Churcher, Thomas S., White, Michael, Hinsley, Wes, Bousema, Teun, Drakeley, Chris J. +3 more·2010·PLoS Medicine
DOI 10.1371/journal.pmed.1000324PMC PMC2919425
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Abstract

BACKGROUND: Over the past decade malaria intervention coverage has been scaled up across Africa. However, it remains unclear what overall reduction in transmission is achievable using currently available tools. METHODS AND FINDINGS: We developed an individual-based simulation model for Plasmodium falciparum transmission in an African context incorporating the three major vector species (Anopheles gambiae s.s., An. arabiensis, and An. funestus) with parameters obtained by fitting to parasite prevalence data from 34 transmission settings across Africa. We incorporated the effect of the switch to artemisinin-combination therapy (ACT) and increasing coverage of long-lasting insecticide treated nets (LLINs) from the year 2000 onwards. We then explored the impact on transmission of continued roll-out of LLINs, additional rounds of indoor residual spraying (IRS), mass screening and treatment (MSAT), and a future RTS,S/AS01 vaccine in six representative settings with varying transmission intensity (as summarized by the annual entomological inoculation rate, EIR: 1 setting with low, 3 with moderate, and 2 with high EIRs), vector-species combinations, and patterns of seasonality. In all settings we considered a realistic target of 80% coverage of interventions. In the low-transmission setting (EIR approximately 3 ibppy [infectious bites per person per year]), LLINs have the potential to reduce malaria transmission to low levels (<1% parasite prevalence in all age-groups) provided usage levels are high and sustained. In two of the moderate-transmission settings (EIR approximately 43 and 81 ibppy), additional rounds of IRS with DDT coupled with MSAT could drive parasite prevalence below a 1% threshold. However, in the third (EIR = 46) with An. arabiensis prevailing, these interventions are insufficient to reach this threshold. In both high-transmission settings (EIR approximately 586 and 675 ibppy), either unrealistically high coverage levels (>90%) or novel tools and/or substantial social improvements will be required, although considerable reductions in prevalence can be achieved with existing tools and realistic coverage levels. CONCLUSIONS: Interventions using current tools can result in major reductions in P. falciparum malaria transmission and the associated disease burden in Africa. Reduction to the 1% parasite prevalence threshold is possible in low- to moderate-transmission settings when vectors are primarily endophilic (indoor-resting), provided a comprehensive and sustained intervention program is achieved through roll-out of interventions. In high-transmission settings and those in which vectors are mainly exophilic (outdoor-resting), additional new tools that target exophagic (outdoor-biting), exophilic, and partly zoophagic mosquitoes will be required.

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  • Advanced agent-based malaria models tend to neglect larval habitat representation.

    “While widely used in malaria intervention studies (Galactionova et al., 2021), these models tend to neglect the larval habitat representation (Griffin et al., 2010; T. Smith et al., 2006) or rely only on rainfall to quantify larval habitats (Eckhoff, 2011).”

    From Investigating the Impact of Irrigation on Malaria Vector Larval Habitats and Transmission Using a Hydrology‐Based Model (2023) · cites this paper as Griffin et al., 2010

    The Discussion says Griffin et al.’s model uses a simple vector cycle with a constant birth rate and treats representation of competition for larval habitats as a possible extension. This supports the point for their model, but the paper does not establish that advanced agent-based malaria models generally tend to neglect larval habitats. The Methods also specify that individuals represent people, while vectors are aggregated populations. No page numbers were provided in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The result of spatial repellency will be reductions in numbers of both humans and vectors being infected and this result has a dramatic effect on mathematical models of malaria transmission.

    “The result will be reductions in numbers of both humans and vectors being infected and this result has a dramatic effect on mathematical models of malaria transmission [27].”

    From Spatial repellents: from discovery and development to evidence-based validation (2012) · cites this paper as [27]

    The Methods > Interventions section models repellency from insecticide-treated nets and indoor residual spraying, including protection of people and reduced transmission from infected people to susceptible mosquitoes. The Results > Continued Scale-Up of LLINs section predicts reduced transmission, but the paper does not establish that spatial repellency alone reduces infections in both humans and vectors or has a dramatic effect on mathematical models. (LLM, conf=0.78)

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Authors
Griffin, J. T., Hollingsworth, T. D., Okell, L. C., Churcher, T. S., White, M., Hinsley, W., Bousema, T., Drakeley, C. J., Ferguson, N. M., Basáñez, M.-G., & Ghani, A. C.
Affiliations
  • Imperial College London (GB)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Ghani, Azra C.
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2010-08-10
Volume
7
Issue
8
Pages
e1000324
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1000324
PMC
PMC2919425
OpenAlex
W2026708814
Cited by
595
References
6
Citations by year
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FWCI
39.45
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IHI Repository (acceptedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Spiral (Imperial College London) (submittedVersion)
Funders
  • Microsoft Research
  • Imperial College London
  • European Commission (223736)
  • Medical Research Council
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mathematical and Theoretical Epidemiology and Ecology Models
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
Keywords
Plasmodium falciparum, malaria transmission, malaria control interventions, long-lasting insecticidal nets, indoor residual spraying, RTS,S/AS01 vaccine, artemisinin-based combination therapy, Anopheles gambiae, Anopheles arabiensis, Anopheles funestus, parasite prevalence, entomological inoculation rate, intervention coverage, agent-based modeling, Africa, transmission intensity, DDT, malaria elimination
MeSH terms
Africa, Animals, Anopheles, Humans, Insect Vectors, Models, Theoretical, Mosquito Control, Plasmodium falciparum, Malaria, Falciparum, Artemisinins

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