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Optimising the deployment of vector control tools against malaria: a data-informed modelling study.

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New insecticide-treated nets (ITNs) combining pyrethroids with piperonyl butoxide (PBO) can halve malaria cases, but long-lasting insecticidal indoor residual spraying (IRS) prevents more cases. Pyrethroid-PBO ITNs are most cost-effective per case averted.

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Area of Science:

  • Vector-borne disease control
  • Malaria epidemiology
  • Public health interventions

Background:

  • Insecticide resistance in mosquitoes threatens malaria control efforts.
  • New insecticide-treated nets (ITNs) and indoor residual spraying (IRS) are being developed.
  • Optimal malaria prevention strategies require comparison of public health impact and cost-effectiveness.

Purpose of the Study:

  • To develop a framework for comparing the public health impact and cost-effectiveness of malaria prevention measures.
  • To evaluate the entomological effectiveness of pyrethroid-only ITNs versus pyrethroid-PBO ITNs.
  • To create an online tool (Malaria INtervention Tool [MINT]) for optimizing vector control packages.

Main Methods:

  • Utilized published data from African experimental hut trials to assess ITN efficacy.
  • Developed and validated a dynamic mathematical model of Plasmodium falciparum malaria using data from randomized control trials (RCTs).
  • Extrapolated model simulations to sub-Saharan African scenarios and incorporated them into the MINT tool.

Main Results:

  • Switching to pyrethroid-PBO ITNs could avert up to twice as many malaria cases, with benefits varying by setting.
  • Annual long-lasting, non-pyrethroid IRS is projected to prevent substantially more cases over three years.
  • Pyrethroid-PBO ITNs generally represent the most cost-effective intervention per case averted.

Conclusions:

  • The most cost-effective vector control strategy is locally dependent.
  • Mathematical models that accurately predict RCT outcomes can guide evidence-based investment in vector control.
  • The MINT tool aids in designing malaria intervention packages tailored to specific regional needs and budgets.