Optimal control strategies supported by system dynamics modelling: a study on hookworm disease in China

Area of Science:

• Parasitology
• Public Health
• Health Economics

Background:

• Hookworm disease remains a significant global health concern.
• China reported a 0.67% infection rate in 2021, necessitating optimized control strategies.
• Uneven distribution of hookworm infections requires targeted interventions.

Purpose of the Study:

• To optimize intervention strategies for hookworm disease control in China.
• To evaluate the cost-effectiveness of various deworming methods.
• To develop a data-driven approach for guiding public health interventions.

Main Methods:

• System dynamics modeling and parameter estimation were employed.
• Delphi method identified key variables for causal loop and stock flow diagrams.
• Cost-effectiveness analysis integrated with intervention models to assess various strategies.
• Generalized linear models accounted for survey site impacts.

Main Results:

• Whole population deworming (WPD) and key population deworming (KPD) demonstrated superior cost-effectiveness compared to examination and voluntarily deworming (EVD).
• Optimal coverage for examination and deworming (ED) and EVD varied by duration, with higher coverage beneficial for longer interventions.
• WPD, ED, and EVD showed higher infection reduction rates than KPD over 1-5 years.
• Health education significantly enhanced cost-effectiveness and intervention outcomes.

Conclusions:

• Prioritize WPD in high-endemic areas (≥20% infection rate) for optimal cost-effectiveness and outcomes.
• In medium-endemic areas (5-20%), utilize ED for cost-effectiveness or KPD for infection reduction if WPD is not feasible.
• In low-endemic areas (<5%), recommend voluntary examination and treatment due to limited mass treatment cost-effectiveness.
• Integrating drug treatment with comprehensive health education is crucial for sustained hookworm control in China.