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Malaria interventions are usually prioritized using efficacy estimates from intervention trials, without considering the context of existing intervention packages or long-term dynamics. We use numerical simulation of mathematical models of malaria in humans and mosquitoes to provide robust quantitative predictions of effectiveness of different strategies in reducing transmission, morbidity and mortality.
We can simulate indoor residual spraying (IRS) and insecticide-treated nets (ITNs), used singly and in combination with each other and with other interventions such as improved case management, intermittent preventive treatment (IPT). We can estimate reductions in entomological inoculation rate (EIR), clinical cases, prevalence and malaria deaths from simulations of different coverage levels ITNs and IRS with different properties, and at different transmission and health system settings.
Our results suggest that sustained coverage of one or two interventions reduces malaria prevalence in two to three years but does not lead to further gains (Figure (Figure1).1). However, in some settings, even with sustained coverage, clinical incidence of malaria increases as the population loses its naturally acquired immunity. In some low to medium transmission settings, our simulations suggest that high coverage of both interventions can lead to interruption of transmission.