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An important shortcoming of existing methods for estimating the cost-effectiveness of malaria control interventions is that the incidence of illness and transmission dynamics are assumed to be independent of the case management system. We have developed a model for case management and integrated it into a stochastic simulation of Plasmodium falciparum malaria dynamics. This allows us to predict the incidence of clinical episodes and of mortality while incorporating effects of case management on persistence of parasites and transmission. We make predictions for a range of different transmission intensities in sub-Saharan Africa and simulate a range of case management scenarios with different coverage rates. The model predicts that high treatment rates have a proportionately greater epidemiologic impact at low transmission levels. Further development is needed for models for health-seeking behavior and referral patterns. The current model is a first step towards useful predictions of the epidemiologic and economic consequences of introducing and/or scaling-up of malaria control interventions.
Received September 18, 2005. Accepted for publication March 27, 2006.
Acknowledgments: We thank Dan Anderegg for editorial assistance, and members of the Technical Advisory Group (Michael Alpers, Paul Coleman, David Evans, Brian Greenwood, Carol Levin, Kevin Marsh, F. Ellis McKenzie, Mark Miller, and Brian Sharp), the Project Management Team at the Program for Appropriate Technology in Health (PATH) Malaria Vaccine Initiative, and GlaxoSmithKline Biologicals S.A for assistance in this study.
Financial support: The mathematical modeling study was supported by the PATH Malaria Vaccine Initiative and GlaxoSmithKline Biologicals S.A.
Disclaimer: This publication and the contents hereof do not necessarily reflect the endorsement, opinion, or view points of the PATH Malaria Vaccine Initiative or of GlaxoSmithKline Biologicals S.A.
* Address correspondence to Thomas Smith, Swiss Tropical Institute, PO Box, CH-4002 Basel, Switzerland. E-mail: Thomas-A.Smith{at}unibas.ch
Authors’ address: Fabrizio Tediosi, Nicolas Maire, Thomas Smith, Guy Hutton, Jürg Utzinger, Amanda Ross, and Marcel Tanner, Swiss Tropical Institute, PO Box, CH-4002 Basel, Switzerland, Telephone: 41-61-284-8273, Fax: 41-61-284-8105, E-mails: fabrizio.tediosi{at}unibas.ch, nicolas.maire{at}unibas.ch, Thomas-A.Smith{at}unibas.ch, guy.hutton{at}unibas.ch, juerg.utzinger{at}unibas.ch, amanda.ross{at}unibas.ch, and marcel.tanner{at}unibas.ch.
Reprint requests: Thomas Smith, Swiss Tropical Institute, Postfach, CH-4002 Basel, Switzerland.
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