Volume 75, Issue 2_suppl
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 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.


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  1. Gold MR, Gold SR, Weinstein MC, 1996. Cost-Effectiveness in Health and Medicine. Oxford, United Kingdom: Oxford University Press.
  2. Drummond M, O’Brien BJ, Stoddart GL, Torrance G, 1997. Methods for the Economic Evaluation of Health Care Programmes. Second edition. New York: Oxford University Press.
  3. Cooper B, Lipsitch M, 2004. The analysis of hospital infection data using hidden Markov models. Biostatistics 5 : 223–237.
  4. Lipsitch M, Cohen T, Cooper B, Robins JM, Ma S, James L, Gopalakrishna G, Chew SK, Tan CC, Samore MH, Fisman D, Murray M, 2003. Transmission dynamics and control of severe acute respiratory syndrome. Science 300 : 1966–1970.
  5. Collins WE, Jeffery GM, 1999. A retrospective examination of the patterns of recrudescence in patients infected with Plasmodium falciparum. Am J Trop Med Hyg 61 : 44–48.
  6. World Health Organization, 1993. A Global Strategy for Malaria Control. Geneva: World Health Organization.
  7. Smith T, Killeen G, Maire N, Ross A, Molineaux L, Tediosi F, Hutton G, Utzinger J, Dietz K, Tanner M, 2006. Mathematical modeling of the impact of malaria vaccines on the clinical epidemiology and natural history of Plasmodium falciparum malaria: overview. Am J Trop Med Hyg 75 (Suppl 2): 1–10.
  8. Smith T, Maire N, Dietz K, Killeen GF, Vounatsou P, Molineaux L, Tanner M, 2006. Relationships between the entomologic inoculation rate and the force of infection for Plasmodium falciparum malaria. Am J Trop Med Hyg 75 (Suppl 2): 11–18.
  9. Maire N, Smith T, Ross A, Owusu-Agyei S, Dietz K, Molineaux L, 2006. A model for natural immunity to asexual blood stages of Plasmodium falciparum in malaria-endemic areas. Am J Trop Med Hyg 75 (Suppl 2): 19–31.
  10. Killeen GF, Ross A, Smith T, 2006. Infectiousness of malaria-endemic human populations to vectors. Am J Trop Med Hyg 75 (Suppl 2): 38–45.
  11. Ross A, Killeen GF, Smith T, 2006. Relationships of host infectivity to mosquitoes and asexual parasite density in Plasmodium falciparum. Am J Trop Med Hyg 75 (Suppl 2): 32–37.
  12. Ross A, Maire N, Molineaux L, Smith T, 2006. An epidemiologic model of severe morbidity and mortality caused by Plasmodium falciparum. Am J Trop Med Hyg 75 (Suppl 2): 63–73.
  13. Smith T, Ross A, Maire N, Rogier C, Trape JF, Molineaux L, 2006. An epidemiologic model of the incidence of acute illness in Plasmodium falciparum malaria. Am J Trop Med Hyg 75 (Suppl 2): 56–62.
  14. Ross A, Smith T, 2006. The effect of malaria transmission intensity on neonatal mortality in malaria-endemic areas. Am J Trop Med Hyg 75 (Suppl 2): 74–81.
  15. Carneiro I, Smith T, Lusingu J, Malima R, Utzinger J, Drakeley C, 2006. Modeling the relationship between the population prevalence of Plasmodium falciparum malaria and anemia. Am J Trop Med Hyg 75 (Suppl 2): 82–89.
  16. Reyburn H, Drakeley C, Carneiro I, Jones C, Cox J, Bruce J, Riley E, Greenwood B, Whitty C, 2004. The epidemiology of severe malaria due to Plasmodium falciparum at different transmission intensities in NE Tanzania. LSHTM Malaria Centre Report 2002–2003: 6–7.
  17. Murray CJL, Lopez AD, 1996. Estimating causes of death: new methods and global and regional applications for 1990. Murray CJL, Lopez AD, eds. The Global Burden of Disease. Geneva: World Health Organization.
  18. Murray CJL, Lopez AD, 1996. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, MA: Harvard University Press.
  19. Network INDEPTH, 2004. Model Life Tables for Sub-Saharan Africa. Aldershot, United Kingdom: Ashgate.
  20. Network INDEPTH, 2002. Population, Health and Survival at INDEPTH Sites. Ottawa, Ontario, Canada: International Development Research Centre.
  21. Smith T, Charlwood JD, Kihonda J, Mwankusye S, Billingsley P, Meuwissen J, Lyimo E, Takken W, Teuscher T, Tanner M, 1993. Absence of seasonal variation in malaria parasitaemia in an area of intense seasonal transmission. Acta Trop 54 : 55–72.
  22. Hay SI, Rogers DJ, Toomer JF, Snow R, 2000. Annual Plasmodium falciparum entomological inoculation rates (EIR) across Africa: literature survey, Internet access and review. Trans R Soc Trop Med Hyg 94 : 113–127.
  23. Robert V, Macintyre K, Keating J, Trape JF, Duchemin JB, Warren M, Beier JC, 2003. Malaria transmission in urban sub-Saharan Africa. Am J Trop Med Hyg 68 : 169–176.
  24. Ministry of Health, 2000. National Guidelines for Malaria Diagnosis and Treatment. Malaria Control. Series 2000. Dar es Salaam, Tanzania: Ministry of Health.
  25. Maire N, Aponte J, Ross A, Thompson R, Alonso P, Utzinger J, Smith T, 2006. Modeling a field trial of the RTS,S/ASO2A malaria vaccine. Am J Trop Med Hyg 75 (Suppl 2): 104–110.
  26. McCombie SC, 1996. Treatment seeking for malaria: a review of recent research. Soc Sci Med 43 : 933–945.
  27. McCombie SC, 2002. Self-treatment for malaria: the evidence and methodological issues. Health Policy Plann 17 : 333–344.
  28. National Malaria Control Program, 2003. National Malaria Medium Term Strategic Plan 2002–2007. Dar es Salaam, Tanzania: National Malaria Control Program.
  29. National Malaria Control Program, 2004. Monitoring Malaria Situation and Control Activities in Tanzania 2001–2003. Health Facility and Community Survey. Dar es Salaam, Tanzania: National Malaria Control Programme Monitoring and Evaluation Unit. National Malaria Control Program.
  30. Hutton G, Tediosi F, 2006. The costs of introducing a malaria vaccine through the expanded program on immunization in Tanzania. Am J Trop Med Hyg 75 (Suppl 2): 119–130.
  31. MSD, 2004. Medical Store Department price catalogue 2004.
  32. Goodman C, Coleman P, Mills A, 2000. Economic Analysis of Malaria Control in Sub-Saharan Africa. Geneva: Global Forum for Health Research.
  33. Adam T, Kakundwa C, Manzi F, Schellenberg JA, Mgalula L, de Savigny D, Mbuya C, Wilzynska K and the MCE team in Tanzania, 2004. Analysis Report on the Costs of IMCI in Tanzania. Multi-Country Evaluation of the Integrated Management of Childhood Illness (IMCI). World Health Organization. Geneva: Department of Child and Adolescent Health and Development, World Health Organization.
  34. Keiser J, Utzinger J, De Castro MC, Smith TA, Tanner M, Singer B, 2004. Urbanization in sub-Saharan Africa and implication for malaria control. Am J Trop Med Hyg 71 : 118–127.
  35. Zhou G, Minakawa N, Githeko AK, Yan G, 2004. Association between climate variability and malaria epidemics in the East African highlands. Proc Natl Acad Sci U S A 101 : 2375–2380.
  36. Tanner M, Vlassoff C, 1998. Treatment-seeking behaviour for malaria: a typology based on endemicity and gender. Soc Sci Med 46 : 523–532.
  37. Muela SH, Ribera JM, Mushi AK, Tanner M, 2002. Medical syncretism with reference to malaria in a Tanzanian community. Soc Sci Med 55 : 403–413.
  38. de Savigny D, Mayombana C, Mwageni E, Masanja H, Minhaj A, Mkilindi Y, Mbuya C, Kasale H, Reid G, 2004. Care-seeking patterns for fatal malaria in Tanzania. Malar J 3 : 27.
  39. Mugittu K, Ndejembi M, Malisa A, Lemnge M, Premji Z, Mwita A, Nkya W, Kataraihya J, Abdulla S, Beck HP, Mshinda H, 2004. Therapeutic efficacy of sulfadoxine-pyrimethamine and prevalence of resistance markers in Tanzania prior to revision of malaria treatment policy: Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthase mutations in monitoring in vivo resistance. Am J Trop Med Hyg 71 : 696–702.
  40. Talisuna AO, Bloland P, D’Alessandro U, 2004. History, dynamics, and public health importance of malaria parasite resistance. Clin Microbiol Rev 17 : 235–254.
  41. Global Fund to Fight AIDS, Tuberculosis, and Malaria, 2004. Available from http://www.theglobalfund.org/search/portfolio.aspx?countryID=TNZ.
  42. Drakeley C, Schellenberg D, Kihonda J, Sousa CA, Arez AP, Lopes D, Lines J, Mshinda H, Lengeler C, Armstrong SJ, Tanner M, Alonso P, 2003. An estimation of the entomological inoculation rate for Ifakara: a semi-urban area in a region of intense malaria transmission in Tanzania. Trop Med Int Health 8 : 767–774.
  43. Craig M, Snow R, Le Sueur D, 1999. A climate-based distribution model of malaria transmission in sub-Saharan Africa. Parasitol Today 15 : 105–111.
  44. Clyde DF, 1967. Malaria in Tanzania. Oxford, United Kingdom: Oxford University Press.
  45. Owusu-Agyei S, Smith T, Beck H-P, Amenga-Etego L, Felger I, 2002. Molecular epidemiology of Plasmodium falciparum infections among asymptomatic inhabitants of a holoendemic malarious area in northern Ghana. Trop Med Int Health 7 : 421–428.
  46. Fox-Rushby J, Hanson K, 2001. Calculating and presenting disability adjusted life years (DALYs) in cost-effectiveness analysis. Health Policy Plann 16 : 326–331.
  47. Brewster DR, Kwiatkowski D, White NJ, 1990. Neurological sequelae of celebral malaria in children. Lancet 336 : 1039–1043.
  48. Health Research for Action, 1999. Health Care Financing in Tanzania: Costing Study of Health Services. Final Report. Volume 1. Laarstraat, Belgium.
  49. Alonso-Gonzalez M, Menendez C, Font F, Kahigwa E, Kimario J, Mshinda H, Tanner M, Bosch-Capblanch X, Alonso PL, 2000. Cost-effectiveness of iron supplementation and malaria chemoprophylaxis in the prevention of anaemia and malaria among Tanzanian infants. Bull World Health Organ 78 : 97–107.

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  • Received : 18 Sep 2005
  • Accepted : 27 Mar 2006

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