Table 1 Example guidelines for a malaria elimination scenario
Background scenario | Suppose we are planning to eliminate malaria from a province with very low malaria transmission |
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Adequate core malaria interventions and identification of malaria hotspots | First, we must ensure the quality coverage of core malaria interventions such as early diagnosis and treatment, and long-lasting insecticide-treated nets (LLINs) in all villages within the province. We then need to identify the hotspot villages based on prevalence surveys or incidence reports |
Information on connectedness | Depending on the budget and the available timeframe, connectedness between villages can be inferred in several ways. Remote sensing and GIS analysis may be used to infer connectedness through metrics such as distance, estimated population size, and estimated travel time. Human mobility surveys may be conducted to inform connectedness. GPS logger studies may be more expensive and labour intensive but could produce more detailed measures of connectedness. A multi-patch or individual-based model may be used to fit historical data of a similar area to yield an estimate of the connectedness |
Optimisation of intervention coverage across hotspots and non-hotspots | Armed with some information on the connectedness between villages and the location of hotspots, we can strategize to ensure the efficiency and effectiveness of the focal MDA is optimized. All malaria hotspots should aim to reach an MDA coverage over the minimal threshold (i.e., 80% in most contexts). Non-hotspot villages that are connected to the hotspots should get an MDA coverage of at least 30% |
Example calculation of MDA rounds required for the intended effective coverage | The MDA coverage which we have used here is the percentage of the target population who receives at least one round of MDA. Different total coverage levels could represent a different number of monthly rounds of MDA. In our model, the final MDA coverage of x% after 3 rounds means 1-(1-x)(1/3) coverage in round 1. Therefore, if we achieve 70% of total MDA coverage after 3 rounds, we could say that 1 round of MDA will cover 33% of the total population. MDA coverage from our model can thus be operationalized into the number of MDA rounds. Using this information in our example scenario would mean that we could target malaria hotspots with three rounds of MDA while the non-hotspots which are connected to the hotspots could be provided with only one round of MDA |