Strategic Approaches to Combat Malaria in Benin

In 2022, malaria claimed the lives of 608,000 people across the globe, with a staggering 76% of those deaths being children under the age of five. This parasitic disease remains one of the leading causes of death in young children. Since the year 2000, significant strides have been made in reducing the malaria burden, largely due to the use of insecticide-treated nets and effective medications. However, progress has plateaued since 2015. The issues of insecticide and drug resistance, the emergence of new mosquito species, and inadequate funding pose serious risks to the gains achieved.

To combat malaria, new strategies are now necessary to complement the existing methods. One such strategy is Seasonal Malaria Chemoprevention (SMC), which involves giving antimalarial drugs to all children living in areas where malaria occurs seasonally. This treatment aims to eliminate existing infections and prevent new ones. Since the World Health Organization (WHO) endorsed SMC in 2012, the number of children treated has increased dramatically, from 200,000 in 2012 to 49 million in 2022.

In Benin, malaria is the leading cause of hospital visits and accounts for a notable percentage of global malaria Cases and fatalities. SMC was first introduced in Benin’s Alibori and Atacora regions in 2019 and has since expanded to serve nearly 600,000 children under five in these areas.

In 2022, the WHO updated its guidelines, now recommending SMC for all children at high risk of severe malaria, not just those under five. This change presents an opportunity for countries affected by malaria to adapt their strategies to meet local needs. However, it also presents challenges for national health programs that must make more informed decisions based on these new recommendations.

Following this update, the Benin health authorities began collaborating with experts from a Swiss health institute to assess the benefits of two potential strategies: broadening SMC to include children under 10 in areas where it has already been implemented or expanding SMC to new areas but limiting it to children under five. Given the widespread risk of malaria in Benin and limited funding, health officials needed to carefully evaluate both options to determine which would be more effective.

Studies show that SMC is an effective intervention for children in both age groups. Some research indicated that administering SMC to children under ten led to significant reductions in malaria cases among younger children. However, the extent of these benefits may vary depending on local conditions.

To aid decision-making, it is crucial to analyze which strategy would lead to more lives saved while considering the financial aspects of the interventions. Mathematical modeling is a useful tool for simulating different scenarios and predicting the impacts of various interventions on malaria cases and deaths.

#The Modeling Approach

Our objective was to evaluate which SMC extension strategy would be more effective and cost-efficient in Benin. We utilized a software called OpenMalaria, which models human malaria infections by simulating both the human and mosquito populations involved in malaria transmission. The model was adjusted to fit the specific context of Benin by using local data.

We gathered data on the effectiveness of interventions and previous malaria cases in Benin to help calibrate the model. The dominant mosquito species responsible for transmission in Benin were also identified, and their behavior was factored into the model.

Key variables such as how often people used insecticide-treated nets and how effective those nets were in protecting against malaria were integrated into the simulation. The model used local data to assess the number of people seeking treatment for malaria over time, thereby providing a more accurate representation of the malaria situation.

Using this modeling framework, we explored outcomes for two strategies: one that extended SMC to children under ten in regions already receiving this intervention and another that expanded SMC to new areas but focused on children under five.

#Predicting Outcomes

Our simulations showed that if SMC were extended demographically to include children under ten in the existing areas, approximately 600,000 malaria cases could be averted between 2024 and 2026. This extension would yield a reduction in severe cases and some lives saved. However, the impact was considerably smaller compared to the geographic extension, which involved targeting children under five in new areas.

The geographic extension predicted that 1.5 million malaria cases could be averted in the same timeframe, leading to significantly more severe cases avoided and lives saved. With over 1.8 million children under five in the new areas, extending SMC geographically provided a far greater benefit.

When looking at the number of cases averted per targeted Child, the demographic extension showed it would prevent about 609 cases per 1,000 targeted children. The geographic extension, on the other hand, could prevent roughly 813 cases per 1,000 children under five. Likewise, the geographical approach would save many more lives per targeted child.

#Decision Making for Health Programs

Given these findings, health authorities faced a critical decision. While both strategies had potential benefits, the geographic extension was clearly more effective. The health programs in Benin opted to implement this approach starting in 2024.

Community health workers will deliver SMC in newly targeted regions, initially focusing on areas where these workers have already been trained. This choice aligns with the data provided by our model and reflects a practical consideration of local capabilities.

While this analysis primarily focused on Benin’s context, the methodology could be adapted for use in other countries facing similar challenges from malaria.

#Conclusion

The evolving nature of malaria transmission demands ongoing adaptation of strategies. Our analysis illustrated that the geographic extension of SMC in Benin would save many more lives than merely broadening eligibility to older children in existing areas.

This modeling exercise reflects the importance of using data to inform critical public health decisions. Even in the face of limited funding, evidence-based approaches can help prioritize interventions that yield the greatest benefits for vulnerable populations. The collaborative effort between local health authorities and international experts can pave the way for more effective strategies against malaria in the future.