Spectrum-Malaria: a user-friendly projection tool for health impact assessment and strategic planning by malaria control programmes in sub-Saharan Africa.
Scale-up of malaria prevention and treatment needs to continue but national strategies and budget allocations are not always evidence-based. This article presents a new modelling tool projecting malaria infection, cases and deaths to support impact evaluation, target setting and strategic planning.



Nested in the Spectrum suite of programme planning tools, the model includes historic estimates of case incidence and deaths in groups aged up to 4, 5-14, and 15+ years, and prevalence of Plasmodium falciparum infection (PfPR) among children 2-9 years, for 43 sub-Saharan African countries and their 602 provinces, from the WHO and malaria atlas project. Impacts over 2016-2030 are projected for insecticide-treated nets (ITNs), indoor residual spraying (IRS), seasonal malaria chemoprevention (SMC), and effective management of uncomplicated cases (CMU) and severe cases (CMS), using statistical functions fitted to proportional burden reductions simulated in the P. falciparum dynamic transmission model OpenMalaria.



In projections for Nigeria, ITNs, IRS, CMU, and CMS scale-up reduced health burdens in all age groups, with largest proportional and especially absolute reductions in children up to 4 years old. Impacts increased from 8 to 10 years following scale-up, reflecting dynamic effects. For scale-up of each intervention to 80% effective coverage, CMU had the largest impacts across all health outcomes, followed by ITNs and IRS; CMS and SMC conferred additional small but rapid mortality impacts.



Spectrum-Malaria's user-friendly interface and intuitive display of baseline data and scenario projections holds promise to facilitate capacity building and policy dialogue in malaria programme prioritization. The module's linking to the OneHealth Tool for costing will support use of the software for strategic budget allocation. In settings with moderately low coverage levels, such as Nigeria, improving case management and achieving universal coverage with ITNs could achieve considerable burden reductions. Projections remain to be refined and validated with local expert input data and actual policy scenarios.
Avenir Health, Geneva, 1 route de Morillons/150 Route de Ferney (WCC, office 164), PO box 2100, 1211, Geneva 2, Switzerland.|Avenir Health, Glastonbury, USA.
Matthew
M
Hamilton
Avenir Health, Geneva, 1 route de Morillons/150 Route de Ferney (WCC, office 164), PO box 2100, 1211, Geneva 2, Switzerland.|Avenir Health, Glastonbury, USA.
Guy
G
Mahiane
Avenir Health, Geneva, 1 route de Morillons/150 Route de Ferney (WCC, office 164), PO box 2100, 1211, Geneva 2, Switzerland.|Avenir Health, Glastonbury, USA.
Elric
E
Werst
Avenir Health, Geneva, 1 route de Morillons/150 Route de Ferney (WCC, office 164), PO box 2100, 1211, Geneva 2, Switzerland.|Avenir Health, Glastonbury, USA.
Rachel
R
Sanders
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Olivier
O
Briët
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
Thomas
T
Smith
World Health Organization Global Malaria Programme, Geneva, Switzerland.
Richard
R
Cibulskis
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Ewan
E
Cameron
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.|Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Samir
S
Bhatt
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Daniel J
DJ
Weiss
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK.
Peter W
PW
Gething
Avenir Health, Geneva, 1 route de Morillons/150 Route de Ferney (WCC, office 164), PO box 2100, 1211, Geneva 2, Switzerland.|Avenir Health, Glastonbury, USA.
Carel
C
Pretorius
Avenir Health, Geneva, 1 route de Morillons/150 Route de Ferney (WCC, office 164), PO box 2100, 1211, Geneva 2, Switzerland. ekorenromp@AvenirHealth.org.|Avenir Health, Glastonbury, USA. ekorenromp@AvenirHealth.org.
Eline L
EL
Korenromp
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000369:Aged, 80 and over; D056808:Biostatistics / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D062489:Health Impact Assessment / Q000379:methods*; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012984:Software; D000070318:Strategic Planning; D016019:Survival Analysis; D055815:Young Adult
Health impact; Malaria; Morbidity; Mortality; Policy evaluation; Prevention; Programmes; Strategic planning; Treatment