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Public health

Indirect intervention

Nature Reviews Microbiology volume 22, page 523 (2024)Cite this article

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Malaria is one of the most important infectious diseases, with Africa accounting for the majority of cases and deaths. Globally, there has been an ambition to eliminate malaria; however, progress towards that goal has stalled. Malaria-elimination intervention could not only prevent disease among recipients, but also onward transmission to nearby non-recipients. This can occur via so-called spillover effects, which could provide greater population health benefits at no extra cost and thus increase the cost-effectiveness of the intervention. Here, Benjamin-Chung et al. analysed data from a previously published cluster-randomized trial of reactive, focal interventions (chemoprevention and/or vector control) in Namibia. They determined the direct effects (intervention recipients within 500 m) and spillover effects (non-intervention recipients within 3 km) on incidence, prevalence and seroprevalence. They found that the combined intervention reduced malaria incidence among non-recipients within 1 km of index cases by 43%. Moreover, infection prevalence was reduced by 79% and seroprevalence by 34% among non-recipients within 3 km of combined interventions. Finally, the authors determined that accounting for spillover effects increased the cost-effectiveness of the combined interventions by 42% compared with previous estimates that did not include spillover effects. Such insights regarding cost-effectiveness are crucial for policy decisions about elimination strategies.

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  1. Nature Reviews Microbiology http://www.nature.com/nrmicro/

    Andrea Du Toit

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  1. Andrea Du Toit
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Correspondence to Andrea Du Toit.

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Du Toit, A. Indirect intervention. Nat Rev Microbiol 22, 523 (2024). https://doi.org/10.1038/s41579-024-01085-3

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