Background: Rigorous assessment of the effect of malaria control strategies on local malaria dynamics is a complex but vital step in informing future strategies to eliminate malaria. However, the interactions between climate forcing, mass drug administration, mosquito control and their effects on the incidence of malaria remain unclear.Methods: Here, we analyze the effects of interventions on the transmission dynamics of malaria (Plasmodium vivax and Plasmodium falciparum) on Hainan Island, China, controlling for environmental factors. Mathematical models were fitted to epidemiological data, including confirmed cases and population-wide blood examinations, collected between 1995 and 2010, a period when malaria control interventions were rolled out with positive outcomes.Results: Prior to the massive scale-up of interventions, malaria incidence shows both interannual variability and seasonality, as well as a strong correlation with climatic patterns linked to the El Nino Southern Oscillation. Based on our mechanistic model, we find that the reduction in malaria is likely due to the large scale rollout of insecticide-treated bed nets, which reduce the infections of P. vivax and P. falciparum malaria by 93.4% and 35.5%, respectively. Mass drug administration has a greater contribution in the control of P. falciparum (54.9%) than P. vivax (5.3%). In a comparison of interventions, indoor residual spraying makes a relatively minor contribution to malaria control (1.3%–9.6%).Conclusions: Although malaria transmission on Hainan Island has been exacerbated by El Nino Southern Oscillation, control methods have eliminated both P. falciparum and P. vivax malaria from this part of China.
Plain language summary: Several malaria control strategies have been implemented on Hainan Island, China, and it is important to determine which of these have been effective to guide future efforts to control malaria. Here, we use mathematical and statistical methods to assess the effectiveness of control methods using data on malaria cases on Hainan, considering the impact of climate change simultaneously, since malaria transmission is affected by the climate. We observe time-related trends in malaria incidence and a strong relationship with climate before the large-scale rollout of malaria control interventions. We find that insecticide-treated bed nets are the most effective strategy in decreasing malaria incidence, while mass drug administration and indoor residual spraying also contribute to malaria control. Our findings provide evidence that a combination of strategies reduces the burden of malaria in affected regions.
Tian et al. use mathematical modelling to estimate the impact of various interventions on malaria incidence on Hainan Island, also taking into account climate change. They find that although malaria transmission has been exacerbated by climate change, insecticide-treated bed nets and other interventions were effective in controlling the disease.