Spatial targeting of Screening + Eave tubes (SET), a house-based malaria control intervention, in Côte d’Ivoire: A geostatistical modelling study

New malaria control tools and tailoring interventions to local contexts are needed to reduce the malaria burden and meet global goals. The housing modification, screening plus a targeted house-based insecticide delivery system called the In2Care® Eave Tubes, has been shown to reduce clinical malaria in a large cluster randomised controlled trial. However, the widescale suitability of this approach is unknown. We aimed to predict household suitability and define the most appropriate locations for ground-truthing where Screening + Eave Tubes (SET) could be implemented across Côte d’Ivoire. We classified DHS sampled households into suitable for SET based on the walls and roof materials. We fitted a Bayesian beta-binomial logistic model using the integrated nested Laplace approximation (INLA) to predict suitability of SET and to define priority locations for ground-truthing and to calculate the potential population coverage and costs. Based on currently available data on house type and malaria infection rate, 31% of the total population and 17.5% of the population in areas of high malaria transmission live in areas suitable for SET. The estimated cost of implementing SET in suitable high malaria transmission areas would be $46m ($13m –$108m). Ground-truthing and more studies should be conducted to evaluate the efficacy and feasibility of SET in these settings. The study provides an example of implementing strategies to reflect local socio-economic and epidemiological factors, and move beyond blanket, one-size-fits-all strategies.

当前亟需研发新型疟疾防控工具，并结合本地实际情境优化干预策略，以降低疟疾疾病负担，达成全球疟疾防控目标。一项大型整群随机对照试验已证实，房屋改造、加装纱窗结合名为In2Care®檐下毒管（Eave Tubes）的靶向住宅杀虫剂投放系统，可有效降低临床疟疾发病风险。然而，该方案的大范围适用性尚未明确。本研究旨在科特迪瓦全境范围内，预测家庭适配性，并确定最适宜开展实地验证的点位，以推广筛查+檐下毒管（Screening + Eave Tubes, SET）方案。本研究依据墙体与屋顶材质，将人口与健康调查（Demographic and Health Surveys, DHS）抽取的家庭户划分为适配SET方案的家庭与非适配家庭。本研究采用集成嵌套拉普拉斯近似（integrated nested Laplace approximation, INLA）方法构建贝叶斯贝塔二项逻辑回归模型，以预测SET方案的家庭适配性、确定实地验证优先点位，并估算潜在的人群覆盖范围与实施成本。基于当前已有的房屋类型与疟疾感染率数据，科特迪瓦全境31%的总人口，以及高疟疾传播区域内17.5%的人口，均居住在适配SET方案的区域中。在适配SET方案的高疟疾传播区域内实施该方案的估算成本为4600万美元（区间为1300万至1.08亿美元）。需开展实地验证与更多研究，以评估SET方案在上述场景中的有效性与可行性。本研究为结合本地社会经济与流行病学特征制定防控策略提供了范例，摒弃了一刀切的通用化防控方案。