Optimizing malaria diagnostic sensitivity as a prerequisite for targeted vector control and rational antimalarial deployment: A compartmental modeling analysis.

Authors

Andrew Cole O, John Odhiambo, Gilbert Kokwaro

Published in

Epidemics. Volume 56. Pages 100941. Aug 09, 2026. Epub Aug 09, 2026.

Abstract

Gains in malaria transmission reduction achieved through insecticide-treated nets (ITNs) are reversing amid emerging artemisinin partial resistance. While sensitive diagnostics are key to monitoring resistant parasite-driven outbreaks, most malaria outbreak models treat diagnostic sensitivity as a fixed background parameter, obscuring its role both in clinical progression and disease burden.
We developed an eight-compartment deterministic model in which diagnostic sensitivity acts as a bifurcation parameter partitioning individuals infected with uncomplicated malaria into treated and false-negative pathways, incorporating severity-stratified gametocyte production and asymmetric disease-progression rates. The model was validated through local stability and sensitivity analysis. Seven intervention strategies spanning vector control, diagnostics, and treatment allocation were compared via simulations using two complementary outcomes: time for the parasite reservoir to reach ≤ 10% of baseline, and cumulative severe case-days.
Raising sensitivity from 0.95 to 0.98 reduced false-negative cases by 60% and mortality by 14%. The top-ranked strategy (90% diagnostic allocation) reached the modeled reservoir threshold 29% faster and 46% cheaper than current ITN-focused practice. Programmatic experiences from Rwanda and Cabo Verde, which have approached or achieved elimination under diagnostic-prioritized frameworks were qualitatively, though not formally, consistent with model predictions.
Diagnostic sensitivity is a high-leverage, currently underused control point that should precede and inform targeted vector-control deployment and rational antimalarial treatment allocation, offering a lower-cost path toward WHO 2030 elimination targets. Formal model validation against country-level surveillance data and explicit simulation of WHO-recommended antimalarial drug-diversification approaches such as adaptive rotation are identified as priorities for future work.

PMID:
42600337
Bibliographic data and abstract were imported from PubMed on 15 Aug 2026.

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