{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:53:51Z","timestamp":1790834031429,"version":"4.1.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T00:00:00Z","timestamp":1629072000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T00:00:00Z","timestamp":1629072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"bill and melinda gates foundation","doi-asserted-by":"publisher","award":["OPP1160129"],"award-info":[{"award-number":["OPP1160129"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Malaria continues to be a public health problem in South Africa. While the disease is mainly confined to three of the nine provinces, most local transmissions occur because of importation of cases from neighbouring countries. The government of South Africa has reiterated its commitment to eliminate malaria within its borders. To support the achievement of this goal, this study presents a cost\u2013benefit analysis of malaria elimination in South Africa through simulating different scenarios aimed at achieving malaria elimination within a 10-year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A dynamic mathematical transmission model was developed to estimate the costs and benefits of malaria elimination in South Africa between 2018 and 2030. The model simulated a range of malaria interventions and estimated their impact on the transmission of<jats:italic>Plasmodium falciparum<\/jats:italic>malaria between 2018 and 2030 in the three endemic provinces of Limpopo, Mpumalanga and KwaZulu-Natal. Local financial, economic, and epidemiological data were used to calibrate the transmission model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Based on the three primary simulated scenarios: Business as Usual, Accelerate and Source Reduction, the total economic burden was estimated as follows: for the Business as Usual scenario, the total economic burden of malaria in South Africa was R 3.69 billion (USD 223.3 million) over an 11-year period (2018\u20132029). The economic burden of malaria was estimated at R4.88 billion (USD 295.5 million) and R6.34 billion (~\u2009USD 384 million) for the Accelerate and Source Reduction scenarios, respectively. Costs and benefits are presented in midyear 2020 values. Malaria elimination was predicted to occur in all three provinces if the Source Reduction strategy was adopted to help reduce malaria rates in southern Mozambique. This could be achieved by limiting annual local incidence in South Africa to less than 1 indigenous case with a prediction of this goal being achieved by the year 2026.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Malaria elimination in South Africa is feasible and economically worthwhile with a guaranteed positive return on investment (ROI). Findings of this study show that through securing funding for the proposed malaria interventions in the endemic areas of South Africa and neighbouring Mozambique, national elimination could be within reach in an 8-year period.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12936-021-03875-z","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T12:03:51Z","timestamp":1629115431000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Investment case for malaria elimination in South Africa: a financing model for resource mobilization to accelerate regional malaria elimination"],"prefix":"10.1186","volume":"20","author":[{"given":"Joseph","family":"Njau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3007-5383","authenticated-orcid":false,"given":"Sheetal P.","family":"Silal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Kollipara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryleen","family":"Balawanth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Yuen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa J.","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandisi","family":"Moya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yogan","family":"Pillay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devanand","family":"Moonasar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"3875_CR1","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1186\/1475-2875-11-423","volume":"11","author":"R Maharaj","year":"2012","unstructured":"Maharaj R, Morris N, Seocharan I, Kruger P, Moonasar D, Mabuza A, et al. The feasibility of malaria elimination in South Africa. Malar J. 2012;11:423.","journal-title":"Malar J"},{"key":"3875_CR2","first-page":"1","volume":"3","author":"KG Ravhuhali","year":"2017","unstructured":"Ravhuhali KG, Ramalwa N, Reddy C. Malaria outbreak investigation-Mopani and Vhembe districts, Limpopo province, South Africa, May 2017. Pan Afr Med J. 2017;3:1.","journal-title":"Pan Afr Med J."},{"key":"3875_CR3","first-page":"2020","volume-title":"20 years of global progress and challenges","author":"WHO. World malaria report","year":"2020","unstructured":"WHO. World malaria report. 20 years of global progress and challenges. Geneva: World Health Organization; 2020. p. 2020."},{"key":"3875_CR4","unstructured":"National Department of Health (NDOH): National Malaria Control Programme - Malaria Epidemiology and Situation Analysis. Cape Town, South Africa, 2018."},{"key":"3875_CR5","unstructured":"South African Development Cooperation (SADC). SADC Malaria Report 2017. South Africa: 2017."},{"key":"3875_CR6","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1186\/s12936-016-1470-8","volume":"15","author":"D Moonasar","year":"2016","unstructured":"Moonasar D, Maharaj R, Kunene S, Candrinho B, Saute F, Ntshalintshali N, et al. Towards malaria elimination in the MOSASWA (Mozambique, South Africa and Swaziland) region. Malar J. 2016;15:419.","journal-title":"Malar J"},{"key":"3875_CR7","volume-title":"Sixteen Countries Sign Windhoek Decraration to Accelerate Malaria Elimination in Southern African Region","author":"RBM Partnership","year":"2018","unstructured":"Partnership RBM. Sixteen Countries Sign Windhoek Decraration to Accelerate Malaria Elimination in Southern African Region. Geneva: Roll Back Malaria Partnership; 2018."},{"key":"3875_CR8","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1186\/s12936-016-1171-3","volume":"15","author":"B Zelman","year":"2016","unstructured":"Zelman B, Melgar M, Larson E, Phillips A, Shretta R. Global fund financing to the 34 malaria-eliminating countries under the new funding model 2014\u20132017: an analysis of national allocations and regional grants. Malar J. 2016;15:118.","journal-title":"Malar J"},{"key":"3875_CR9","volume-title":"Technical evaluation reference group-position paper on malaria elimination in Southern Africa","author":"The Global Fund","year":"2018","unstructured":"The Global Fund. Technical evaluation reference group-position paper on malaria elimination in Southern Africa. Geneva: Global Fund; 2018."},{"key":"3875_CR10","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1186\/s12936-015-0776-2","volume":"14","author":"SP Silal","year":"2015","unstructured":"Silal SP, Little F, Barnes KI, White LJ. Predicting the impact of border control on malaria transmission: a simulated focal screen and treat campaign. Malar J. 2015;14:268.","journal-title":"Malar J"},{"key":"3875_CR11","doi-asserted-by":"publisher","first-page":"e0144990","DOI":"10.1371\/journal.pone.0144990","volume":"10","author":"SP Silal","year":"2015","unstructured":"Silal SP, Little F, Barnes KI, White LJ. Hitting a moving target: a model for malaria elimination in the presence of population movement. PLoS One. 2015;10:e0144990.","journal-title":"PLoS One."},{"key":"3875_CR12","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s12936-020-03267-9","volume":"19","author":"R Shretta","year":"2020","unstructured":"Shretta R, Silal SP, Malm K, Mohammed W, Narh J, Piccinini D, et al. Estimating the risk of declining funding for malaria in Ghana: the case for continued investment in the malaria response. Malar J. 2020;19:196.","journal-title":"Malar J"},{"key":"3875_CR13","doi-asserted-by":"publisher","first-page":"62","DOI":"10.12688\/wellcomeopenres.14771.2","volume":"4","author":"SP Silal","year":"2019","unstructured":"Silal SP, Shretta R, Celhay O, Gran Mercado CE, Saralamba S, Maude RJ, White LJ. Malaria elimination transmission and costing in the Asia-Pacific: a multi-species dynamic transmission model. Wellcome Open Res. 2019;4:62.","journal-title":"Wellcome Open Res"},{"key":"3875_CR14","doi-asserted-by":"publisher","first-page":"1898","DOI":"10.1016\/S0140-6736(13)62105-4","volume":"382","author":"DT Jamison","year":"2013","unstructured":"Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382:1898\u2013955.","journal-title":"Lancet"},{"key":"3875_CR15","unstructured":"WHO-Roll Back Malaria (RBM). Action and Investment to defeat Malaria 2016\u20132030 (AIM)\u2014for a malaria-free world. Geneva: World Health Organization, 2015."},{"key":"3875_CR16","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1111\/j.1365-3156.2007.01979.x","volume":"13","author":"M Castillo-Riquelme","year":"2008","unstructured":"Castillo-Riquelme M, McIntyre D, Barnes K. Household burden of malaria in South Africa and Mozambique: is there a catastrophic impact? Trop Med Int Health. 2008;13:108\u201322.","journal-title":"Trop Med Int Health"},{"key":"3875_CR17","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1016\/S0140-6736(10)61924-1","volume":"376","author":"AM Dondorp","year":"2010","unstructured":"Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010;376:1647\u201357.","journal-title":"Lancet"},{"key":"3875_CR18","first-page":"CD008152","volume":"2","author":"PM Graves","year":"2018","unstructured":"Graves PM, Choi L, Gelband H, Garner P. Primaquine or other 8-aminoquinolines for reducing Plasmodium falciparum transmission. Cochrane Database Syst Rev. 2018;2:CD008152.","journal-title":"Cochrane Database Syst Rev."},{"key":"3875_CR19","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1046\/j.1365-2915.2000.00228.x","volume":"14","author":"C Mendis","year":"2000","unstructured":"Mendis C, Jacobsen J, Gamage-Mendis A, Bule E, Dgedge M, Thompson R, et al. Anopheles arabiensis and An. funestus are equally important vectors of malaria in Matola coastal suburb of Maputo, southern Mozambique. Med Vet Entomol. 2000;14:171\u201380.","journal-title":"Med Vet Entomol."},{"issue":"19","key":"3875_CR20","first-page":"150","volume":"2020","author":"J-AA Tangena","year":"1997","unstructured":"Tangena J-AA, Hendriks CM, Devine M, Tammaro M, Trett AE, Williams I. Indoor residual spraying for malaria control in sub-Saharan Africa 1997 to 2017: an adjusted retrospective analysis. Malar J. 1997;2020(19):150.","journal-title":"Malar J"},{"key":"3875_CR21","doi-asserted-by":"publisher","first-page":"784","DOI":"10.7196\/SAMJ.7447","volume":"103","author":"B Brooke","year":"2013","unstructured":"Brooke B, Koekemoer L, Kruger P, Urbach J, Misiani E, Coetzee M. Malaria vector control in South Africa. S Afr Med J. 2013;103:784\u20138.","journal-title":"S Afr Med J"},{"key":"3875_CR22","doi-asserted-by":"publisher","first-page":"779","DOI":"10.7196\/SAMJ.7441","volume":"103","author":"R Maharaj","year":"2013","unstructured":"Maharaj R, Raman J, Morris N, Moonasar D, Durrheim D, Seocharan I, Kruger P, Shandukani B, Kleinschmidt I. Epidemiology of malaria in South Africa: from control to elimination. S Afr Med J. 2013;103:779\u201383.","journal-title":"S Afr Med J"},{"key":"3875_CR23","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1186\/s12936-019-3001-x","volume":"18","author":"R Maharaj","year":"2019","unstructured":"Maharaj R, Seocharan I, Qwabe B, Mkhabela M, Kissoon S, Lakan V. Decadal epidemiology of malaria in KwaZulu-Natal, a province in South Africa targeting elimination. Malar J. 2019;18:368.","journal-title":"Malar J"},{"key":"3875_CR24","doi-asserted-by":"publisher","first-page":"e368","DOI":"10.1371\/journal.pmed.0020368","volume":"2","author":"PE Duffy","year":"2005","unstructured":"Duffy PE, Mutabingwa TK. Rolling back a malaria epidemic in South Africa. PLoS Med. 2005;2:e368.","journal-title":"PLoS Med."},{"key":"3875_CR25","doi-asserted-by":"publisher","first-page":"770","DOI":"10.7196\/SAMJ.7446","volume":"103","author":"M Coetzee","year":"2013","unstructured":"Coetzee M, Kruger P, Hunt R, Durrheim D, Urbach J, Hansford C. Malaria in South Africa: 110 years of learning to control the disease. S Afr Med J. 2013;103:770\u20138.","journal-title":"S Afr Med J"},{"key":"3875_CR26","doi-asserted-by":"publisher","first-page":"e000176","DOI":"10.1136\/bmjgh-2016-000176","volume":"2","author":"E Patouillard","year":"2017","unstructured":"Patouillard E, Griffin J, Bhatt S, Ghani A, Cibulskis R. Global investment targets for malaria control and elimination between 2016 and 2030. BMJ Glob Health. 2017;2:e000176.","journal-title":"BMJ Glob Health."},{"key":"3875_CR27","doi-asserted-by":"publisher","first-page":"e23832","DOI":"10.1371\/journal.pone.0023832","volume":"6","author":"A Tatarsky","year":"2011","unstructured":"Tatarsky A, Aboobakar S, Cohen JM, Gopee N, Bheecarry A, Moonasar D, et al. Preventing the reintroduction of malaria in Mauritius: a programmatic and financial assessment. PLoS One. 2011;6:e23832.","journal-title":"PLoS One."},{"key":"3875_CR28","doi-asserted-by":"crossref","unstructured":"Uwimana A, Umulisa N, Venkatesan M, Svigel SS, Zhou Z, Munyaneza T, et al. Association of Plasmodium falciparum kelch13 R561H genotypes with delayed parasite clearance in Rwanda: an open-label, single-arm, multicentre, therapeutic efficacy study. Lancet Infect Dis. 2021; Online ahead of print.","DOI":"10.1016\/S1473-3099(21)00142-0"},{"key":"3875_CR29","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1186\/s12936-016-1497-x","volume":"15","author":"J Raman","year":"2016","unstructured":"Raman J, Morris N, Frean J, Brooke B, Blumberg L, Kruger P, et al. Reviewing South Africa\u2019s malaria elimination strategy (2012\u20132018): progress, challenges and priorities. Malar J. 2016;15:438.","journal-title":"Malar J"},{"key":"3875_CR30","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.4102\/phcfm.v8i1.1078","volume":"8","author":"KW Hlongwana","year":"2016","unstructured":"Hlongwana KW, Tsoka-Gwegweni J. From malaria control to elimination in South Africa: the researchers\u2019 perspectives. Afr J Prim Health Care Fam Med. 2016;8:e1\u201310.","journal-title":"Afr J Prim Health Care Fam Med"},{"key":"3875_CR31","unstructured":"Kollipara A, Moonasar D, Balawanth R, Silal SP, Yuen A, Fox K, Graffy R, Njau R, Pillay Y, Blecher M. Using an Investment Case to mobilize resources for malaria elimination in South Africa. Malar J. 2021; submitted."}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-021-03875-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-021-03875-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-021-03875-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T12:37:31Z","timestamp":1673095051000},"score":1,"resource":{"primary":{"URL":"https:\/\/malariajournal.biomedcentral.com\/articles\/10.1186\/s12936-021-03875-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,16]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["3875"],"URL":"https:\/\/doi.org\/10.1186\/s12936-021-03875-z","relation":{},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,16]]},"assertion":[{"value":"21 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was granted from the University of Cape Town (FSREC 18-2019).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"There are no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"344"}}