Towards effective malaria control among high-risk populations in sub-Saharan Africa

Malaria remains a major public health challenge in sub-Saharan Africa, disproportionately affecting high-risk groups such as children under five and pregnant women. Despite the availability of effective prevention and treatment tools, persistent transmission, environmental suitability, and socio-economic inequalities hinder elimination efforts. This thesis addresses these challenges by evaluating integrated vector management (IVM), mapping malaria risk using geospatial methods, and examining behavioral determinants of prevention and care-seeking, to inform targeted, context-specific interventions.

The research employed two complementary methodological approaches: a systematic evidence synthesis and secondary analysis of nationally representative survey data from Togo. The systematic review and meta-analysis combined data from randomized controlled trials and observational studies to estimate the effectiveness of IVM strategies, particularly those integrating insecticide-treated nets with additional control measures. The secondary analyses utilized geospatial modeling, temporal trend assessment, and multivariate regression to identify environmental and socio-demographic drivers of malaria risk, intervention coverage, and health-seeking behaviors.

The findings indicate that IVM strategies can reduce malaria risk by approximately 42%, although the degree of benefit varies depending on the context. Malaria transmission in Togo is spatially heterogeneous, with clearly defined hotspots strongly associated with rainfall patterns, proximity to water bodies, and other ecological factors. Substantial regional disparities in prevalence, prevention coverage, and care-seeking were observed, often linked to maternal education, household wealth, and rural residence. Progress in long-lasting insecticidal net ownership and use over the past decade has been notable, but it remains below the universal coverage targets. Care-seeking for febrile illness in children was suboptimal, with significant inequities between regions in Togo.

Overall, the results underscore the importance of tailoring malaria control strategies to local epidemiological, environmental, and socio-economic contexts. Sustainable progress will require integrated, community-engaged interventions, backed by robust surveillance systems and long-term financing, to reduce inequities and accelerate the path toward malaria elimination in sub-Saharan Africa.