Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00207-9
Prof Martin Hensher PhD , Leigh Blizzard PhD , Julie Campbell PhD , Ben Canny PhD , Craig Zimitat PhD , Prof Andrew Palmer MBBS
Background
Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions.
Methods
Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots—points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially—were estimated and countries in the vicinity of these knots identified.
Findings
Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions.
Interpretation
Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries—low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use.
Funding
None.
背景：低收入国家医疗支出的增加与健康状况的迅速改善有关。人们较少关注在高支出水平下医疗支出边际收益递减的可能性，也较少关注医疗保健温室气体排放与结果之间的关系。我们的研究旨在调查医疗支出和排放边际收益递减的存在、规模和影响：方法：采用分段（片断）回归分析来探讨全球疾病负担项目中的两种健康结果测量指标（适合医疗保健的死亡率[MAH]和健康调整后预期寿命[HALE]）、世界卫生组织全球卫生支出数据库中的四种人均卫生支出总量以及 Lenzen 及其同事的 2020 年研究中得出的医疗保健部门人均温室气体排放量之间的关系。我们估算了转折点--支出和排放的回报弹性或增加速度发生重大变化的点，并确定了这些转折点附近的国家：据估计，在低收入和中低收入国家，卫生支出的回报（以 MAH 和 HALE 衡量的人口健康改善）迅速增加；当人均支出水平超过约 500 美元时，这些回报开始减缓。当支出水平超过意大利等高收入国家的水平（约 3400 美元）时，几乎没有证据表明增加支出或增加医疗保健温室气体排放会带来进一步的健康回报：在低收入国家，通过增加医疗支出投资，可以显著改善人口的健康状况。相反，高收入国家医疗支出的持续增长本身不太可能迅速改善健康结果。我们的研究结果为正在出现的关于地球范围内充足性重要性的辩论提供了信息--低收入国家需要快速增长医疗支出，而高收入国家则有可能在大幅降低资源使用水平的情况下实现更好的健康结果：无。
{"title":"Diminishing marginal returns and sufficiency in health-care resource use: an exploratory analysis of outcomes, expenditure, and emissions","authors":"Prof Martin Hensher PhD , Leigh Blizzard PhD , Julie Campbell PhD , Ben Canny PhD , Craig Zimitat PhD , Prof Andrew Palmer MBBS","doi":"10.1016/S2542-5196(24)00207-9","DOIUrl":"10.1016/S2542-5196(24)00207-9","url":null,"abstract":"<div><h3>Background</h3><div>Increasing health expenditure in low-income countries is associated with rapid gains in health status. Less attention has been paid to the possibility of diminishing marginal returns to health expenditure at high levels of spending, or to the relationship between health-care greenhouse gas emissions and outcomes. Our study aimed to investigate the existence, scale, and implications of diminishing marginal returns to health-care expenditure and emissions.</div></div><div><h3>Methods</h3><div>Segmented (piecewise) regression analysis was used to explore the relationship between two measures of health outcome from the Global Burden of Disease project (mortality amenable to health care [MAH] and health-adjusted life expectancy [HALE]), four aggregates of health expenditure per capita from the WHO Global Health Expenditure Database, and health-care sector greenhouse gas emissions per capita derived from a 2020 study by Lenzen and colleagues. Turning point knots—points at which the elasticity or velocity of increasing returns to expenditure and emissions changed substantially—were estimated and countries in the vicinity of these knots identified.</div></div><div><h3>Findings</h3><div>Rapidly increasing returns (improvements in population health as measured by MAH and HALE) to health expenditure were estimated in low-income and lower-middle-income countries; at levels of spending above approximately US$500 per capita, these returns start to slow. At levels of spending above those seen in high-income countries such as Italy (approximately US$3400), there is little or no evidence of further health returns to additional spending or to increasing health-care greenhouse gas emissions.</div></div><div><h3>Interpretation</h3><div>Dramatic improvements in population health outcomes could be achieved by additional investment in health expenditure in low-income countries. Conversely, continuing growth in health expenditure in high-income countries will, by itself, be unlikely to yield rapid improvements in health outcomes. Our findings inform the emerging debate on the importance of sufficiency within planetary boundaries—low-income countries need rapid growth in health expenditure, whereas high-income countries could potentially achieve better health outcomes at substantially lower levels of resource use.</div></div><div><h3>Funding</h3><div>None.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e744-e753"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00206-7
Iris Martine Blom MD , Fawzia N Rasheed PhD , Hardeep Singh MD , Matthew J Eckelman PhD , Meghnath Dhimal PhD , Martin Hensher PhD , Renzo R Guinto MD , Alice McGushin MBBS , Xuejuan Ning MHS , Poornima Prabhakaran PhD , Marina Romanello PhD , Dana van Alphen PhD , Nick Watts MBBS , Jessica C Yu PhD , Carol Zavaleta-Cortijo PhD , Andrea J MacNeill MD , Jodi D Sherman MD
A global initiative to develop low-carbon, resilient health systems—the COP26 Health Programme—launched at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in 2021. As of May, 2024, 83 nations have committed to participate in this initiative. This analysis evaluates the effectiveness of existing and proposed indicators towards public monitoring and accountability to these commitments. Our findings reveal substantial gaps in data availability and indicator relevance, with many countries reporting process indicators that do not reflect actual progress towards achieving sustainable health-care systems. We found a dearth of suitable indicators and an urgent need to develop robust ones that are adaptable to different health-care system contexts. These indicators should be designed to capture tangible outcomes, support policy making, and prevent greenwashing. Integration of more robust indicators into independent scientific monitoring can support systematic inclusion of health care in global climate strategies, thereby enhancing the overall effectiveness of the COP26 Health Programme.
{"title":"Evaluating progress and accountability for achieving COP26 Health Programme international ambitions for sustainable, low-carbon, resilient health-care systems","authors":"Iris Martine Blom MD , Fawzia N Rasheed PhD , Hardeep Singh MD , Matthew J Eckelman PhD , Meghnath Dhimal PhD , Martin Hensher PhD , Renzo R Guinto MD , Alice McGushin MBBS , Xuejuan Ning MHS , Poornima Prabhakaran PhD , Marina Romanello PhD , Dana van Alphen PhD , Nick Watts MBBS , Jessica C Yu PhD , Carol Zavaleta-Cortijo PhD , Andrea J MacNeill MD , Jodi D Sherman MD","doi":"10.1016/S2542-5196(24)00206-7","DOIUrl":"10.1016/S2542-5196(24)00206-7","url":null,"abstract":"<div><div>A global initiative to develop low-carbon, resilient health systems—the COP26 Health Programme—launched at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in 2021. As of May, 2024, 83 nations have committed to participate in this initiative. This analysis evaluates the effectiveness of existing and proposed indicators towards public monitoring and accountability to these commitments. Our findings reveal substantial gaps in data availability and indicator relevance, with many countries reporting process indicators that do not reflect actual progress towards achieving sustainable health-care systems. We found a dearth of suitable indicators and an urgent need to develop robust ones that are adaptable to different health-care system contexts. These indicators should be designed to capture tangible outcomes, support policy making, and prevent greenwashing. Integration of more robust indicators into independent scientific monitoring can support systematic inclusion of health care in global climate strategies, thereby enhancing the overall effectiveness of the COP26 Health Programme.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e778-e789"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00249-3
Cahal McQuillan
{"title":"Planetary Health Research Digest","authors":"Cahal McQuillan","doi":"10.1016/S2542-5196(24)00249-3","DOIUrl":"10.1016/S2542-5196(24)00249-3","url":null,"abstract":"","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Page e722"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00212-2
Prof Xavier Basagaña PhD , Joan Ballester PhD
Background
Exposure to environmental factors has a high burden on human health, with millions of premature annual deaths associated with the short-term health effects of ambient temperatures and air pollution. However, direct estimations of exposure-related mortality from real data are still not available in most parts of the world, especially in low-resource settings, due to the unavailability of daily health records to calibrate epidemiological models.
Methods
In this study, we have filled the crucial gap in available direct estimations by developing a method to make valid inference for the relationship between exposure and response data that uses only exposure and temporally aggregated response data. We provided the mathematical derivation of the method, and compared the results by using simulations applied to daily temperature and daily, weekly, and monthly mortality data. The method was then applied to the newly created database of the EARLY-ADAPT project.
Findings
The daily and weekly models produced similar and unbiased estimates of the temperature-related relative risks and attributable mortality, with only slightly more imprecision in the weekly model. Even the estimates of the monthly model were unbiased when using enough data, although at the expense of a substantial increase in variability. The real data analysis showed that the similarity between the regional values of two aggregation models increased with the number of years and regions of the dataset, and decreased with the difference in their degree of temporal aggregation.
Interpretation
Our method opens the door to conducting epidemiological studies in low-resource settings, where access to daily health data is not possible. Moreover, it allows accurate estimation of the short-term health effects of environmental exposures in near-real time, when daily health data are still not available, such as in the estimation of the mortality burden of recent record-breaking heat episodes. Overall, our method represents an important new approach to how the public health community can use data to create new evidence for research, translation and policy making.
{"title":"Unbiased temperature-related mortality estimates using weekly and monthly health data: a new method for environmental epidemiology and climate impact studies","authors":"Prof Xavier Basagaña PhD , Joan Ballester PhD","doi":"10.1016/S2542-5196(24)00212-2","DOIUrl":"10.1016/S2542-5196(24)00212-2","url":null,"abstract":"<div><h3>Background</h3><div>Exposure to environmental factors has a high burden on human health, with millions of premature annual deaths associated with the short-term health effects of ambient temperatures and air pollution. However, direct estimations of exposure-related mortality from real data are still not available in most parts of the world, especially in low-resource settings, due to the unavailability of daily health records to calibrate epidemiological models.</div></div><div><h3>Methods</h3><div>In this study, we have filled the crucial gap in available direct estimations by developing a method to make valid inference for the relationship between exposure and response data that uses only exposure and temporally aggregated response data. We provided the mathematical derivation of the method, and compared the results by using simulations applied to daily temperature and daily, weekly, and monthly mortality data. The method was then applied to the newly created database of the EARLY-ADAPT project.</div></div><div><h3>Findings</h3><div>The daily and weekly models produced similar and unbiased estimates of the temperature-related relative risks and attributable mortality, with only slightly more imprecision in the weekly model. Even the estimates of the monthly model were unbiased when using enough data, although at the expense of a substantial increase in variability. The real data analysis showed that the similarity between the regional values of two aggregation models increased with the number of years and regions of the dataset, and decreased with the difference in their degree of temporal aggregation.</div></div><div><h3>Interpretation</h3><div>Our method opens the door to conducting epidemiological studies in low-resource settings, where access to daily health data is not possible. Moreover, it allows accurate estimation of the short-term health effects of environmental exposures in near-real time, when daily health data are still not available, such as in the estimation of the mortality burden of recent record-breaking heat episodes. Overall, our method represents an important new approach to how the public health community can use data to create new evidence for research, translation and policy making.</div></div><div><h3>Funding</h3><div>European Research Council (ERC).</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e766-e777"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background</h3><div>Cooking with traditional fuels can lead to severe health issues caused by household air pollution, and can also affect gender equality and drive environmental degradation. In Nepal, despite government efforts to promote electric cooking, more than half of the population still uses traditional fuels, with electric cooking adoption remaining below 1%. Several of the barriers to and enablers of clean cooking vary geographically; however, few studies have considered spatial explicit information in planning national-scale transitions to clean cooking. In this study we provide a spatially explicit roadmap to estimate the required investments and benefits gained from the transition across Nepal.</div></div><div><h3>Methods</h3><div>This study uses geospatial modelling methods to evaluate strategies to achieve the Government of Nepal's vision for a national-scale transition to clean cooking. We integrate the open-source clean cooking geospatial assessment tool OnStove and a spatial multicriteria analysis model. With OnStove, we evaluate which cooking technologies and fuels maximise the net benefits of a clean-cooking transition across each km<sup>2</sup> of the region. With the multicriteria analysis, we weigh stakeholder preferences and prioritise areas of action where policy should be implemented. We used the most up-to-date geospatial data to the year 2023, such as the High Resolution Settlement Layer, Open Street Maps’ road networks, the Global Human Settlement Layer, NASA/USGS forest cover maps, and Facebook's Relative Wealth Index, among others. We also relied on data from the Nepal Oil Corporation, the Nepal Electricity Agency, the Central Bureau of Statistic's 2021 national census, and the Alternative Energy Promotion Center. We evaluate four scenarios capturing advances on clean cooking policy up to the year 2022, current market inefficiencies, and the potential effects of new policies for clean-cooking transition in Nepal.</div></div><div><h3>Findings</h3><div>Our results show that transitional and clean cooking technologies provide higher net benefits than traditional options everywhere across Nepal in all scenarios. Our net-benefit analysis shows that around 9563 deaths could be averted yearly if benefits and externalities were perceived and valued correctly. Furthermore, substantial benefits could be achieved in regard to greenhouse gas emissions avoidance, time saved, and health-cost reductions. Our results also show that the current subsidy strategy from the Government of Nepal is well aligned with the benefits achieved under a cost–benefit analysis. In this context, electric cooking can bring the highest benefits to the largest part of the population. The analysis showed how high subsidies for liquefied petroleum gas in Nepal can present trade-offs with energy security and independence, and how this could be avoided by transferring part of the subsidy to cover differentiated electric cooking tariffs. Accountin
{"title":"Achieving Nepal's clean cooking ambitions: an open source and geospatial cost–benefit analysis","authors":"Camilo Ramirez MSc , Babak Khavari PhD , Alicia Oberholzer MSc , Bhoj Raj Ghimire PhD , Bhogendra Mishra PhD , Santiago Sinclair-Lecaros MSc , Dimitris Mentis PhD , Anobha Gurung PhD , Dilip Khatiwada PhD , Francesco Fuso Nerini PhD","doi":"10.1016/S2542-5196(24)00209-2","DOIUrl":"10.1016/S2542-5196(24)00209-2","url":null,"abstract":"<div><h3>Background</h3><div>Cooking with traditional fuels can lead to severe health issues caused by household air pollution, and can also affect gender equality and drive environmental degradation. In Nepal, despite government efforts to promote electric cooking, more than half of the population still uses traditional fuels, with electric cooking adoption remaining below 1%. Several of the barriers to and enablers of clean cooking vary geographically; however, few studies have considered spatial explicit information in planning national-scale transitions to clean cooking. In this study we provide a spatially explicit roadmap to estimate the required investments and benefits gained from the transition across Nepal.</div></div><div><h3>Methods</h3><div>This study uses geospatial modelling methods to evaluate strategies to achieve the Government of Nepal's vision for a national-scale transition to clean cooking. We integrate the open-source clean cooking geospatial assessment tool OnStove and a spatial multicriteria analysis model. With OnStove, we evaluate which cooking technologies and fuels maximise the net benefits of a clean-cooking transition across each km<sup>2</sup> of the region. With the multicriteria analysis, we weigh stakeholder preferences and prioritise areas of action where policy should be implemented. We used the most up-to-date geospatial data to the year 2023, such as the High Resolution Settlement Layer, Open Street Maps’ road networks, the Global Human Settlement Layer, NASA/USGS forest cover maps, and Facebook's Relative Wealth Index, among others. We also relied on data from the Nepal Oil Corporation, the Nepal Electricity Agency, the Central Bureau of Statistic's 2021 national census, and the Alternative Energy Promotion Center. We evaluate four scenarios capturing advances on clean cooking policy up to the year 2022, current market inefficiencies, and the potential effects of new policies for clean-cooking transition in Nepal.</div></div><div><h3>Findings</h3><div>Our results show that transitional and clean cooking technologies provide higher net benefits than traditional options everywhere across Nepal in all scenarios. Our net-benefit analysis shows that around 9563 deaths could be averted yearly if benefits and externalities were perceived and valued correctly. Furthermore, substantial benefits could be achieved in regard to greenhouse gas emissions avoidance, time saved, and health-cost reductions. Our results also show that the current subsidy strategy from the Government of Nepal is well aligned with the benefits achieved under a cost–benefit analysis. In this context, electric cooking can bring the highest benefits to the largest part of the population. The analysis showed how high subsidies for liquefied petroleum gas in Nepal can present trade-offs with energy security and independence, and how this could be avoided by transferring part of the subsidy to cover differentiated electric cooking tariffs. Accountin","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e754-e765"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S2542-5196(24)00172-4
Richard M Oxborough PhD , Karen L Figueroa Chilito MSc , Filemon Tokponnon PhD , Louisa A Messenger PhD
Mass distribution of insecticide-treated nets (ITNs) has been a key factor in reducing malaria cases and deaths in sub-Saharan Africa. A shortcoming has been the over-reliance on pyrethroid insecticides, with more than 2·13 billion pyrethroid ITNs (PY ITNs) distributed in the past two decades, leading to widespread pyrethroid resistance. Progressive changes are occurring, with increased deployment of more effective pyrethroid-chlorfenapyr (PY-CFP) or pyrethroid-piperonyl butoxide (PY-PBO) ITNs in areas of pyrethroid resistance. In 2023, PY-PBO ITNs accounted for 58% of all ITNs shipped to sub-Saharan Africa. PY-PBO and PY-CFP ITNs are 30–37% more expensive than standard PY ITNs, equating to an additional US$132–159 million required per year in sub-Saharan Africa to fund the shift to more effective ITNs. Several countries are withdrawing or scaling back indoor residual spraying (IRS) programmes to cover the shortfall, which is reflected by the number of structures sprayed by the US President's Malaria Initiative decreasing by 30% from 5·67 million (2021) to 3·96 million (2023). Benin, located in West Africa, is a prime example of a country that ceased IRS in 2021 after 14 years of annual spraying. Our economic evaluation indicates that IRS in Benin cost $3·50 per person protected per year, around five times more per person protected per year compared with PY-PBO ($0·73) or PY-CFP ITNs ($0·76). Although costly to implement, a major advantage of IRS is the portfolio of at least three chemical classes for prospective resistance management. With loss of synergy to PBO developing rapidly, there is the danger of over-reliance on PY-CFP ITNs. As gains in global malaria control continue to reverse each year, current WHO projections estimate that key 2030 malaria incidence milestones will be missed by a staggering 89%. This Personal View explores contemporary malaria vector control trends in sub-Saharan Africa and cost implications for improved disease control and resistance management.
{"title":"Malaria vector control in sub-Saharan Africa: complex trade-offs to combat the growing threat of insecticide resistance","authors":"Richard M Oxborough PhD , Karen L Figueroa Chilito MSc , Filemon Tokponnon PhD , Louisa A Messenger PhD","doi":"10.1016/S2542-5196(24)00172-4","DOIUrl":"10.1016/S2542-5196(24)00172-4","url":null,"abstract":"<div><div>Mass distribution of insecticide-treated nets (ITNs) has been a key factor in reducing malaria cases and deaths in sub-Saharan Africa. A shortcoming has been the over-reliance on pyrethroid insecticides, with more than 2·13 billion pyrethroid ITNs (PY ITNs) distributed in the past two decades, leading to widespread pyrethroid resistance. Progressive changes are occurring, with increased deployment of more effective pyrethroid-chlorfenapyr (PY-CFP) or pyrethroid-piperonyl butoxide (PY-PBO) ITNs in areas of pyrethroid resistance. In 2023, PY-PBO ITNs accounted for 58% of all ITNs shipped to sub-Saharan Africa. PY-PBO and PY-CFP ITNs are 30–37% more expensive than standard PY ITNs, equating to an additional US$132–159 million required per year in sub-Saharan Africa to fund the shift to more effective ITNs. Several countries are withdrawing or scaling back indoor residual spraying (IRS) programmes to cover the shortfall, which is reflected by the number of structures sprayed by the US President's Malaria Initiative decreasing by 30% from 5·67 million (2021) to 3·96 million (2023). Benin, located in West Africa, is a prime example of a country that ceased IRS in 2021 after 14 years of annual spraying. Our economic evaluation indicates that IRS in Benin cost $3·50 per person protected per year, around five times more per person protected per year compared with PY-PBO ($0·73) or PY-CFP ITNs ($0·76). Although costly to implement, a major advantage of IRS is the portfolio of at least three chemical classes for prospective resistance management. With loss of synergy to PBO developing rapidly, there is the danger of over-reliance on PY-CFP ITNs. As gains in global malaria control continue to reverse each year, current WHO projections estimate that key 2030 malaria incidence milestones will be missed by a staggering 89%. This Personal View explores contemporary malaria vector control trends in sub-Saharan Africa and cost implications for improved disease control and resistance management.</div></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"8 10","pages":"Pages e804-e812"},"PeriodicalIF":24.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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