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ObjectiveTo test the effect of proactive home visits by trained community health workers (CHWs) on child survival.MethodsWe conducted a two arm, parallel, unmasked cluster-randomized trial in 137 village-clusters in rural Mali. From February 2017 to January 2020, 31 761 children enrolled at the trial start or at birth. Village-clusters received either primary care services by CHWs providing regular home visits (intervention) or by CHWs providing care at a fixed site (control). In both arms, user fees were removed and primary health centres received staffing and infrastructure improvements before trial start. Using lifetime birth histories from women aged 15-49 years surveyed annually, we estimated incidence rate ratios (IRR) for intention-to-treat and per-protocol effects on under-five mortality using Poisson regression models.FindingsOver three years, we observed 52 970 person-years (27 332 in intervention arm; 25 638 in control arm). During the trial, 909 children in the intervention arm and 827 children in the control arm died. The under-five mortality rate declined from 142.8 (95% CI: 133.3-152.9) to 56.7 (95% CI: 48.5-66.4) deaths per 1000 live births in the intervention arm; and from 154.3 (95% CI: 144.3-164.9) to 54.9 (95% CI: 45.2-64.5) deaths per 1000 live births in the control arm. Intention-to-treat (IRR: 1.02; 95% CI: 0.88-1.19) and per-protocol estimates (IRR: 1.01; 95% CI: 0.87-1.18) showed no difference between study arms.ConclusionThough proactive home visits did not reduce under-five mortality, system-strengthening measures may have contributed to the decline in under-five mortality in both arms.

The Proactive Community Case Management (ProCCM) trial in Mali reinforced the health system across both arms with user fee removal, professional Community Health Workers (CHWs), and upgraded primary health centres (PHCs)-and randomized village-clusters to receive proactive home visits by CHWs (intervention) or fixed site-based services by passive CHWs (control). Across both arms, sick children's 24-hour treatment and pregnant women's four or more antenatal visits doubled, and under-five mortality halved, over three years compared to baseline. In the intervention arm, proactive CHW home visits had modest effects on children's curative and women's antenatal care utilization, but no effect on under-five mortality, compared to the control arm. We aimed to explain these results by examining implementation, mechanisms, and context in both arms. We conducted a process evaluation with a mixed method convergent design that included 79 in-depth interviews with providers and participants over two time-points, surveys with 195 providers, and secondary analyses of clinical data. We embedded realist approaches in novel ways to test, refine, and consolidate theories about how ProCCM worked, generating three context-intervention-actor-mechanism-outcome nodes that unfolded in a cascade. First, removing user fees and deploying professional CHWs in every cluster enabled participants to seek health sector care promptly and created a context of facilitated access. Second, health systems support to all CHWs and PHCs enabled equitable, respectful, quality healthcare, which motivated increased, rapid utilization. Third, proactive CHW home visits facilitated CHWs and participants to deliver and seek care, and build relationships, trust, and expectations, but these mechanisms were also activated in both arms. Addressing multiple structural barriers to care, user fee removal, professional CHWs, and upgraded clinics interacted with providers' and patients' agency to achieve rapid care and child survival in both arms. Proactive home visits expedited or compounded mechanisms that were activated and changed the context across arms.

Abstract Background The COVID-19 pandemic has highlighted the need for more effective immunization programs, including in limited resource settings. This paper presents outcomes and lessons learnt from a COVID-19 vaccination campaign (VC), which used a tailored adaptive strategy to optimise vaccine uptake in the Boeny region of Madagascar. Methods Guided by the Dynamic Sustainability Framework (DSF), the VC implementation was regularly reviewed through multi-sectoral stakeholder feedback, key informant interviews, problem-solving meetings, and weekly monitoring of outcome indicators to identify and apply key adaptations. Qualitative data on processes were collected and analysed using a rapid assessment approach. Outcome indicators, including pre- and post-VC vaccine hesitancy and trends in vaccine doses administered, were analysed using generalized linear models. Additionally, vaccination coverage, geographic reach, and target population characteristics, and sustainability indicators, such as staff trained, facilities equipped, and degree of integration of operational and educational materials were also tracked. Results Key strategy adaptations included using a proactive campaign approach, community-led awareness and outreach, particularly in remote areas, and addressing cold chain, waste management, vaccine transport, and information technology (IT) equipment gaps. Over six months, 24,888 COVID-19 vaccines were administered. The adapted strategy led to an 8% increase in doses administered weekly (RR = 1.08, CI 95%: 1.01-1.15). However, vaccine hesitancy among the unvaccinated population remained unchanged (∆ = 0.02, CI 95%: -0.04-0.08). In terms of sustainability, 340 staff were trained, and 10 primary healthcare facilities were equipped and refurbished. Conclusions Implementing collaborative, multi-sectoral vaccination strategies that integrate healthcare services with proactive outreach and community-driven campaigns are effective in increasing vaccine coverage in resource-limited settings. It demonstrates how theory-based adaptive strategies can enhance vaccination rates, even if they do not significantly impact COVID-19 vaccine hesitancy within the community. More generally, this initiative has important implications for adult vaccination programmes other than those related to COVID-19.

Rift Valley fever (RVF) is one of the major viral arthropod-borne diseases in Africa. In recent decades, RVF virus (RVFV), the causative agent of RVF, has been responsible for multiple outbreaks in West Africa with important consequences on human and animal health. In particular, an outbreak occurred in 2010 after heavy rains in the desertic region of Adrar, Mauritania. It was characterized by the appearance of severe clinical signs among dromedary camels. Another one occurred in 2013-2014 across Senegal and the southern part of Mauritania. In this study, we characterized two RVFV field strains isolated during these two outbreaks. The first strain, MRU25010-30, was isolated from a camel (2010) while the second, MRU2687-3, was isolated from a goat (2013). By deep-sequencing and rapid amplification of cDNA-ends by polymerase chain reaction, we successfully sequenced the complete genome of these two RVFV strains as well as the reference laboratory strain ZH548. Phylogenetic analysis showed that the two field viruses belong to two different RVFV genetic lineages. Moreover, we showed that MRU25010-30 replicates more efficiently in various in vitro cell culture models than MRU2687-3 and ZH548. In vivo, MRU25010-30 caused rapid death of BALB/c mice and proved to be more virulent than MRU2687-3, regardless of the route of inoculation (subcutaneous or intranasal). The virulence of MRU25010-30 is associated with a high viral load in the liver and serum of infected mice, while the death of mice infected with MRU2687-3 and ZH548 correlated with a high viral load in the brain. Altogether, the data presented in this study provide new avenues to unveil the molecular viral determinants that modulate RVFV virulence and replication capacity.

Introduction Despite recommendations from the WHO, antenatal care (ANC) coverage remains low in many low-income and middle-income countries (LMICs). Community health workers (CHWs) can play an important role in expanding ANC coverage through pregnancy identification, provision of health education, screening for complications, delivery of therapeutic care and referral to higher levels of care. However, despite the success of CHW programmes in various countries, WHO has called for additional research to develop evidence-based models that optimise CHW service delivery and that can be replicated across geographies.Methods The ProCCM Trial was a cluster-randomised controlled trial to compare proactive home visits by CHWs (intervention, 69 village clusters) to the provision of CHW care at community fixed sites only (control, 68 village clusters) in the Bankass health district in Central Mali. In this study, we conducted a cost-effectiveness analysis of proactive CHW home visits in improving ANC utilisation, a secondary outcome of the ProCCM trial. We analysed five ANC outcomes: (1) number of ANC contacts, (2) at least one ANC contact, (3) at least four ANC contacts, (4) at least eight ANC contacts and (5) ANC initiated in the first trimester. We assumed two perspectives, a CHW programme’s and the Full ANC programme’s perspective, which included facility-based as well as community-based ANC. We estimated programme costs, incremental cost-effectiveness ratios (ICERs) and probabilities of the intervention being more cost-effective than the control at different willingness-to-pay (WTP) thresholds.Results Proactive home visits were cost-saving from the CHW programme’s perspective (ICERs: −$21.39 to −$79.20 per ANC utilisation outcome) and from the Full ANC programme perspective (ICERs: −$1.70 to −$6.30 per ANC utilisation outcome) compared with the fixed-site CHW care. The likelihood of the intervention being more cost-effective than the control was 100% at WTP thresholds $0 per ANC utilisation outcome and between $12.5 and $50.00 per ANC utilisation outcome in the CHW- and Full ANC programme perspectives, respectively.Conclusion Our results provide evidence that proactive home visits produce more value per dollar spent as a means of improving the uptake of ANC services compared with fixed-site CHW services.Trial registration number NCT02694055.

BackgroundA country claiming to have achieved elimination of Lymphatic filariasis (LF) as a public health problem must undergo and document a quality assessment of the World Health Organization (WHO) recommended essential package of care for patients with lymphedema and hydrocele. This must be done in at least 10% of facilities offering services. In Liberia, Côte d’Ivoire, Mali and Guinea-Bissau the LF programmes used the Hydrocele Facility Assessment Tool (HFAT) and the Lymphedema Facility Assessment Tool (LFAT) to provide an objective assessment of facilities providing LF morbidity management services. Information gathered through these tools is used to improve service delivery and document the number of implementation units with at least one facility providing the essential package of care in the WHO epidemiological reporting form (EPIRF). The development of the HFAT and LFAT digital tools were informed by WHO’s direct inspection protocol (DIP) for lymphedema, WHO’s service availability and readiness assessment (SARA), and WHO’s situational analysis to assess emergency and essential surgical care.MethodsBetween May 2022 and January 2023, 33 hydrocele facility assessments and 102 lymphedema facility assessments were implemented in these four countries. Facility and indicator score benchmarks were set at 75%.ResultsThe LFAT and HFAT indicator results were variable both within and between countries. 26 (79%) facilities scored 75% or better on the assessment for hydrocele surgery and 15 (15%) facilities scored 75% or better on the assessment for lymphedema. Examples of indicators with significant need for quality improvement actions were 1) LFAT indicator ‘Trained staff - Community Health Care Providers trained in lymphoedema management’ which did not achieve the 75% benchmark in any of the countries; 2) HFAT indicator on use of surgical safety checklist which only achieved the 75% benchmark in Liberia.DiscussionThe discussion highlights the current challenges faced by endemic countries to ensure that an essential package of care (of sufficient quality) for lymphedema management and hydrocele surgery is available.

Objectives This study aims to identify the factors influencing vaccine hesitancy, willingness and its variation over time in order to inform more responsive strategies for increasing vaccination uptake. The specific objectives are: (1) to describe and compare levels of COVID-19 vaccine hesitancy among the general population in rural and urban settings in West Africa over time and (2) to identify factors associated with COVID-19 vaccination willingness and hesitancy among the general population across five West African countries over time.Design Following a baseline survey (Wave I), three serial cross-sectional surveys (Waves II-IV) were implemented.Setting The study was conducted in Burkina Faso, Guinea, Mali, Senegal and Sierra Leone from November 2021 to July 2022.Participants A total of 13 571 study participants were included in the study (n=4373, n=4593 and n=4605 for survey Waves II, III and IV, respectively). Inclusion criteria were being 18 years or older, living in the study area and willing to provide informed consent. A two-stage sampling strategy was used to select the sample from among the general population.Primary and secondary outcomes Primary outcomes were the variability of vaccine hesitancy over time and across the five West African countries. Secondary outcomes were factors associated with vaccine willingness.Results A small but steady increase in hesitancy to COVID-19-vaccination can be observed across countries, with an upward trend of vaccine hesitancy reported by 952 participants (33.9 %) in Wave II, 1055 (37.3%) in Wave III and 1089 (38.1%) in Wave IV. Among the countries included, Senegal shows the highest level of vaccine hesitancy (‘Definitely no’ and ‘Probably no’ ranging from 50.2% to 56.0% and 26.2 to 28.3%, respectively). At the same time, Senegal has the lowest vaccination coverage overall. Across all five countries and survey waves, the primary factor associated with vaccination willingness is fear of experiencing severe COVID-19 disease (Wave II: OR 0.42, 95% CI 0.34 to 0.51, Wave III: OR 0.48, 95% CI 0.40 to 0.59 and Wave IV: OR 0.54, 95% CI 0.44 to 0.66). Perceived improved financial status seems to influence willingness to get vaccinated negatively (OR 0.57, 95% CI 0.40 to 0.81) and unlike in Western, Educated, Industrialised, Rich and Democratic countries, men seem more reluctant to get vaccinated than women (OR 0.77, 95%, CI 0.65 to 0.93).Conclusions Our findings suggest that vaccine hesitancy should be monitored over time to inform communication strategies, which are responsive to changes in vaccination-related public sentiments. Additionally, a focus on social solidarity and the importance of women in vaccination advocacy can help improve COVID-19 vaccination coverage in West Africa.Trial registration number The general protocol is registered on clinicaltrial.gov (protocol number: NCT04912284).

La gestion des instances sportives à Bamako est dominée par les hommes, avec des femmes occupant souvent des postes à connotation féminine. Cet article examine les facteurs contextuels et dispositionnels qui ont favorisé cette sexualisation des postes. Nous avons analysé les listes des membres des bureaux des fédérations sportives sur 20 ans (2002-2022), mené des entretiens avec trois présidentes et distribué des questionnaires à 30 présidents et 80 femmes membres. Les résultats montrent une grande disparité : 3 femmes présidentes contre 30 hommes, et 83 femmes membres contre 901 hommes. Nous avons observé divers modes d'entrée pour les femmes, avec des postes souvent limités à des rôles socialement définis. ,

Introduction Five of the neglected tropical diseases use a strategy of preventative chemotherapy distributed via mass drug administration (MDA) for all eligible people living in endemic areas. To be successful, high coverage must be sustained over multiple rounds. Therefore, it will be difficult to reach elimination as a public health problem using MDA if there remain clusters of people who have never been treated. The study aims to explore the reasons why people with high mobility report being never treated during MDA and to provide evidence to support the development of standardised questions for data collection using qualitative research tools.Methods We conducted an exploratory study using qualitative methods among displaced people, nomads/transhumants and economic migrants who self-reported that they had never been treated during MDA in the health districts of Tominian and Kalabancoro in Mali. Data were collected through in-depth individual interviews and focus group discussions. Nvivo V.14 software was used for data management and analysis.Results The main reasons reported for never treatment included: geographical mobility, lack of awareness/information, negative rumours, fear of side effects, conflict and insecurity and logistical difficulties faced in reaching these populations. Proposed solutions included involving communities in the MDA, increasing awareness and information campaigns, effectively managing side effects, and designing and implementing flexible and effective interventions.Conclusion This study highlights that there are people with high mobility who may never have been treated during any round of MDA. The reasons for never treatment highlight the challenges faced when reaching particular groups during MDA activities/interventions. Suggested remedies will require programmes to implement more flexible and tailored interventions. Customised approaches based on the context are essential to guarantee fair access to preventive chemotherapy. Effective interventions must consider the supply and demand side in crafting interventions. This research adds to the evidence base to understand never treatment, particularly among highly mobile population groups and in schistosomiasis elimination programmes.

This paper examines the impact of globalization on Nigerian cultural heritage between 2012 and 2022. As part of its objectives, it provided a detailed background on the extent to which globalization has influenced the traditional values and practices in Nigerian cultural heritage. It also provided a detailed analysis of globalization's positive and negative outcomes on Nigeria’s cultural heritage. The source of data collection was employed through secondary sources such as the use of textbooks, journals, government publications, conference and seminar lecture materials, and the Internet. The paper adopted the Cultural Hybridity Theory and the Cultural Imperialism Theory as the main theoretical framework for analysis. The paper reveals that globalization has had both positive and negative effects on Nigerian cultural heritage, including increased cultural exchange and awareness, but also erosion of traditional values, and loss of cultural identity. The paper also identifies the role of stakeholders, including government, communities, and individuals, in mitigating the negative effects and harnessing the benefits of globalization for the preservation and promotion of Nigerian cultural heritage. The research contributes to the understanding of the complex relationship between globalization and cultural heritage and provides recommendations for sustainable cultural heritage management in Nigeria. Some of the recommendations include promoting cultural exchange and collaboration, strengthening cultural education and awareness programs, and establishing collaborative frameworks among stakeholders.

Objective To describe antibiotic prescribing practices using the WHO AWaRe (Access, Watch, Reserve) classification in West African children under 5 years of age attending public primary health centres (PHCs).Design Cross-sectional study.Setting The AIRE project implemented the systematic use of pulse oximetry into integrated management of childhood illness consultations in West African countries (Burkina Faso, Guinea, Mali and Niger). We described antibiotic prescriptions for outpatient children at 16 PHCs and for severe cases referred at district hospitals.Patients Between 14 June 2021 and 19 June 2022, 15 854 outpatients were included: 968 neonates and young infants (0–28 days) and 14 886 children (2–59 months). Among them, 78 (8.1%) neonates and young infants and 385 (2.6%) children were hospitalised. We evaluated 58 hospitalised neonates and young infants and 275 hospitalised children, respectively.Main outcome measures Frequency of antibiotic prescriptions according to the AWaRe classification recommended by WHO.Results At the PHC level, proportions of neonates and young infants with ≥1 antibiotic prescription were 83%, 62%, 71% and 59% in Burkina Faso, Guinea, Mali and Niger, respectively. A total of 805 antibiotics were prescribed (85% Access and 13% Watch). The proportions of children with ≥1 antibiotic prescription reached 71%, 66%, 63% and 36% in Burkina Faso, Guinea, Mali and Niger, respectively. Out of the 9630 antibiotics prescribed, 93% were Access (mainly amoxicillin), and 7% Watch. At the hospital level, Watch antibiotics were mainly prescribed for severe cases referred. No Reserve antibiotics were prescribed.Conclusions High proportions of antibiotics were prescribed to outpatient children included, the appropriateness of which needs further study. Nevertheless, in every country, the proportion prescribed in the Access group reached the minimum threshold of 60% of all antibiotic prescriptions, as recommended by WHO.Trial registration number PACTR202206525204526.

Despite a significant reduction in the burden of malaria in children under five years-old, the efficient implementation of seasonal malaria chemoprevention (SMC) at large scale remains a major concern in areas with long malaria transmission. Low coverage rate in the unattainable areas during the rainy season, a shift in the risk of malaria to older children and the rebound in malaria incidence after stopping drug administration are mainly reported in these areas. These gaps represent a major challenge in the efficient implementation of SMC measures. An open randomized study was conducted to assess the effect of a fifth additional round to current regime of SMC in older children living in Dangassa, a rural malaria endemic area. Poisson regression Model was used to estimate the reduction in malaria incidence in the intervention group compared to the control group including age groups (5-9 and 10-14 years) and the use of long-lasting insecticidal nets (LLINs; Yes or No) with a threshold at 5%. Overall, a downward trend in participation rate was observed from August (94.3%) to November (87.2%). In November (round 4), the risk of malaria incidence was similar in both groups (IRR = 0.66, 95%CI [0.35-1.22]). In December (round 5), a decrease of 51% in malaria incidence was observed in intervention group compared to control group adjusted for age groups and the use of LLINs (IRR = 0.49, 95%CI [0.26-0.94]), of which 17% of reduction is attributable to the 5th round in the intervention group. An additional fifth round of SMC resulted in a significant reduction of malaria incidence in the intervention group. The number of SMC rounds could be adapted to the local condition of malaria transmission.

Anthropogenic emissions are the result of many different economic sectors, including transportation, power generation, industrial, residential and commercial activities, waste treatment and agricultural practices. Air quality models are used to forecast the atmospheric composition, analyze observations and reconstruct the chemical composition of the atmosphere during the previous decades. In order to drive these models, gridded emissions of all compounds need to be provided. This paper describes a new global inventory of emissions called CAMS-GLOB-ANT, developed as part of the Copernicus Atmosphere Monitoring Service (CAMS; https://doi.org/10.24380/eets-qd81, Soulie et al., 2023). The inventory provides monthly averages of the global emissions of 36 compounds, including the main air pollutants and greenhouse gases, at a spatial resolution of 0.1° × 0.1° in latitude and longitude, for 17 emission sectors. The methodology to generate the emissions for the 2000–2023 period is explained, and the datasets are analyzed and compared with publicly available global and regional inventories for selected world regions. Depending on the species and regions, good agreements as well as significant differences are highlighted, which can be further explained through an analysis of different sectors as shown in the figures in the Supplement.

Abstract Introduction Although an essential frontline service in the prevention of child morbidity and mortality, there are indications that routine vaccinations have been disrupted during the COVID-19 pandemic. The present study aimed to compare vaccination coverage before COVID-19 in Mali in 2019 and during COVID-19 in 2020. Objective To compare vaccination coverages before COVID-19 in Mali in 2019 and during COVID-19 in 2020. Design Cross-sectional study. Setting and participants We collected routine immunization data from 2019 to 2020 of children under one year in the health district of Commune V in Bamako which includes twelve community health centers (CSCom). Results Considering all vaccines together, coverage in 2019 was higher than in 2020 (88.7% vs. 71,6%) (p

Malaria is the leading cause of morbidity among children under five years of age and pregnant women in Côte d’Ivoire. We assessed the geographical distribution of its risk in all climatic zones of the country based on the Fifth Assessment Report (AR5) of the United Nations Intergovernmental Panel on Climate Change (IPCC) approach to climate risk analysis. This methodology considers three main driving components affecting the risk: Hazard, exposure and vulnerability. Considering the malaria impact chain, various variables were identified for each of the risk factors and for each variable, a measurable indicator was identified. These indicators were then standardized, weighted through a participatory approach based on expert judgement and finally aggregated to calculate current and future risk. With regard to the four climatic zones in the country: Attieen (sub-equatorial regime) in the South, Baouleen (humid tropical) in the centre, Sudanese or equatorial (tropical transition regime) in the North and the mountainous (humid) in the West. Malaria risk among pregnant women and children under 5 was found to be higher in the mountainous and the Baouleen climate, with the hazard highest in the mountainous climate and Exposure very high in the Attieen climate. The most vulnerable districts were those in Baouleen, Attieen and the mountainous climates. By 2050, the IPCC representative concentration pathway (RCP) 4.5 and 8.5 scenarios predict an increase in risk in almost all climatic zones, compared to current levels, with the former considering a moderate scenario, with an emissions peak around 2040 followed by a decline and RCP 8.5 giving the highest baseline emissions scenario, in which emissions continue to rise. It is expected that the AR5 approach to climate risk analysis will be increasingly used in climate risk assessment studies so that it can be better assessed at a variety of scales.

Introduction African cities, particularly Abidjan and Johannesburg, face challenges of rapid urban growth, informality and strained health services, compounded by increasing temperatures due to climate change. This study aims to understand the complexities of heat-related health impacts in these cities. The objectives are: (1) mapping intraurban heat risk and exposure using health, socioeconomic, climate and satellite imagery data; (2) creating a stratified heat–health forecast model to predict adverse health outcomes; and (3) establishing an early warning system for timely heatwave alerts. The ultimate goal is to foster climate-resilient African cities, protecting disproportionately affected populations from heat hazards.Methods and analysis The research will acquire health-related datasets from eligible adult clinical trials or cohort studies conducted in Johannesburg and Abidjan between 2000 and 2022. Additional data will be collected, including socioeconomic, climate datasets and satellite imagery. These resources will aid in mapping heat hazards and quantifying heat–health exposure, the extent of elevated risk and morbidity. Outcomes will be determined using advanced data analysis methods, including statistical evaluation, machine learning and deep learning techniques.Ethics and dissemination The study has been approved by the Wits Human Research Ethics Committee (reference no: 220606). Data management will follow approved procedures. The results will be disseminated through workshops, community forums, conferences and publications. Data deposition and curation plans will be established in line with ethical and safety considerations.

Sexual violence is a global issue facing countries around the world. However, this problem is more prevalent in countries that have experienced protracted conflict. The present study explored the complex relationship between date rape attitudes, rape myths, and sexual violence using data from Ivory Coast. Two hundred college students from one of the major cities in Ivory Coast were invited to participate in the study through a convenience sampling approach. The results revealed rape myths acceptance influence date rape attitudes but date rape attitudes did not influence rape myths. Also, sexual harassment, age, gender, and religion influenced rape myths acceptance. Our findings do not only serve as a springboard for a policy or program development to create awareness about the negative effects of upholding false beliefs about rape but also, serve as a perfect starting point to reduce bad attitudes toward rape and its victims on campus.

Résumé : La présente étude vise à présenter sociologiquement et linguistiquement une langue qui, jusqu’à présent n’a pas été étudiée : le gbandjé. En effet, cette langue, située au nord de la Côte d’Ivoire, à la frontière avec le Mali, fait partie des langues en danger et qui n’ont pas encore été l’objet d’une étude descriptive ou sociolinguistique. Une langue en danger dont la constitution des ressources documentaires s’avère capitale pour la recherche scientifique la préservation et la promotion de patrimoine linguistique et culturel de la Côte d’Ivoire. Mots-clés : Gbandjé, langue en danger, sociolinguistique, linguistique.

BackgroundAttractive targeted sugar baits (ATSBs) are a promising new tool for malaria control as they can target outdoor-feeding mosquito populations, in contrast to current vector control tools which predominantly target indoor-feeding mosquitoes.MethodsIt was sought to estimate the potential impact of these new tools on Plasmodium falciparum malaria prevalence in African settings by combining data from a recent entomological field trial of ATSBs undertaken in Mali with mathematical models of malaria transmission. The key parameter determining impact on the mosquito population is the excess mortality due to ATSBs, which is estimated from the observed reduction in mosquito catch numbers. A mathematical model capturing the life cycle of P. falciparum malaria in mosquitoes and humans and incorporating the excess mortality was used to estimate the potential epidemiological effect of ATSBs.ResultsThe entomological study showed a significant reduction of ~ 57% (95% CI 33-72%) in mosquito catch numbers, and a larger reduction of ~ 89% (95% CI 75-100%) in the entomological inoculation rate due to the fact that, in the presence of ATSBs, most mosquitoes do not live long enough to transmit malaria. The excess mortality due to ATSBs was estimated to be lower (mean 0.09 per mosquito per day, seasonal range 0.07-0.11 per day) than the bait feeding rate obtained from one-day staining tests (mean 0.34 per mosquito per day, seasonal range 0.28-0.38 per day).ConclusionsFrom epidemiological modelling, it was predicted that ATSBs could result in large reductions (> 30% annually) in prevalence and clinical incidence of malaria, even in regions with an existing high malaria burden. These results suggest that this new tool could provide a promising addition to existing vector control tools and result in significant reductions in malaria burden across a range of malaria-endemic settings.