Optimizing public health strategies in low-income countries: epidemiology, ecology and evolution for the control of malaria

Abstract

During the 20th century, health inequalities among countries have increased. Several factors explain this pattern, such as immunization and massive antibiotherapy, but nutrition, housing and hygiene are key parameters for health improvement. This heterogeneity among countries is well illustrated by malaria, although disappeared from many high-income countries, is still endemic and prevalent in low- and middle-income countries. We question these differences and detail the recommendations proposed by the World Health Organization to tackle malaria. We investigate the optimal combination of actions to deploy in resource-limited countries and the best spatio-temporal window to target. We propose a new framework for health program management based on evolutionary biology approaches to tailor global programs, to improve their local efficiency and avoid resistance. Thus, we explore all components of the ecological niche of the parasite (human, vector and environment) and consider the magnitude of actions to deploy to reach its local.