Controlling malaria in a population accessing counterfeit antimalarial drugs

A mathematical model is developed for describing malaria transmission in a population consisting of infants and adults and in which there are users of counterfeit antimalarial drugs. Three distinct control mechanisms, namely, effective malarial drugs for treatment and insecticide-treated bednets (ITNs) and indoor residual spraying (IRS) for prevention, are incorporated in the model which is then analyzed to gain an understanding of the disease dynamics in the population and to identify the optimal control strategy. We show that the basic reproduction number, R₀, is a decreasing function of all three controls and that a locally asymptotically stable disease-free equilibrium exists when R₀ < 1. Moreover, under certain circumstances, the model exhibits backward bifurcation. The results we establish support a multi-control strategy in which either a combination of ITNs, IRS and highly effective drugs or a combination of IRS and highly effective drugs is used as the optimal strategy for controlling and eliminating malaria. In addition, our analysis indicates that the control strategies primarily benefit the infant population and further reveals that a high use of counterfeit drugs and low recrudescence can compromise the optimal strategy.