PhD defence Gountante Kombate

Supervisors

• Prof. dr. Rick (D.E.) Grobbee (Utrecht University)

• Prof. dr. Marianne (M.A.B.) van der Sande (ITM/Utrecht University)

• Dr. André Soubeiga (Université de Ouagadougou)

Abstract

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 evaluates how these challenges can be addressed from various angles:  assessing integrated vector management (IVM), mapping malaria risks using geospatial methods, and examining behavioural 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. 

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. Care-seeking for febrile illness in children was suboptimal, with significant inequities between regions in Togo. On the other hand, progress in long-lasting insecticidal net ownership and use over the past decade has been notable, although still  below universal coverage targets. Also, we determined that IVM strategies can reduce malaria risk by approximately 42%, whereby the degree of benefit varies by context.

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.