Closing the Malaria Prevention Gap: Measuring and Characterizing Human Behavioral Drivers of Persistent Malaria Transmission in Sub-Saharan Africa

Malaria kills a person nearly every minute, most often a child under the age of five. While endemic in many parts of the world, a disproportionate burden of cases and deaths are borne by people living in sub-Saharan Africa. Malaria is transmitted by the female Anopheles mosquito and ongoing transmission is a direct result of the overlap between human and vector behavior, and intervention presence and use. Significant gains have been achieved, with insecticide-treated nets (ITNs) accounting for an estimated two-thirds of the reduction in malaria burden over the past two decades. However, progress has begun to stall in recent years highlighting the importance of enhanced malaria prevention efforts. The aim of this thesis is to identify opportunities to improve malaria prevention in sub-Saharan Africa by optimizing ITN access and use and identifying prevention gaps that can remain once high coverage of core vector control interventions has been achieved. This aim was realized through a range of methodological approaches, including a systematic review of the published literature, secondary analysis of large-scale survey data from ten countries in sub-Saharan Africa, primary research utilizing quantitative and qualitative methods, and development of a standardized approach for measuring human exposure to malaria vectors. This work will help to inform effective targeting of core and complementary vector control tools and social and behavior change strategies.