Baby with stethoscope

BOHEMIA (Broad One Health Endectocide-based Malaria Intervention in Africa)



The Broad One Health Endectocide-based Malaria Intervention in Africa (BOHEMIA) project aims to reduce malaria transmission by administering ivermectin to humans and livestock. Ivermectin is an endectocide drug with an excellent safety profile that can kill ecto- and endoparasites, as well as mosquitoes that feed on treated humans or animals.

This five-year project, funded by Unitaid, will conduct a clinical trial within different ecological and epidemiological settings in east and southern Africa, specifically Mozambique and Kenya. Ivermectin will be distributed in mass drug administration campaigns (iMDA) to humans and livestock to reduce mosquito populations that transmit malaria.

This innovative One Health approach also offers an opportunity to prevent neglected tropical diseases in humans, which will positively impact households. Delivery to livestock reduces the burden of intestinal helminths and ectoparasites in domesticated herds, thereby increasing income and food security.

Project Overview

The primary purpose of BOHEMIA is to contribute to the global public health goals for malaria control by developing a complementary strategy for vector control. BOHEMIA will specifically seek to:

  • Generate evidence on the impact of ivermectin MDA on malaria infection in humans, mosquito populations, the environment, and its safety and acceptability by communities.
  • Support policy and translation of ivermectin as a potential vector control strategy for malaria impact.
  • Engage generic drug manufacturers as key partners for malaria intervention.



We developed an analytical tool based on a full factorial experimental design to assess the potential impact of iMDA in nine high burden sub-Saharan African countries. The simulated iMDA regimen was assumed to be delivered monthly to the targeted population for three months each year from 2023 to 2027. A broad set of parameters measuring ivermectin’s efficacy, uptake levels, and global intervention scenarios were used to predict averted malaria cases and deaths. We then explored the potential averted treatment costs, expected implementation costs, and cost-effectiveness ratios under different scenarios. Results in the scenario where coverage of malaria interventions was maintained at 2018 levels, we found that iMDA in these nine countries has the potential to reverse the predicted growth of malaria burden by averting 20–50 million cases and 36, 000–90,000 deaths with an assumed efficacy of 20%. If iMDA has an efficacy of 40%, we predict between 40–99 million cases and 73,000–179,000 deaths will be averted with an estimated net cost per case averted between US$2 and US$7. The net cost per death averted would fall between US$1,460 and US$4,374.

For more findings, see publications.

Selected Publications
Network Systems Science and Advanced Computing
Chaccour C; Casellas A; Hammann F; Ruiz-Castillo P; Nicolas P; Montana J; Mael M; Selvaraj P; Duthaler U; Mrema S; Kakolwa M; Lyimo I; Okumu F; Marathe A; Schurch R; Elobolobo E; Sacoor C; Saute F; Xia K; Jones C; Rist C; Maia M; Rabinovich R . BMC Trials. 2023; 24(128)
Network Systems Science and Advanced Computing
Marathe A; Xie K; Deng X; Mutepa V; Ruiz-Castillo P; Sanz A; Mamudo Sale M; Nicolas P; Martinho S; Montana J; Kiru C; Materula F; Munguambe H; Mael M; Xerinda A; Elobolobo E; Richardson M; Lewis B; Rabinovich R; Chaccour C; Saute F; Rist C . American Society of Tropical Medicine and Hygiene, Annual Meeting. 2022;
Network Systems Science and Advanced Computing
Marathe A; Shi R; Mendez-Lopez A; Hu Z; Lewis B; Rabinovich R; Chaccour C; Rist C . BMJ Global Health. BMJ. 2021; 6(11):e006424


Professor of Public Health Sciences, School of Medicine

Research Associate Professor