An evolutionary game model of individual choices and bed net use: elucidating key aspect in malaria elimination strategies.

Insecticide-treated net (ITN) is the most applicable and cost-effective malaria intervention measure in sub-Saharan Africa and elsewhere. Although ITNs have been widely distributed to malaria-endemic regions in the past, their success has been threatened by misuses (in fishing, agriculture etc.) and decay in ITN efficacy. Decision-making in using the ITNs depends on multiple coevolving factors: malaria prevalence, mosquito density, ITN availability and its efficacy, and other socio-economic determinants. While ITN misuse increases as the efficacy of ITNs declines, high efficacy also impedes proper use due to free-riding. This irrational usage leads to increased malaria prevalence, thereby worsening malaria control efforts. It also remains unclear if the optimum ITN use for malaria elimination can be achieved under such an adaptive social learning process. Here, we incorporate evolutionary game theory into a disease transmission model to demonstrate these behavioural interactions and their impact on malaria prevalence. We show that social optimum usage is a function of transmission potential, ITN efficacy and mosquito demography. Under specific parameter regimes, our model exhibits patterns of ITN usage similar to observed data from parts of Africa. Our study suggests that the provision of financial incentives as prompt feedback to improper ITN use can reduce misuse and contribute positively towards malaria elimination efforts in Africa and elsewhere.