School-Based Malaria Screening and Treatment Reduces Plasmodium falciparum Infection and Anemia Prevalence in Two Transmission Settings in Malawi.
adolescent
anemia
chemoprevention
intervention
schoolchildren
Journal
The Journal of infectious diseases
ISSN: 1537-6613
Titre abrégé: J Infect Dis
Pays: United States
ID NLM: 0413675
Informations de publication
Date de publication:
12 08 2022
12 08 2022
Historique:
received:
06
01
2022
accepted:
12
03
2022
pubmed:
16
3
2022
medline:
16
8
2022
entrez:
15
3
2022
Statut:
ppublish
Résumé
In areas highly endemic for malaria, Plasmodium falciparum infection prevalence peaks in school-age children, adversely affecting health and education. School-based intermittent preventive treatment reduces this burden but concerns about cost and widespread use of antimalarial drugs limit enthusiasm for this approach. School-based screening and treatment is an attractive alternative. In a prospective cohort study, we evaluated the impact of school-based screening and treatment on the prevalence of P. falciparum infection and anemia in 2 transmission settings. We screened 704 students in 4 Malawian primary schools for P. falciparum infection using rapid diagnostic tests (RDTs), and treated students who tested positive with artemether-lumefantrine. We determined P. falciparum infection by microscopy and quantitative polymerase chain reaction (qPCR), and hemoglobin concentrations over 6 weeks in all students. Prevalence of infection by RDT screening was 37% (9%-64% among schools). An additional 9% of students had infections detected by qPCR. Following the intervention, significant reductions in infections were detected by microscopy (adjusted relative reduction [aRR], 48.8%; P < .0001) and qPCR (aRR, 24.5%; P < .0001), and in anemia prevalence (aRR, 30.8%; P = .003). Intervention impact was reduced by infections not detected by RDT and new infections following treatment. School-based screening and treatment reduced P. falciparum infection and anemia. This approach could be enhanced by repeating screening, using more-sensitive screening tests, and providing longer-acting drugs. NCT04858087.
Sections du résumé
BACKGROUND
In areas highly endemic for malaria, Plasmodium falciparum infection prevalence peaks in school-age children, adversely affecting health and education. School-based intermittent preventive treatment reduces this burden but concerns about cost and widespread use of antimalarial drugs limit enthusiasm for this approach. School-based screening and treatment is an attractive alternative. In a prospective cohort study, we evaluated the impact of school-based screening and treatment on the prevalence of P. falciparum infection and anemia in 2 transmission settings.
METHODS
We screened 704 students in 4 Malawian primary schools for P. falciparum infection using rapid diagnostic tests (RDTs), and treated students who tested positive with artemether-lumefantrine. We determined P. falciparum infection by microscopy and quantitative polymerase chain reaction (qPCR), and hemoglobin concentrations over 6 weeks in all students.
RESULTS
Prevalence of infection by RDT screening was 37% (9%-64% among schools). An additional 9% of students had infections detected by qPCR. Following the intervention, significant reductions in infections were detected by microscopy (adjusted relative reduction [aRR], 48.8%; P < .0001) and qPCR (aRR, 24.5%; P < .0001), and in anemia prevalence (aRR, 30.8%; P = .003). Intervention impact was reduced by infections not detected by RDT and new infections following treatment.
CONCLUSIONS
School-based screening and treatment reduced P. falciparum infection and anemia. This approach could be enhanced by repeating screening, using more-sensitive screening tests, and providing longer-acting drugs.
CLINICAL TRIALS REGISTRATION
NCT04858087.
Identifiants
pubmed: 35290461
pii: 6549047
doi: 10.1093/infdis/jiac097
pmc: PMC9373151
doi:
Substances chimiques
Antimalarials
0
Artemether, Lumefantrine Drug Combination
0
Artemether
C7D6T3H22J
Banques de données
ClinicalTrials.gov
['NCT04858087']
Types de publication
Clinical Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
138-146Subventions
Organisme : NIAID NIH HHS
ID : K23 AI135076
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI114996
Pays : United States
Organisme : NIAID NIH HHS
ID : U19 AI089683
Pays : United States
Organisme : NIH HHS
ID : U19AI089683
Pays : United States
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Déclaration de conflit d'intérêts
Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Références
Clin Infect Dis. 2021 Jun 1;72(11):1927-1935
pubmed: 32324850
N Engl J Med. 2012 Dec 13;367(24):2284-95
pubmed: 23136909
Clin Infect Dis. 2014 May;58(10):1404-12
pubmed: 24621953
Lancet Glob Health. 2020 Dec;8(12):e1499-e1511
pubmed: 33222799
Parasitol Today. 2000 May;16(5):183-6
pubmed: 10782073
Am J Trop Med Hyg. 2021 Jan 04;104(3):1013-1017
pubmed: 33399043
Malar J. 2014 Jan 27;13:30
pubmed: 24467946
Am J Trop Med Hyg. 2013 Jun;88(6):1102-1108
pubmed: 23589533
Lancet. 2008 Jul 12;372(9633):127-138
pubmed: 18620950
Trop Med Int Health. 2012 Jul;17(7):858-70
pubmed: 22574948
Trop Med Int Health. 2009 Jul;14(7):784-91
pubmed: 19497079
Am J Trop Med Hyg. 2016 Aug 3;95(2):373-7
pubmed: 27325802
Trans R Soc Trop Med Hyg. 2003 Nov-Dec;97(6):633-9
pubmed: 16117954
Nat Commun. 2021 Apr 26;12(1):2443
pubmed: 33903595
Nat Commun. 2014 Nov 26;5:5606
pubmed: 25425081
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Soc Sci Med. 2010 Jul;71(2):324-334
pubmed: 20413198
Am J Trop Med Hyg. 2017 Oct;97(4):1190-1197
pubmed: 28722627
Malar J. 2016 Nov 4;15(1):527
pubmed: 27809907
PLoS One. 2010 Oct 19;5(10):e13438
pubmed: 20976051
Malar J. 2015 Dec 30;14:528
pubmed: 26714465
Lancet Glob Health. 2018 Jun;6(6):e668-e679
pubmed: 29661635
Lancet Infect Dis. 2021 Nov;21(11):1568-1578
pubmed: 34146476
Trends Parasitol. 2020 Nov;36(11):906-913
pubmed: 32917511
Nat Commun. 2012;3:1237
pubmed: 23212366
BMJ Glob Health. 2017 Jun 28;2(2):e000182
pubmed: 29081992
Malar J. 2013 May 16;12:163
pubmed: 23680454
PLoS Med. 2014 Jan 28;11(1):e1001594
pubmed: 24492859
J Clin Microbiol. 2019 Aug 26;57(9):
pubmed: 31270184
PLoS One. 2015 Jul 24;10(7):e0134061
pubmed: 26207758
Lancet Infect Dis. 2018 Apr;18(4):e119-e132
pubmed: 29395997
PLoS One. 2015 Sep 15;10(9):e0138362
pubmed: 26371885
Trends Parasitol. 2015 Jul;31(7):287-96
pubmed: 25985898
Am J Trop Med Hyg. 2006 Mar;74(3):386-93
pubmed: 16525095
Trop Med Int Health. 2014 Nov;19(11):1294-309
pubmed: 25145389