A cluster-randomized trial of mass drug administration with a gametocytocidal drug combination to interrupt malaria transmission in a low endemic area in Tanzania.

Title: A cluster-randomized trial of mass drug administration with a gametocytocidal drug combination to interrupt malaria transmission in a low endemic area in Tanzania.
Author(s): Shekalaghe, SA
Drakeley, C
Van den Bosch, S
Ter Braak, R
Van den Bijllaardt, W
Mwanziva, C
Semvua, S
Masokoto, A
Mosha, F
Teelen, K
Hermsen, R
Okell, L
Gosling, R
Sauerwein, R
Bousema, T
Item Type: Journal Article
Abstract: BACKGROUND: Effective mass drug administration (MDA) with anti-malarial drugs can clear the human infectious reservoir for malaria and thereby interrupt malaria transmission. The likelihood of success of MDA depends on the intensity and seasonality of malaria transmission, the efficacy of the intervention in rapidly clearing all malaria parasite stages and the degree to which symptomatic and asymptomatic parasite carriers participate in the intervention. The impact of MDA with the gametocytocidal drug combination sulphadoxine-pyrimethamine (SP) plus artesunate (AS) plus primaquine (PQ, single dose 0.75 mg/kg) on malaria transmission was determined in an area of very low and seasonal malaria transmission in northern Tanzania. METHODS: In a cluster-randomized trial in four villages in Lower Moshi, Tanzania, eight clusters (1,110 individuals; cluster size 47- 209) were randomized to observed treatment with SP+AS+PQ and eight clusters (2,347 individuals, cluster size 55- 737) to treatment with placebo over three days. Intervention and control clusters were 1 km apart; households that were located between clusters were treated as buffer zones where all individuals received SP+AS+PQ but were not selected for the evaluation. Passive case detection was done for the entire cohort and active case detection in 149 children aged 1-10 year from the intervention arm and 143 from the control arm. Four cross-sectional surveys assessed parasite carriage by microscopy and molecular methods during a five-month follow-up period. RESULTS: The coverage rate in the intervention arm was 93.0% (1,117/1,201). Parasite prevalence by molecular detection methods was 2.2-2.7% prior to the intervention and undetectable during follow-up in both the control and intervention clusters. None of the slides collected during cross-sectional surveys had microscopically detectable parasite densities. Three clinical malaria episodes occurred in the intervention (n = 1) and control clusters (n = 2). CONCLUSIONS: This study illustrates the possibility to achieve high coverage with a three-day intervention but also the difficulty in defining suitable outcome measures to evaluate interventions in areas of very low malaria transmission intensity. The decline in transmission intensity prior to the intervention made it impossible to assess the impact of MDA in the chosen study setting. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00509015.
Publication Date: 24-Aug-2011
Date of Acceptance: 24-Aug-2011
URI: http://hdl.handle.net/10044/1/56143
DOI: https://dx.doi.org/10.1186/1475-2875-10-247
Start Page: 247
Journal / Book Title: Malar J
Volume: 10
Copyright Statement: © 2011 Shekalaghe et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Adolescent
Adult
Aged
Aged, 80 and over
Antimalarials
Artemisinins
Child
Child, Preschool
Drug Combinations
Drug Therapy, Combination
Endemic Diseases
Female
Humans
Infant
Malaria
Male
Microscopy
Middle Aged
Parasitemia
Placebos
Primaquine
Pyrimethamine
Sulfadoxine
Tanzania
Treatment Outcome
Young Adult
Humans
Parasitemia
Malaria
Sulfadoxine
Artemisinins
Pyrimethamine
Primaquine
Drug Combinations
Placebos
Antimalarials
Microscopy
Treatment Outcome
Drug Therapy, Combination
Endemic Diseases
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Child
Child, Preschool
Infant
Tanzania
Female
Male
Young Adult
1108 Medical Microbiology
Tropical Medicine
Publication Status: Published online
Conference Place: England
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



Items in Spiral are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commons