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

Malaria Journal

Research

Roly Gosling¹  Chris Drakeley¹  Karina Teelen²  Robert Sauerwein²  Wouter van den Bijllaardt²  Sven van den Bosch²  Rob Hermsen²  Roel ter Braak²  Teun Bousema³  Frank Mosha⁴  Charles Mwanziva⁴  Alutu Masokoto⁴  Salimu Semvua⁴  Seif A Shekalaghe⁵  Lucy Okell⁶ 

[1] Department of Immunology & Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;Department of Immunology & Infection; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;Kilimanjaro Christian Medical College-Kilimanjaro Clinical Research Institute, Moshi, Tanzania;Kilimanjaro Christian Medical College-Kilimanjaro Clinical Research Institute, Moshi, Tanzania;Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, Tanzania;MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, UK;

关键词: Malaria;    Malaria Transmission;    Rapid Diagnostic Test;    Transmission Intensity;    Mass Drug Administration;   

DOI  :  10.1186/1475-2875-10-247

 received in 2011-06-10, accepted in 2011-08-24,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundEffective 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.MethodsIn 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 1km 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.ResultsThe 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).ConclusionsThis 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 RegistrationClinicalTrials.gov: NCT00509015

【 授权许可】

CC BY   
© Shekalaghe et al; licensee BioMed Central Ltd. 2011