A controlled, parallel, cluster-randomized trial of community-wide screening and treatment of asymptomatic carriers of Plasmodium falciparum in Burkina Faso

Malaria Journal

Research

Sam Coulibaly¹  Alphonse Ouédraogo¹  Adama Gansané¹  Alfred B Tiono¹  Amidou Diarra¹  Sodiomon B Sirima¹  Bernhards Ogutu²  Amitava Mukhopadhyay³  Gregory O’Neil⁴  Kamal Hamed⁵ 

[1] Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso;Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya;Novartis Healthcare Private Limited, Hyderabad, India;Novartis Pharma AG, Basel, Switzerland;Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA;

关键词: Malaria;    Plasmodium falciparum;    Asymptomatic carriers;    Mass screening;    Transmission;    Artemether-lumefantrine;   

DOI  :  10.1186/1475-2875-12-79

 received in 2013-01-14, accepted in 2013-02-23,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundIn malaria-endemic countries, large proportions of infected individuals are asymptomatic, constituting a reservoir of parasites for infection of newly hatched mosquitoes. This study evaluated the impact of screening and treatment of asymptomatic carriers of Plasmodium falciparum.MethodsEighteen villages were randomized (1:1) to study arms and inhabitants participated in four community screening campaigns: three before the rainy season ~1 month apart, and the fourth after the rains at ~12 months. On day 1 of campaigns 1–3, asymptomatic carriers in the intervention arm were identified by rapid diagnostic test and treated with artemether-lumefantrine. Outcomes were symptomatic malaria with parasite density >5,000/μL per person-year in children <5 years and change in haemoglobin between days 1 and 28 of campaign 1.ResultsAt 12 months, the number of symptomatic malaria episodes with a parasite density >5,000/μL per person-year in children <5 years was not significantly different between arms (1.69 vs 1.60, p = 0.3482). Mean haemoglobin change in asymptomatic carriers during campaign 1 was greater in the intervention vs control arm (+0.53 g/dL vs -0.21 g/dL, p <0.0001). ANCOVA demonstrated that mean asymptomatic carriage at the cluster level was lower in the intervention vs control arm at day 1 of campaigns 2 (5.0% vs 34.9%, p <0.0001) and 3 (3.5% vs 31.5%, p <0.0001), but showed only a small difference at day 1 of campaign 4 (34.6% vs 37.6%, p = 0.2982). Mean gametocyte carriage was lower in the intervention vs control arm at day 1 of campaigns 2 and 3 (0.7% vs 5.4%, p <0.0001; 0.5% vs 5.8%, p <0.0001), but was similar at day 1 of campaign 4 (4.9% vs 5.1%, p = 0.7208).ConclusionsSystematic screening and treatment of asymptomatic carriers at the community level did not reduce clinical malaria incidence in the subsequent transmission season, indicating greater levels of parasite clearance are required to achieve a sustained impact in this setting.

【 授权许可】

CC BY   
© Tiono et al.; licensee BioMed Central Ltd. 2013