Clinical epidemiology of malaria related morbidities among school-aged children in Tanzania: A focus on Impact of Intermittent preventive treatment of malaria in school children
Project summary
In endemic areas, malaria accounts for around 50% of the mortality and 13-50% of all school absenteeism in school aged children. About 85 million school-aged children of sub Saharan Africa are affected by malaria related anaemia which impairs their cognitive development. In high transmission settings, up to 70% of school-aged children harbour malaria parasites without showing any clinical symptoms. Thus, epidemiologically, school aged children contribute substantial reservoir for malaria transmission and therefore undermining the effectiveness of control programmes such as bed nets. Intermittent preventive treatment (IPT) of pregnant women as well as seasonal malaria chemoprevention in children under-five years of age have been implemented in several sub-Saharan countries and have proven to be highly effective. However, none of the IPT strategies is targeting school children. A clinical trial [NCT03640403] is being conducted in Muheza, Tanzania to expand the IPT by testing effectiveness and safety of two antimalarial drugs, namely Dihydroartemisinin-piperaquine (DP) and Artesunate-amodiaquine (ASAQ) in preventing malaria related morbidity in school aged children (IPTsc) living in a high endemic area.
The study is a randomized, open label, controlled trial planned to enrol 1602 school children aged 5-15 years, who will receive either DP or ASAQ or control (no drug ), using a “balanced block design” with the “standard of care” arm as reference. The interventional treatments will be given 4 monthly for the first year. A second non-interventional year will assess possible rebound effects. All study arms are coupled with albendazole as mass treatment for helminthiasis and praziquantel which is only given to those with schistosomiasis. The primary endpoints are change in mean haemoglobin from baseline concentration at months 12 and 20 of follow-up and reduction in clinical malaria incidence from month 0 untill month 12 and 20 of follow up. Adverse events are being monitored throughout the study. Mixed design methods will be used to assess the acceptability, cost-effectiveness and feasibility of IPTsc as part of a more comprehensive school children health package.
School aged children are a reachable target population in any endemic malaria setting. The suggested strategy is expected to provide effective protection against malaria, hasten either the elimination process and/or diminish the reservoir and burden.