School-Based Malaria Screening and Treatment Reduces Plasmodium falciparum Infection and Anemia Prevalence in Two Transmission Settings in Malawi.

Abstract

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.

• Authors: Lauren M Cohee, Ingrid Peterson, Andrea G Buchwald, Jenna E Coalson, Clarissa Valim, Moses Chilombe, Andrew Ngwira, Andy Bauleni, Sarah Schaffer-DeRoo, Karl B Seydel, Mark L Wilson, Terrie E Taylor, Don P Mathanga, Miriam K Laufer
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 226 Issue 1 Pg. 138-146 (08 12 2022) ISSN: 1537-6613 [Electronic] United States
• PMID: 35290461 (Publication Type: Clinical Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2022. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Antimalarials
• Artemether, Lumefantrine Drug Combination
• Artemether

Topics

• Anemia (diagnosis, epidemiology, prevention & control)
• Antimalarials (therapeutic use)
• Artemether
• Artemether, Lumefantrine Drug Combination (therapeutic use)
• Child
• Humans
• Malaria (epidemiology)
• Malaria, Falciparum (diagnosis, drug therapy, epidemiology)
• Malawi (epidemiology)
• Plasmodium falciparum
• Prevalence
• Prospective Studies
• Schools