Project Details

Preventing malaria in school children to protect the whole community

Lauren Cohee, MD, MS

Summary

BACKGROUND: Malaria, the disease caused by the parasite Plasmodium falciparum (Pf), remains a leading cause of morbidity and mortality among children under five years of age in sub-Saharan Africa, but school-age children also suffer an underappreciated burden of malaria that negatively impacts their health and educational outcomes as well as serves as a critical reservoir of human-to-mosquito infection thereby perpetuating malaria transmission. GAP: In April 2022, the World Health Organization released guidance on expanding the use of intermittent preventive treatment (IPT) of malaria, which has been used to decrease malaria in other high-risk populations, to include school-age children (IPTsc). However, two key gaps in knowledge hinder implementation of IPTsc: 1) given the threat of emerging drug resistance to first-line antimalarials, which drugs should be used for IPTsc? and 2) does IPTsc decrease community-level transmission, thus providing indirect protection to younger children who are at higher risk of malaria morbidity and mortality? HYPOTHESIS: Hypothesis 1: IPTsc using sulfadoxine-pyrimethamine plus amodiaquine (SPAQ), chloroquine plus sulfadoxine-pyrimethamine (CQSP), or dihydroartemisinin-piperaquine (DP) reduces Pf infection, clinical malaria, and anemia in schoolchildren compared to control. Hypothesis 2: Because school-age children are the primary reservoirs of Pf infection, young children living in households with children who receive IPTsc will have a lower the prevalence of Pf infection than young children who live in households with schoolchildren who do not receive IPTsc. METHODS: We will enroll primary school students in rural Malawi in a four-arm, open-label, single-blind, randomized controlled trial to compare the efficacy of IPTsc with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ), chloroquine plus sulfadoxine-pyrimethamine (CQSP), or dihydroartemisinin-piperaquine (DP) to decrease Pf infection (primary outcome), clinical malaria and anemia in enrolled students, as well as Pf infection and clinical malaria in their siblings under 5 years old. RESULTS: Pending. IMPACT: Health policy makers in Malawi and throughout Africa will be able to make evidenced-based decisions on which antimalarial drug regimens are effective for IPTsc and how to prioritize ITPsc among malaria control interventions.