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 three-arm, open-label, single-blind, randomized controlled trial to compare the efficacy of IPTsc with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) or dihydroartemisinin-piperaquine (DP) compared to control (standard care) 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.