A cluster-randomized trial of mass drug administration with a gametocytocidal drug combination to interrupt malaria transmission in a low endemic area in Tanzania

Autor: Teun Bousema, Alutu Masokoto, Lucy C Okell, Chris Drakeley, Salimu Semvua, Rob Hermsen, Robert W. Sauerwein, Sven van den Bosch, Seif Shekalaghe, Karina Teelen, Charles Mwanziva, Roly Gosling, Roel ter Braak, Frank W. Mosha, Wouter van den Bijllaardt
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Male
Primaquine
Endemic Diseases
medicine.medical_treatment
Artesunate
Parasitemia
Tanzania
Placebos
chemistry.chemical_compound
0302 clinical medicine
1108 Medical Microbiology
Medicine
030212 general & internal medicine
Child
Aged
80 and over
Microscopy
biology
Middle Aged
Artemisinins
3. Good health
Drug Combinations
Infectious Diseases
Pyrimethamine
Treatment Outcome
Child
Preschool
Drug Therapy
Combination
Female
medicine.drug
Adult
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
Adolescent
Sulfadoxine
lcsh:RC955-962
030231 tropical medicine
lcsh:Infectious and parasitic diseases
03 medical and health sciences
Antimalarials
Young Adult
Internal medicine
Tropical Medicine
parasitic diseases
Humans
lcsh:RC109-216
Mass drug administration
Aged
business.industry
Research
Infant
Pathogenesis and modulation of inflammation Infection and autoimmunity [N4i 1]
medicine.disease
biology.organism_classification
Malaria
chemistry
Immunology
Parasitology
business
Zdroj: Malaria Journal, Vol 10, Iss 1, p 247 (2011)
Malaria Journal, 10, 247-247
Malaria Journal, 10, pp. 247-247
Malaria Journal
ISSN: 1475-2875
Popis: Background Effective mass drug administration (MDA) with anti-malarial drugs can clear the human infectious reservoir for malaria and thereby interrupt malaria transmission. The likelihood of success of MDA depends on the intensity and seasonality of malaria transmission, the efficacy of the intervention in rapidly clearing all malaria parasite stages and the degree to which symptomatic and asymptomatic parasite carriers participate in the intervention. The impact of MDA with the gametocytocidal drug combination sulphadoxine-pyrimethamine (SP) plus artesunate (AS) plus primaquine (PQ, single dose 0.75 mg/kg) on malaria transmission was determined in an area of very low and seasonal malaria transmission in northern Tanzania. Methods In a cluster-randomized trial in four villages in Lower Moshi, Tanzania, eight clusters (1,110 individuals; cluster size 47- 209) were randomized to observed treatment with SP+AS+PQ and eight clusters (2,347 individuals, cluster size 55- 737) to treatment with placebo over three days. Intervention and control clusters were 1km apart; households that were located between clusters were treated as buffer zones where all individuals received SP+AS+PQ but were not selected for the evaluation. Passive case detection was done for the entire cohort and active case detection in 149 children aged 1-10 year from the intervention arm and 143 from the control arm. Four cross-sectional surveys assessed parasite carriage by microscopy and molecular methods during a five-month follow-up period. Results The coverage rate in the intervention arm was 93.0% (1,117/1,201). Parasite prevalence by molecular detection methods was 2.2-2.7% prior to the intervention and undetectable during follow-up in both the control and intervention clusters. None of the slides collected during cross-sectional surveys had microscopically detectable parasite densities. Three clinical malaria episodes occurred in the intervention (n = 1) and control clusters (n = 2). Conclusions This study illustrates the possibility to achieve high coverage with a three-day intervention but also the difficulty in defining suitable outcome measures to evaluate interventions in areas of very low malaria transmission intensity. The decline in transmission intensity prior to the intervention made it impossible to assess the impact of MDA in the chosen study setting. Trial Registration ClinicalTrials.gov: NCT00509015
Databáze: OpenAIRE
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