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Observational Study
. 2022 Aug 12;226(1):138-146.
doi: 10.1093/infdis/jiac097.

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

Lauren M Cohee  1 , Ingrid Peterson  1 , Andrea G Buchwald  1 , Jenna E Coalson  2 , Clarissa Valim  3 , Moses Chilombe  4 , Andrew Ngwira  4 , Andy Bauleni  4 , Sarah Schaffer-DeRoo  5 , Karl B Seydel  6 , Mark L Wilson  2 , Terrie E Taylor  6 , Don P Mathanga  4 , Miriam K Laufer  1
Affiliations
Observational Study

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

Lauren M Cohee et al. J Infect Dis. .

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.

Keywords: adolescent; anemia; chemoprevention; intervention; schoolchildren.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Enrollment and follow-up of participants in school-based cohorts. Abbreviation: AL, artemether-lumefantrine.
Figure 2.
Figure 2.
Proportion of Plasmodium falciparum infections stratified by school, treatment status, and detection method. Low, seasonal-transmission schools (Bvumbwe and Ngowe) infections detected by microscopy (A) and polymerase chain reaction (PCR) (C). High-transmission schools (Maseya and Makhuwira) infections detected by microscopy (B) and PCR (D). Treated students, solid lines; untreated students, dashed lines. Error bars are 95% Confidence Intervals.
See this image and copyright information in PMC

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References

    1. World Health Organization (WHO). World malaria report 2019. Geneva: WHO, 2019. https://www.who.int/publications/i/item/9789241565721. Accessed 1 March 2020.
    1. Nankabirwa J, Brooker SJ, Clarke SE, et al. . Malaria in school-age children in Africa: an increasingly important challenge. Trop Med Int Health 2014; 19:1294–309. - PMC - PubMed
    1. Clarke SE, Jukes MC, Njagi JK, et al. . Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial. Lancet 2008; 372:127–38. - PMC - PubMed
    1. Gitonga CW, Edwards T, Karanja PN, Noor AM, Snow RW, Brooker SJ.. Plasmodium infection, anaemia and mosquito net use among school children across different settings in Kenya. Trop Med Int Health 2012; 17:858–70. - PMC - PubMed
    1. Barger B, Maiga H, Traore OB, et al. . Intermittent preventive treatment using artemisinin-based combination therapy reduces malaria morbidity among school-aged children in Mali. Trop Med Int Health 2009; 14:784–91. - PMC - PubMed

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