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Reactive, self-administered malaria treatment against asymptomatic malaria infection: results of a cluster randomized controlled trial in The Gambia

Okebe, Joseph ORCID:, Dabira, Edgard, Jaiteh, Fatou, Mohammed, Nuredin, Bradley, John, Drammeh, Ndey-Fatou, Bah, Amadou, Masunaga, Yoriko, Achan, Jane, Muela Ribera, Joan, Yeung, Shunmay, Balen, Julie, Peeters Grietens, Koen and D’Alessandro, Umberto (2021) 'Reactive, self-administered malaria treatment against asymptomatic malaria infection: results of a cluster randomized controlled trial in The Gambia'. Malaria Journal, Vol 20, Issue 253.

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Background: Selectively targeting and treating malaria‑infected individuals may further decrease parasite carriage in low‑burden settings. Using a trans‑disciplinary approach, a reactive treatment strategy to reduce Plasmodium falciparum prevalence in participating communities was co‑developed and tested. Methods: This is a 2‑arm, open‑label, cluster‑randomized trial involving villages in Central Gambia during the 2017 and 2018 malaria transmission season. Villages were randomized in a 1:1 ratio using a minimizing algorithm. In the intervention arm, trained village health workers delivered a full course of pre‑packed dihydroartemisinin‑piperaquine to all residents of compounds where clinical cases were reported while in the control arm, compound residents were screened for infection at the time of the index case reporting. All index cases were treated following national guide‑ lines. The primary endpoint was malaria prevalence, determined by molecular methods, at the end of the intervention period. Results: The trial was carried out in 50 villages: 34 in 2017 and 16 additional villages in 2018. At the end of the 2018 transmission season, malaria prevalence was 0.8% (16/1924, range 0–4%) and 1.1% (20/1814, range 0–17%) in the intervention and control arms, respectively. The odds of malaria infection were 29% lower in the intervention than in the control arm after adjustment for age (OR 0.71, 95% CI 0.27–1.84, p = 0.48). Adherence to treatment was high, with 98% (964/979) of those treated completing the 3‑day treatment. Over the course of the study, only 37 villages, 20 in the intervention and 17 in the control arm, reported at least one clinical case. The distribution of clinical cases by month in both transmission seasons was similar and the odds of new clinical malaria cases during the trial period did not vary between arms (OR 1.04, 95% CI 0.57–1.91, p = 0.893). All adverse events were classified as mild to moderate and resolved completely. Conclusion: The systematic and timely administration of an anti‑malarial treatment to residents of compounds with confirmed malaria cases did not significantly decrease malaria prevalence and incidence in communities where malaria prevalence was already low. Treatment coverage and adherence was very high. Results were strongly influenced by the lower‑than‑expected malaria prevalence, and by no clinical cases in villages with asymptomatic malaria‑infected individuals. Trial registration: This study is registered with, NCT02878200. Registered 25 August 2016.https:// clinicaltrials. gov/ ct2/ show/ NCT02 878200.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 770 Therapy
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Rachel Dominguez
Date Deposited: 08 Jun 2021 11:25
Last Modified: 08 Jun 2021 11:25


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