Malaria in School-Age Children: Defining new interventions to improve health and reduce transmission
Specific Aim 1: To determine the prevalence of malaria infection and the performance of rapid diagnostic tests among children attending school.
Specific Aim 2: To evaluate the contribution of malaria infections in children attending school on transmission of malaria in the surrounding community and determine the impact of treating these infections with standard malaria treatment on the infectiousness of this population.
Despite increasing availability of control efforts, malaria remains a leading cause of death and illness among children in Malawi and other sub-Saharan African countries. Community-based studies in Malawi indicate that older children (5-15 year olds) have the highest rates of malaria infection and disease. This population has limited access to health care and the lowest use of existing malaria control interventions, because current efforts generally focus on children under five years of age. Untreated malaria infections not only threaten the health of infected children, but also serve as a reservoir of malaria transmission. Our studies show that older children have the highest proportion of malaria infections containing gametocytes, the stage of the malaria parasite required to transmit malaria to mosquitoes and perpetuate the cycle of infection. We hypothesize that by controlling malaria in older children, we will improve their health and reduce malaria transmission in the community.
Children ages 5-15 years are expected to be in school; thus, developing school-based interventions to target this population is appealing. Previous studies evaluating malaria testing and treatment in schools have had mixed results. Several key questions have arisen that are essential to the design of school-based programs that provide the greatest possible benefit to children and their communities. We propose a school-based study to answer these questions and develop an evidence-based clinical trial of interventions in schools.
Cross-sectional surveys in schools will be compared to concurrent community-based surveys. Participants (n=240) will have blood collected for RDT and molecular detection of malaria infection and gametocytes to measure malaria prevalence and transmission potential. Children with positive RDTs will be treated and followed with repeated blood samples to determine the time to assess gametocyte clearance rate and reinfection containing gametocytes. We will establish the positive and negative predictive values of RDTs compared to molecular detection of any malaria and infections containing gametocytes. We will model the efficacy of screening versus mass drug administration interventions to improve health and reduce malaria transmission