Date Published: January 06, 2018
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Lauren M. Cohee, Moses Chilombe, Andrew Ngwira, Samuel K. Jemu, Don P. Mathanga, Miriam K. Laufer.
Malaria and neglected tropical diseases (NTDs), including schistosomiasis and soil transmitted helminths, threaten the health of school aged in sub-Saharan Africa. Established school-based mass drug administration (MDA) programs are used to control NTDs. Recent clinical trials have shown benefit of mass treatment of malaria in schools. The potential of adding malaria treatment to existing NTD programs has not been thoroughly evaluated. We offered malaria treatment with artemether-lumefantrine during routine NTD MDA and developed peer education programs in two primary schools in southern Malawi. We assessed participation, safety, and tolerability of coadministration of artemether-lumefantrine with praziquantel and albendazole. Results were compared with two schools conducting standard NTD MDA with additional monitoring by study staff. A total of 3,387 students (68%) received the standard NTD MDA. Among parents who came to schools on the day of the MDA, malaria treatment was well accepted; 87% of students who received the standard NTD MDA in intervention schools also consented for treatment with artemether-lumefantrine. The most frequent treatment emergent adverse events (AEs) were headache and vomiting. However, AEs were rare and were not more frequent in students who received artemether-lumefantrine in addition to praziquantel and albendazole. In this study, we found that the addition of malaria treatment to NTD MDA is well-received and safe. Such integrated programs may leverage existing infrastructures to reduce intervention costs and could become the framework for further integrated school-based health programs.
In Malawi, as in many other sub-Saharan African countries, school-age children bear a heavy burden of infection and morbidity due to neglected tropical diseases (NTDs) and malaria.1–4 NTDs and malaria impact the health of this population leading to anemia and lower educational attainment.5–10 A key component of current NTD control policy is at least annual preventive chemotherapy distributed through school-based mass drug administration (MDA).11,12 By contrast, current malaria control interventions do not specifically target school-age children despite increasing evidence that school-age children bear the highest burden of infection among all age groups.13–15 Clinical trials have shown benefits of school-based mass treatment of malaria, including decreased Plasmodium falciparum prevalence, incidence of clinical malaria, and prevalence of anemia.8,16–21
A total of 4,361 students were listed on MDA registers at the four schools before initiation of the study. Attendance surveys before the intervention and on the day of the MDA identified 614 students previously not listed on the school registers. These students were added to the registers yielding a total of 4,976 students on the final registers. Among these, 3,387 students (68%) attended school during the MDA and received the standard NTD treatment.
This study supports the potential for and safety of combining malaria treatment and standard school-based MDA for NTDs. Provision of artemether-lumefantrine following routine praziquantel and albendazole was well-received by parents and was well-tolerated and safe. Although offering malaria treatment did not increase coverage of the standard NTD MDA in the context of a research study, combining malaria treatment with already established platforms for NTD control may increase the cost-effectiveness of both interventions, leading to increased sustainability. Thus, the combination of interventions is an appealing model.