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Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial

BACKGROUND: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence of the benefits of alternative school-based malaria interventions or how the impacts of interventions vary ac...

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Autores principales: Halliday, Katherine E., Okello, George, Turner, Elizabeth L., Njagi, Kiambo, Mcharo, Carlos, Kengo, Juddy, Allen, Elizabeth, Dubeck, Margaret M., Jukes, Matthew C. H., Brooker, Simon J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904819/
https://www.ncbi.nlm.nih.gov/pubmed/24492859
http://dx.doi.org/10.1371/journal.pmed.1001594
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author Halliday, Katherine E.
Okello, George
Turner, Elizabeth L.
Njagi, Kiambo
Mcharo, Carlos
Kengo, Juddy
Allen, Elizabeth
Dubeck, Margaret M.
Jukes, Matthew C. H.
Brooker, Simon J.
author_facet Halliday, Katherine E.
Okello, George
Turner, Elizabeth L.
Njagi, Kiambo
Mcharo, Carlos
Kengo, Juddy
Allen, Elizabeth
Dubeck, Margaret M.
Jukes, Matthew C. H.
Brooker, Simon J.
author_sort Halliday, Katherine E.
collection PubMed
description BACKGROUND: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence of the benefits of alternative school-based malaria interventions or how the impacts of interventions vary according to intensity of malaria transmission. We investigated the effect of intermittent screening and treatment (IST) for malaria on the health and education of school children in an area of low to moderate malaria transmission. METHODS AND FINDINGS: A cluster randomised trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010–2012. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up for 24 months. Once a school term, children were screened by public health workers using malaria rapid diagnostic tests (RDTs), and children (with or without malaria symptoms) found to be RDT-positive were treated with a six dose regimen of artemether-lumefantrine (AL). Given the nature of the intervention, the trial was not blinded. The primary outcomes were anaemia and sustained attention. Secondary outcomes were malaria parasitaemia and educational achievement. Data were analysed on an intention-to-treat basis. During the intervention period, an average of 88.3% children in intervention schools were screened at each round, of whom 17.5% were RDT-positive. 80.3% of children in the control and 80.2% in the intervention group were followed-up at 24 months. No impact of the malaria IST intervention was observed for prevalence of anaemia at either 12 or 24 months (adjusted risk ratio [Adj.RR]: 1.03, 95% CI 0.93–1.13, p = 0.621 and Adj.RR: 1.00, 95% CI 0.90–1.11, p = 0.953) respectively, or on prevalence of P. falciparum infection or scores of classroom attention. No effect of IST was observed on educational achievement in the older class, but an apparent negative effect was seen on spelling scores in the younger class at 9 and 24 months and on arithmetic scores at 24 months. CONCLUSION: In this setting in Kenya, IST as implemented in this study is not effective in improving the health or education of school children. Possible reasons for the absence of an impact are the marked geographical heterogeneity in transmission, the rapid rate of reinfection following AL treatment, the variable reliability of RDTs, and the relative contribution of malaria to the aetiology of anaemia in this setting. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT00878007 Please see later in the article for the Editors' Summary
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spelling pubmed-39048192014-01-31 Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial Halliday, Katherine E. Okello, George Turner, Elizabeth L. Njagi, Kiambo Mcharo, Carlos Kengo, Juddy Allen, Elizabeth Dubeck, Margaret M. Jukes, Matthew C. H. Brooker, Simon J. PLoS Med Research Article BACKGROUND: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence of the benefits of alternative school-based malaria interventions or how the impacts of interventions vary according to intensity of malaria transmission. We investigated the effect of intermittent screening and treatment (IST) for malaria on the health and education of school children in an area of low to moderate malaria transmission. METHODS AND FINDINGS: A cluster randomised trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010–2012. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up for 24 months. Once a school term, children were screened by public health workers using malaria rapid diagnostic tests (RDTs), and children (with or without malaria symptoms) found to be RDT-positive were treated with a six dose regimen of artemether-lumefantrine (AL). Given the nature of the intervention, the trial was not blinded. The primary outcomes were anaemia and sustained attention. Secondary outcomes were malaria parasitaemia and educational achievement. Data were analysed on an intention-to-treat basis. During the intervention period, an average of 88.3% children in intervention schools were screened at each round, of whom 17.5% were RDT-positive. 80.3% of children in the control and 80.2% in the intervention group were followed-up at 24 months. No impact of the malaria IST intervention was observed for prevalence of anaemia at either 12 or 24 months (adjusted risk ratio [Adj.RR]: 1.03, 95% CI 0.93–1.13, p = 0.621 and Adj.RR: 1.00, 95% CI 0.90–1.11, p = 0.953) respectively, or on prevalence of P. falciparum infection or scores of classroom attention. No effect of IST was observed on educational achievement in the older class, but an apparent negative effect was seen on spelling scores in the younger class at 9 and 24 months and on arithmetic scores at 24 months. CONCLUSION: In this setting in Kenya, IST as implemented in this study is not effective in improving the health or education of school children. Possible reasons for the absence of an impact are the marked geographical heterogeneity in transmission, the rapid rate of reinfection following AL treatment, the variable reliability of RDTs, and the relative contribution of malaria to the aetiology of anaemia in this setting. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT00878007 Please see later in the article for the Editors' Summary Public Library of Science 2014-01-28 /pmc/articles/PMC3904819/ /pubmed/24492859 http://dx.doi.org/10.1371/journal.pmed.1001594 Text en © 2014 Halliday et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Halliday, Katherine E.
Okello, George
Turner, Elizabeth L.
Njagi, Kiambo
Mcharo, Carlos
Kengo, Juddy
Allen, Elizabeth
Dubeck, Margaret M.
Jukes, Matthew C. H.
Brooker, Simon J.
Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
title Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
title_full Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
title_fullStr Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
title_full_unstemmed Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
title_short Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
title_sort impact of intermittent screening and treatment for malaria among school children in kenya: a cluster randomised trial
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904819/
https://www.ncbi.nlm.nih.gov/pubmed/24492859
http://dx.doi.org/10.1371/journal.pmed.1001594
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