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Effect of malaria chemoprevention for school-age children across transmission archetypes: a modelling study
Joshua Suresh1, Marita Zimmermann1, Catherine Maiteki2
1Institute for Disease Modeling, Gates Foundation, Seattle, WA, USA.
Insights
Intermittent preventive treatment (IPT) in school-aged children significantly reduces malaria cases and transmission. This strategy, when combined with existing tools, offers substantial community benefits, particularly in reducing Plasmodium falciparum spread.
Area of Science:
- Malariology
- Public Health
- Epidemiology
Background:
- School-aged children are a significant reservoir for Plasmodium falciparum transmission.
- Intermittent preventive treatment (IPT) in this age group reduces malaria incidence, anemia, and clinical cases.
- Understanding the impact of IPT on broader community transmission is crucial for malaria control.
Purpose of the Study:
- To estimate the effect of IPT in school-aged children on Plasmodium falciparum transmission to younger children and adults.
- To compare the effectiveness of different antimalarial drugs and delivery strategies for IPT.
- To assess the impact of IPT across diverse epidemiological settings in Africa.
Main Methods:
- Utilized an established malaria transmission model with three African epidemiological archetypes (Sahelian, Central, Southern).
- Modeled IPT of school-aged children with varying drug options (dihydroartemisinin-piperaquine, artesunate-amodiaquine, sulfadoxine-pyrimethamine-amodiaquine) and delivery methods (school-based, community-based).
- Included long-lasting insecticide-treated nets and clinical case management as baseline interventions, estimating clinical cases averted.
Main Results:
- Frequent administration of long-acting drugs (monthly dihydroartemisinin-piperaquine) averted 70-90% of cases in school-aged children and 20-60% in other age groups.
- Less frequent or shorter-acting drug regimens averted 40-60% of cases in school-aged children and 15-50% in others.
- Greater community benefits were observed at lower transmission levels (PfPR2-10: 5-10%).
Conclusions:
- Adding IPT for school-aged children to existing malaria control strategies can significantly decrease the malaria burden in this population.
- IPT in school-aged children is a viable strategy to reduce overall Plasmodium falciparum transmission within communities.
- The effectiveness of IPT varies depending on drug choice, administration frequency, and local transmission intensity.
Background:
Intermittent preventive treatment (IPT) of school-aged children with antimalarial drugs decreases rates of infection, anaemia, and clinical malaria. Since school-aged children are a major transmission reservoir, we estimated the effect of IPT for this group on Plasmodium falciparum transmission to younger children and adults across three epidemiological settings.
Methods:
With the use of an established malaria transmission model, we developed three epidemiological archetypes (Sahelian, Central, and Southern African) and estimated the effect of IPT of school-age children across transmission levels (P falciparum parasite rate in children aged 2-10 years [PfPR2-10]: 5-40%). Long-lasting insecticide-treated nets and clinical case management were always included as baseline interventions. We compared scenarios for three of the most widely studied drug options (dihydroartemisinin-piperaquine, artesunate-amodiaquine, and sulfadoxine-pyrimethamine-amodiaquine) and delivery options (school-based or community-based), estimating clinical cases averted.
Findings:
When long-acting drugs were administered frequently (monthly campaigns with dihydroartemisinin-piperaquine), modelled IPT of school-age children averted 70-90% of cases in school-aged children (up to about 2·0 cases per child per year) and 20-60% of cases in younger children and adults (up to about 0·5 cases per person per year), with greater community benefit at lower transmission levels (PfPR2-10 5-10%). Shorter-acting drugs (sulfadoxine-pyrimethamine-amodiaquine in the Sahelian archetype or artesunate-amodiaquine in the Central and Southern archetypes) administered monthly or longer-acting drugs administered once per school term averted 40-60% of cases in school-aged children (up to about 1·3 cases per child per year) and 15-50% of cases in other ages (up to about 0·5 cases per person per year).
Interpretation:
Our model suggests that adding IPT of school-age children to current control tools could decrease malaria burden in this group and reduce P falciparum transmission.
Funding:
US National Institutes of Health, Doris Duke Clinical Scientist Development Award.
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