Negligible impact of mass screening and treatment on mesoendemic malaria transmission at west timor in eastern Indonesia: A cluster-randomized trial
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Date
2018-10-15
Source Title
Clinical Infectious Diseases
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OXFORD UNIV PRESS INC
Melbourne Authors
Affiliation
Medical Biology (W.E.H.I.)
Document Type
Journal Article
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Sutanto, I., Kosasih, A., Elyazar, I. R. F., Simanjuntak, D. R., Larasati, T. A., Dahlan, M. S., Wahid, I., Mueller, I., Koepfli, C., Kusriastuti, R., Surya, A., Laihad, F. J., Hawley, W. A., Collins, F. H., Baird, J. K. & Lobo, N. F. (2018). Negligible impact of mass screening and treatment on mesoendemic malaria transmission at west timor in eastern Indonesia: A cluster-randomized trial. Clinical Infectious Diseases, 67 (9), pp.1364-1372. https://doi.org/10.1093/cid/ciy231.
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Abstract
BACKGROUND: Mass screening and treatment (MST) aims to reduce malaria risk in communities by identifying and treating infected persons without regard to illness. METHODS: A cluster-randomized trial evaluated malaria incidence with and without MST. Clusters were randomized to 3, 2, or no MST interventions: MST3, 6 clusters (156 households/670 individuals); MST2, 5 clusters (89 households/423 individuals); and MST0, 5 clusters (174 households/777 individuals). All clusters completed the study with 14 residents withdrawing. In a cohort of 324 schoolchildren (MST3, n = 124; MST2, n = 57; MST0, n = 143) negative by microscopy at enrollment, we evaluated the incidence density of malaria during 3 months of MST and 3 months following. The MST intervention involved community-wide expert malaria microscopic screening and standard therapy with dihydroartemisinin-piperaquine and primaquine for glucose-6 phosphate dehydrogenase-normal subjects. All blood examinations included polymerase chain reaction assays, which did not guide on-site treatment. RESULTS: The risk ratios for incidence density of microscopically patent malaria in MST3 or MST2 relative to that in MST0 clusters were 1.00 (95% confidence interval [CI], .53-1.91) and 1.22 (95% CI, .42-3.55), respectively. Similar results were obtained with molecular analysis and species-specific (P. falciparum and P. vivax) infections. Microscopically subpatent, untreated infections accounted for 72% of those infected. CONCLUSIONS: Two or 3 rounds of MST within 3 months did not impact the force of anopheline mosquito-borne infection in these communities. The high rate of untreated microscopically subpatent infections likely explains the observed poor impact. CLINICAL TRIALS REGISTRATION: NCT01878357.