Effectiveness and Cost-effectiveness of Integrated Model for Malaria and Helminth Control
Status:
Not yet recruiting
Trial end date:
2026-01-12
Target enrollment:
Participant gender:
Summary
Malaria remains a major health problem, especially among children living in sub-Saharan
Africa where more than 90% of the disease and deaths occur. Adding to this high burden among
the children is the co-existence of parasitic worms in their intestines and urinary tract.
The combined infection of malaria and parasitic worms in these children has additive adverse
effects of anaemia, poor physical and cognitive development, and death. Existing control
programmes for the parasitic worms are operating sub-optimally despite the 2012 London
Declaration on Neglected Tropical Diseases (NTDs) of achieving 75% treatment coverage by
2020. On the other hand, a malaria prevention programme, called Seasonal Malaria
Chemoprevention (SMC), introduced in the same year as the London Declaration on NTDs has
achieved more than 75% treatment coverage and prevented 75-85% of cases of uncomplicated and
severe malaria in children. The remarkable success of SMC has led to the recent WHO
recommendation for its extension to other at-risk age groups and in highly seasonal malaria
transmission settings outside the Sahel region. This encouraging development supports the
need to explore the possibility of integrating helminth control programmes with other
successful delivery platforms such as SMC. However, limited empirical evidence exists on an
integrated approach that integrated the control of malaria and parasitic worms in a safe,
acceptable, easy-to-deliver and effective manner.
To address this knowledge gap, the investigators conducted a randomised controlled trial in
the first stage of this project to establish the feasibility and safety of integrating
helminth control with SMC among Senegalese children. This second stage will assess the
effectiveness and cost-effectiveness of using SMC platform to deliver deworming drugs to
preschool and school-aged children living in communities where the burden of malaria and
parasitic worms is high in central Ghana. One thousand, two hundred children aged 1-14 years
will be randomly assigned equally to two study communities where antimalarial (SMC) drugs and
deworming drugs will be administered in combination to the children living in one study
community, and antimalarial (SMC) drugs alone will be delivered to the children living in the
second study community. The effectiveness of the combined delivery will be determined by
checking whether the combined antimalarial and deworming drugs prevent anaemia in the
children who receive the combined drugs compared to the children who receive antimalarial
drugs only. We will also determine the cost and cost-effectiveness of this approach by
estimating the incremental cost savings due to cases of moderate and severe anaemia averted
by giving antimalarial and deworming drugs together to the children. The findings of this
study would provide evidence to boost public health recommendations for an integrated control
of malaria and parasitic worms among children living in the poorest countries of the world.
The findings may also reinforce the empirical evidence that the future direction of
healthcare systems in developing countries should be comprehensive health management rather
than vertical management of a single disease.
Phase:
N/A
Details
Lead Sponsor:
London School of Hygiene and Tropical Medicine
Collaborator:
Kintampo Health Research Centre, Ghana
Treatments:
Amodiaquine Fanasil, pyrimethamine drug combination Pyrimethamine Sulfadoxine