Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

BMC Public Health ◽

10.1186/s12889-019-7986-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ignatius Cheng Ndong ◽

Daniel Okyere ◽

Juliana Yartey Enos ◽

Benedicta A. Mensah ◽

Alexander Nyarko ◽

...

Keyword(s):

Scale Up ◽

Intermittent Preventive Treatment ◽

Indoor Residual Spraying ◽

Asymptomatic Malaria ◽

Malaria Parasitaemia ◽

Axillary Temperature ◽

Community Based ◽

High Coverage ◽

Asymptomatic Parasitaemia ◽

The Impact

Abstract Background Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia. Methods A population of about 5000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every 4 months and treated positive cases with Artemisinin–based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases. Results MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1795/4941) in July 2017 to 32.9% (1303/3966) in July 2018 (p = 0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1043/1984) in July 2017 to 47.5% (820/1728) in July 2018 (p = 0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR = 0.76, CI = 0.67, 0.85 p ≤ 0.001). Conclusion This study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation. Trial registration NCT04167566, Date 14/11/2019. Retrospective registration.

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Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

10.21203/rs.2.12320/v4 ◽

2019 ◽

Author(s):

Ignatius Cheng Ndong ◽

Daniel Okyere ◽

Juliana Yartey Enos ◽

Benedicta Ayiedu Mensah ◽

Alexander Kwadwo Nyarko ◽

...

Keyword(s):

Scale Up ◽

Intermittent Preventive Treatment ◽

Indoor Residual Spraying ◽

Asymptomatic Malaria ◽

Malaria Parasitaemia ◽

Axillary Temperature ◽

Community Based ◽

High Coverage ◽

Asymptomatic Parasitaemia ◽

The Impact

Abstract Background: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia. Methods: A population of about 5,000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every four months and treated positive cases with Artemisinin–based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases. Results: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1,795/4941) in July 2017 to 32.9% (1,303/3966) in July 2018 (p=0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1,043/1984) in July 2017 to 47.5% (820/1,728) in July 2018 (p=0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR=0.76, CI=0.67, 0.85 p≤0.001). Conclusion: This study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation. Trial registration: NCT04167566, Date 14/11/2019 Retrospective registration.

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Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

10.21203/rs.2.12320/v2 ◽

2019 ◽

Author(s):

Ignatius Cheng Ndong ◽

Daniel Okyere ◽

Juliana Yartey Enos ◽

Benedicta Ayiedu Mensah ◽

Alexander Kwadwo Nyarko ◽

...

Keyword(s):

Malaria Control ◽

Lower Cost ◽

Health Centre ◽

Scale Up ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Asymptomatic Malaria ◽

Community Based ◽

High Coverage ◽

Asymptomatic Parasitaemia

Abstract Background: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Intermittent Preventive Treatment and Test, Treat and Track (T3) using ACTs. Intermittent preventive treatment of children (IPTc) in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – whether mass treatment of population sub-groups such as IPTc could be scaled-up to whole populations as in mass testing, treatment and tracking (MTTT)? What is needed to implement MTTT at scale? Can MTTT reduce asymptomatic parasitaemia levels in children under 15? And whether MTTT of populations complemented by community-based management of malaria (CBMm) using volunteers could be an effective strategy for malaria control at a lower cost. Methods: A population of 5,000 asymptomatic individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers (CBHVs) who conducted house-to-house testing using RDTs every four months and treated positive cases with ACTs. Between interventions, CBMm was done on symptomatic cases. Results: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 1,795 (36.3%) in July 2017 to 1,303 (32.9%) in July 2018. Implementing MTTT significantly averted asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and temperature (OR=0.76, CI=0.67, 0.85 p ≤ 0.001). In comparison, treatment of symptomatic patients at the Health Centre reduced parasitaemia by 9% over the same period which was however, not statistically significant (OR=0.91, CI=0.67, 1.38 p = 0.672). A total of 223 (5.1%) cases were averted in children under 15 years (X² = 9.7, p < 0.002). An important observation was a decrease in hospital attendance, which negatively affected the internally generated funds (IGF) scheme of the participating health facilities. Conclusion: This study has demonstrated that implementing MTTT was feasible and could reduce prevalence of malaria asymptomatic parasitaemia in children under 15 years of age. Furthermore, the use of CBHVs could ensure high coverage at lower cost.

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Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

10.21203/rs.2.12320/v1 ◽

2019 ◽

Author(s):

Ignatius Cheng Ndong ◽

Daniel Okyere ◽

Juliana Yartey Enos ◽

Benedicta Ayiedu Mensah ◽

Alexander Kwadwo Nyarko ◽

...

Keyword(s):

Malaria Control ◽

Lower Cost ◽

Health Centre ◽

Scale Up ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Asymptomatic Malaria ◽

Community Based ◽

High Coverage ◽

Asymptomatic Parasitaemia

Abstract Background: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Intermittent Preventive Treatment and Test, Treat and Track (T3) using ACTs. Intermittent preventive treatment of children (IPTc) in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – whether mass treatment of population sub-groups such as IPTc could be scaled-up to whole populations as in mass testing, treatment and tracking (MTTT)? What is needed to implement MTTT at scale? Can MTTT reduce asymptomatic parasitaemia levels in children under 15? And whether MTTT of populations complemented by community-based management of malaria (CBMm) using volunteers could be an effective strategy for malaria control at a lower cost. Methods: A population of 5,000 asymptomatic individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers (CBHVs) who conducted house-to-house testing using RDTs every four months and treated positive cases with ACTs. Between interventions, CBMm was done on symptomatic cases. Results: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 1,795 (36.3%) in July 2017 to 1,303 (32.9%) in July 2018. Implementing MTTT significantly averted asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and temperature (OR=0.76, CI=0.67, 0.85 p ≤ 0.001). In comparison, treatment of symptomatic patients at the Health Centre reduced parasitaemia by 9% over the same period which was however, not statistically significant (OR=0.91, CI=0.67, 1.38 p = 0.672). A total of 223 (5.1%) cases were averted in children under 15 years (X² = 9.7, p < 0.002). An important observation was a decrease in hospital attendance, which negatively affected the internally generated funds (IGF) scheme of the participating health facilities. Conclusion: This study has demonstrated that implementing MTTT was feasible and could reduce prevalence of malaria asymptomatic parasitaemia in children under 15 years of age. Furthermore, the use of CBHVs could ensure high coverage at lower cost.

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OC 8453 SCALING-UP MASS TESTING AND TREATMENT EFFECTIVELY REDUCED MALARIA ASYMPTOMATIC PARASITAEMIA IN CHILDREN UNDER 15 YEARS OF AGE IN GHANA

BMJ Global Health ◽

10.1136/bmjgh-2019-edc.16 ◽

2019 ◽

Vol 4 (Suppl 3) ◽

pp. A7.1-A7

Author(s):

Ignatius Cheng Ndong ◽

Collins Stephan Ahorlu ◽

Daniel Okyere ◽

Alexander A Nyarko ◽

Alfred Amambua-Ngwa ◽

...

Keyword(s):

Health System ◽

Lower Cost ◽

Scale Up ◽

Intermittent Preventive Treatment ◽

Parasite Load ◽

Asymptomatic Malaria ◽

Asymptomatic Parasitaemia ◽

Home Based ◽

Negative Effect ◽

Community Volunteers

BackgroundGlobal efforts to scale up malaria control interventions that work, are gaining momentum. These include the use of long-lasting insecticide nets, intermittent preventive treatment and test, treat and track using artemisinin-based combination therapies. Mass testing, treatment and tracking (MTTT) of the entire populations complemented by home-based management (HBM) using volunteers could be an effective approach at lower cost. MTTT of children in Ghana has demonstrated a parasite load reduction of 90%. However, unanswered questions include – Could this be scaled-up? What proportion of the community could be covered? What do we need? Can MTTT reduce asymptomatic parasitaemia levels in under-15 children?MethodsThe target population for this study was 5000 asymptomatic individuals in seven communities in the Pakro subdistrict in Ghana. A community register was developed following a census. Community volunteers conducted quarterly house-to-house testing (using RDTs) and treating positive cases with ACTs. Between interventions HBM was conducted.ResultsIn those tested, asymptomatic malaria parasitaemia reduced from 1795 (36.3%) in July 2017 to 942 (23.1%) in March 2018. In eight months, parasitaemia declined by 43.5% and 37.3% in children under 15 and under 5, respectively. Coverage was 98.8% in July 2017 and 81.4% in March 2018. One of the challenges that surfaced was the fact that decrease in hospital attendance had a negative effect on money generated by the health facility. The district and subdistrict services, though appreciating the work, indicated that the negative effect on the health system may be serious and that measures need to be taken to address alternative financing for the health system.ConclusionThis study has demonstrated that combining MTTT and home-based management of malaria could reduce prevalence in under-15 children and that using community volunteers could ensure effective coverage at lower cost. There is need to start looking at financing of the health system without malaria.

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Understanding adherence to reactive treatment of asymptomatic malaria infections in The Gambia

Scientific Reports ◽

10.1038/s41598-021-81468-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Fatou Jaiteh ◽

Joseph Okebe ◽

Yoriko Masunaga ◽

Umberto D’Alessandro ◽

Jane Achan ◽

...

Keyword(s):

Day Treatment ◽

Treatment Completion ◽

Clinical Malaria ◽

Research Process ◽

The Gambia ◽

Individual Compound ◽

Asymptomatic Malaria ◽

High Coverage ◽

Major Health Problem ◽

The Impact

AbstractThe impact of different types of reactive case detection and/or treatment strategies for malaria elimination depends on high coverage and participants’ adherence. However, strategies to optimise adherence are limited, particularly for people with asymptomatic or no infections. As part of a cluster-randomized trial to evaluate the effect of reactive treatment in The Gambia, all residents in the compound of a diagnosed clinical malaria patient received dihydro-artemisinin–piperaquine (DP). Using a mixed method approach, we assessed which factors contribute to adherence among the contacts of malaria cases that showed no symptoms. Adherence was defined as the proportion of compound members that (1) returned all medicine bags empty and (2) self-reported (3-day) treatment completion. Among the 273 individuals from 14 compounds who received DP, 227 (83.1%) were available for and willing to participate in the survey; 85.3% (233/273) returned empty medicine bags and 91.6% (208/227) self-reported treatment completion. Although clinical malaria was not considered a major health problem, reported adherence was high. The drivers of adherence were the strong sense of responsibility towards protecting the individual, compound and the village. Adherence can be optimised through a transdisciplinary implementation research process of engaging communities to bridge the gap between research goals and social realities.

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Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada

Primary Health Care Research & Development ◽

10.1017/s1463423618000518 ◽

2018 ◽

Vol 20 ◽

Cited By ~ 5

Author(s):

Sabrina T. Wong ◽

Julia M. Langton ◽

Alan Katz ◽

Martin Fortin ◽

Marshall Godwin ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Working Group ◽

Scale Up ◽

Data Sources ◽

Knowledge Generation ◽

Community Based ◽

Primary Health ◽

The Impact

AbstractAimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.BackgroundA pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.MethodsA working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.FindingsNineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

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The impact of intermittent preventive treatment with sulfadoxine-pyrimethamine on the prevalence of malaria parasitaemia in pregnancy

Tropical Doctor ◽

10.1258/td.2011.110402 ◽

2012 ◽

Vol 42 (3) ◽

pp. 133-135 ◽

Cited By ~ 6

Author(s):

Uchenna Anthony Umeh ◽

Samuel N Obi ◽

Hyacinth E Onah ◽

Emmanuel Onyebuchi V Ugwu ◽

Leonard Ogbonna Ajah ◽

...

Keyword(s):

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Malaria Parasitaemia ◽

The Impact ◽

In Pregnancy

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Reduction of malaria vector mosquitoes in a large-scale intervention trial in rural Burkina Faso using Bti based larval source management

Malaria Journal ◽

10.1186/s12936-019-2951-3 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Peter Dambach ◽

Till Baernighausen ◽

Issouf Traoré ◽

Saidou Ouedraogo ◽

Ali Sié ◽

...

Keyword(s):

Malaria Vector ◽

Large Scale ◽

Intermittent Preventive Treatment ◽

Indoor Residual Spraying ◽

Control Measures ◽

Sub Saharan Africa ◽

Intervention Period ◽

Selective Treatment ◽

Breeding Sites ◽

The Impact

Abstract Background Malaria remains one of the most important causes of morbidity and death in sub-Saharan Africa. Along with early diagnosis and treatment of malaria cases and intermittent preventive treatment in pregnancy (IPTp), vector control is an important tool in the reduction of new cases. Alongside the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), targeting the vector larvae with biological larvicides, such as Bacillus thuringiensis israelensis (Bti) is gaining importance as a means of reducing the number of mosquito larvae before they emerge to their adult stage. This study presents data corroborating the entomological impact of such an intervention in a rural African environment. Methods The study extended over 2 years and researched the impact of biological larviciding with Bti on malaria mosquitoes that were caught indoors and outdoors of houses using light traps. The achieved reductions in female Anopheles mosquitoes were calculated for two different larviciding choices using a regression model. Results In villages that received selective treatment of the most productive breeding sites, the number of female Anopheles spp. dropped by 61% (95% CI 54–66%) compared to the pre-intervention period. In villages in which all breeding sites were treated, the number of female Anopheles spp. was reduced by 70% (95% CI 64–74%) compared to the pre-intervention period. Conclusion It was shown that malaria vector abundance can be dramatically reduced through larviciding of breeding habitats and that, in many geographical settings, they are a viable addition to current malaria control measures.

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The impact of stopping and starting indoor residual spraying on malaria burden in 14 districts of Uganda

10.21203/rs.3.rs-126095/v1 ◽

2020 ◽

Author(s):

Jane Namuganga ◽

Adrienne Epstein ◽

Joaniter Nankabirwa ◽

Arthur Mpimbaza ◽

Moses Kiggundu ◽

...

Keyword(s):

Malaria Incidence ◽

Critical Role ◽

Scale Up ◽

Indoor Residual Spraying ◽

Fold Increase ◽

Bed Nets ◽

Malaria Burden ◽

Vector Control Intervention ◽

Using Data ◽

The Impact

Abstract The scale-up of malaria control efforts has led to marked reductions in malaria burden over the past twenty years, but progress has slowed. Implementation of indoor residual spraying (IRS) of insecticide, a proven vector control intervention, has been limited and difficult to sustain partly because questions remain on its added impact over widely accepted interventions such as bed nets. Using data from 14 enhanced surveillance health facilities in Uganda, a country with high bet net coverage yet high malaria burden, we estimate the impact of starting and stopping IRS. We show that stopping IRS resulted in a 5-fold increase in malaria incidence within 10 months, but reinstating IRS led to an over 5-fold decrease within 8 months. In areas where IRS was initiated and sustained, malaria incidence dropped by 85% after year 4. IRS could play a critical role in achieving global malaria targets, particularly in areas where progress has stalled.

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