Abstract
ABSTRACT.Malaria elimination and eradication efforts have stalled globally. Further, asymptomatic infections as silent transmission reservoirs are considered a major challenge to malaria elimination efforts. There is increased interest in a mass screen-and-treat (MSAT) strategy as an alternative to mass drug administration to reduce malaria burden and transmission in endemic settings. This study systematically synthesized the existing evidence on MSAT, from both epidemiological and economic perspectives. Searches were conducted on six databases (PubMed, EMBASE, CINALH, Web of Science, Global Health, and Google Scholar) between October and December 2020. Only experimental and quasi-experimental studies assessing the effectiveness and/or cost-effectiveness of MSAT in reducing malaria prevalence or incidence were included. Of the 2,424 citation hits, 14 studies based on 11 intervention trials were eligible. Eight trials were conducted in sub-Saharan Africa and three trials in Asia. While five trials targeted the community as a whole, pregnant women were targeted in five trials, and school children in one trial. Transmission setting, frequency, and timing of MSAT rounds, and measured outcomes varied across studies. The pooled effect size of MSAT in reducing malaria incidence and prevalence was marginal and statistically nonsignificant. Only one study conducted an economic evaluation of the intervention and found it to be cost-effective when compared with the standard of care of no MSAT. We concluded that the evidence for implementing MSAT as part of a routine malaria control program is growing but limited. More research is necessary on its short- and longer-term impacts on clinical malaria and malaria transmission and its economic value.
Highlights
Malaria is a vector-borne disease that affected over 200 million people in 2019,1 and imposes a significant economic burden on endemic countries
To the best of our knowledge, this is the first systematic literature review on the effectiveness and the costeffectiveness of mass screen-and-treat (MSAT), and the second attempt to revisit this intervention since the WHO Malaria Policy Advisory Committee (MPAC) issued a recommendation on its use in 2015.5 In the absence of sufficient evidence, the WHO MPAC discouraged the use of MSAT in situations other than complex emergencies and epidemics.[29]
This recommendation was informed by a review of only four studies that evaluated MSAT-like interventions, including focal screening-and-test (FSAT)—which is similar to, but different from MSAT, for instance, in terms of geographic scope
Summary
Malaria is a vector-borne disease that affected over 200 million people in 2019,1 and imposes a significant economic burden on endemic countries. According to the 2019 WHO malaria report, 19 countries collectively account for 85% of global malaria burden.[1] All of these high-burden countries are resource poor, and (except for India) are located in sub-Saharan Africa (SSA) In these countries, Plasmodium falciparum and P. vivax infections account for the majority of malaria cases.[1] In the past two decades, great strides have been made in malaria control, and this has increased enthusiasm toward malaria elimination with the ultimate goal of its eradication.[2] Worryingly, progress on malaria elimination and eradication has stalled globally in the last few years,[1] and it has been argued that we have reached the limits of what we can achieve with the imperfect tools and limited resources we have.[3] Currently, a serious obstacle to malaria control and elimination efforts is asymptomatic infections that provide Anopheles mosquitoes with a silent parasite reservoir that sustain transmission in endemic areas.[4]. We synthesized the existing evidence on MSAT, from both epidemiological and economic perspectives, to identify knowledge gaps and provide guidance on future research and implementation of MSAT in the context of malaria control and elimination programs
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