Abstract
BackgroundGlobal 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.MethodsA 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.ResultsMTTT 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).ConclusionThis 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 registrationNCT04167566, Date 14/11/2019. Retrospective registration.
Highlights
Global efforts to scale-up malaria control interventions are gaining steam
MTTT may face similar challenges such as ineffective coverage and a lack of community ownership etc., requiring the following questions to be addressed; what level of community coverage can be achieved through MTTT? Can MTTT reduce malaria incidence? What will be the impact of MTTT on malaria-related hospital visits? We demonstrated in our earlier report that communities are willing to fully engage and take ownership of the MTTT interventions [28]
There are a number of unanswered questions, including: whether MTTT intervention could be scaled-up to the entire population since asymptomatic carriage is higher in adults who have developed partial immunity or premunition [47, 48]? What are the challenges to scaling up the intervention to the adult population? What effect MTTT would have on the prevalence of symptomatic parasitaemia in the short-term? In this article, we report findings from MTTT implementation across seven communities in the Pakro sub-district of Ghana over a period of 1 year, hypothesizing that implementing MTTT complemented by CBMm could reduce the prevalence of asymptomatic parasitaemia
Summary
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. 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 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. Over the last two decades, tremendous progress has been made in the fight against malaria achieving significant reduction in the global prevalence by 18%, mortality and mobility in all age groups declined by 48%, while mortality in children 2–10 years declined by 33% [1, 2] This has resulted from a step-up in control efforts toward its elimination [3]. MDA was used in the malaria eradication efforts at different points in history between 1950s – 1970s [6, 8, 14, 15]
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