Population-wide malaria testing and treatment with rapid diagnostic tests and artemether-lumefantrine in southern Zambia: a community randomized step-wedge control trial design
Reducing the human reservoir of malaria parasites is critical for elimination. We conducted a community randomized controlled trial in Southern Province, Zambia to assess the impact of three rounds of a mass test and treatment (MTAT) intervention on malaria prevalence and health facility outpatient...
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| Veröffentlicht in: | The American journal of tropical medicine and hygiene 2015-05, Vol.92 (5), p.913-921 |
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| container_title | The American journal of tropical medicine and hygiene |
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| creator | Larsen, David A Bennett, Adam Silumbe, Kafula Hamainza, Busiku Yukich, Joshua O Keating, Joseph Littrell, Megan Miller, John M Steketee, Richard W Eisele, Thomas P |
| description | Reducing the human reservoir of malaria parasites is critical for elimination. We conducted a community randomized controlled trial in Southern Province, Zambia to assess the impact of three rounds of a mass test and treatment (MTAT) intervention on malaria prevalence and health facility outpatient case incidence using random effects logistic regression and negative binomial regression, respectively. Following the intervention, children in the intervention group had lower odds of a malaria infection than individuals in the control group (adjusted odds ratio = 0.47, 95% confidence interval [CI] = 0.24-0.90). Malaria outpatient case incidence decreased 17% in the intervention group relative to the control group (incidence rate ratio = 0.83, 95% CI = 0.68-1.01). Although a single year of MTAT reduced malaria prevalence and incidence, the impact of the intervention was insufficient to reduce transmission to a level approaching elimination where a strategy of aggressive case investigations could be used. Mass drug administration, more sensitive diagnostics, and gametocidal drugs may potentially improve interventions targeting the human reservoir of malaria parasites. |
| doi_str_mv | 10.4269/ajtmh.14-0347 |
| format | Article |
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We conducted a community randomized controlled trial in Southern Province, Zambia to assess the impact of three rounds of a mass test and treatment (MTAT) intervention on malaria prevalence and health facility outpatient case incidence using random effects logistic regression and negative binomial regression, respectively. Following the intervention, children in the intervention group had lower odds of a malaria infection than individuals in the control group (adjusted odds ratio = 0.47, 95% confidence interval [CI] = 0.24-0.90). Malaria outpatient case incidence decreased 17% in the intervention group relative to the control group (incidence rate ratio = 0.83, 95% CI = 0.68-1.01). Although a single year of MTAT reduced malaria prevalence and incidence, the impact of the intervention was insufficient to reduce transmission to a level approaching elimination where a strategy of aggressive case investigations could be used. Mass drug administration, more sensitive diagnostics, and gametocidal drugs may potentially improve interventions targeting the human reservoir of malaria parasites.</description><identifier>ISSN: 0002-9637</identifier><identifier>EISSN: 1476-1645</identifier><identifier>DOI: 10.4269/ajtmh.14-0347</identifier><identifier>PMID: 25802434</identifier><language>eng</language><publisher>United States: The American Society of Tropical Medicine and Hygiene</publisher><subject>Antimalarials - therapeutic use ; Artemether, Lumefantrine Drug Combination ; Artemisinins - therapeutic use ; Child, Preschool ; Diagnostic Tests, Routine ; Drug Combinations ; Ethanolamines - therapeutic use ; Female ; Fluorenes - therapeutic use ; Follow-Up Studies ; Geography ; Humans ; Incidence ; Infant ; Malaria - diagnosis ; Malaria - drug therapy ; Malaria - epidemiology ; Malaria - transmission ; Male ; Mass Screening ; Prevalence ; Residence Characteristics ; Zambia - epidemiology</subject><ispartof>The American journal of tropical medicine and hygiene, 2015-05, Vol.92 (5), p.913-921</ispartof><rights>The American Society of Tropical Medicine and Hygiene.</rights><rights>The American Society of Tropical Medicine and Hygiene 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-3db947db646a35d17f209aa9741fe29c65d27ce3779f88d712ac08f0329caea43</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426577/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426577/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53768,53770</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25802434$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Larsen, David A</creatorcontrib><creatorcontrib>Bennett, Adam</creatorcontrib><creatorcontrib>Silumbe, Kafula</creatorcontrib><creatorcontrib>Hamainza, Busiku</creatorcontrib><creatorcontrib>Yukich, Joshua O</creatorcontrib><creatorcontrib>Keating, Joseph</creatorcontrib><creatorcontrib>Littrell, Megan</creatorcontrib><creatorcontrib>Miller, John M</creatorcontrib><creatorcontrib>Steketee, Richard W</creatorcontrib><creatorcontrib>Eisele, Thomas P</creatorcontrib><title>Population-wide malaria testing and treatment with rapid diagnostic tests and artemether-lumefantrine in southern Zambia: a community randomized step-wedge control trial design</title><title>The American journal of tropical medicine and hygiene</title><addtitle>Am J Trop Med Hyg</addtitle><description>Reducing the human reservoir of malaria parasites is critical for elimination. We conducted a community randomized controlled trial in Southern Province, Zambia to assess the impact of three rounds of a mass test and treatment (MTAT) intervention on malaria prevalence and health facility outpatient case incidence using random effects logistic regression and negative binomial regression, respectively. Following the intervention, children in the intervention group had lower odds of a malaria infection than individuals in the control group (adjusted odds ratio = 0.47, 95% confidence interval [CI] = 0.24-0.90). Malaria outpatient case incidence decreased 17% in the intervention group relative to the control group (incidence rate ratio = 0.83, 95% CI = 0.68-1.01). Although a single year of MTAT reduced malaria prevalence and incidence, the impact of the intervention was insufficient to reduce transmission to a level approaching elimination where a strategy of aggressive case investigations could be used. 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We conducted a community randomized controlled trial in Southern Province, Zambia to assess the impact of three rounds of a mass test and treatment (MTAT) intervention on malaria prevalence and health facility outpatient case incidence using random effects logistic regression and negative binomial regression, respectively. Following the intervention, children in the intervention group had lower odds of a malaria infection than individuals in the control group (adjusted odds ratio = 0.47, 95% confidence interval [CI] = 0.24-0.90). Malaria outpatient case incidence decreased 17% in the intervention group relative to the control group (incidence rate ratio = 0.83, 95% CI = 0.68-1.01). Although a single year of MTAT reduced malaria prevalence and incidence, the impact of the intervention was insufficient to reduce transmission to a level approaching elimination where a strategy of aggressive case investigations could be used. 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| ispartof | The American journal of tropical medicine and hygiene, 2015-05, Vol.92 (5), p.913-921 |
| issn | 0002-9637 1476-1645 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Antimalarials - therapeutic use Artemether, Lumefantrine Drug Combination Artemisinins - therapeutic use Child, Preschool Diagnostic Tests, Routine Drug Combinations Ethanolamines - therapeutic use Female Fluorenes - therapeutic use Follow-Up Studies Geography Humans Incidence Infant Malaria - diagnosis Malaria - drug therapy Malaria - epidemiology Malaria - transmission Male Mass Screening Prevalence Residence Characteristics Zambia - epidemiology |
| title | Population-wide malaria testing and treatment with rapid diagnostic tests and artemether-lumefantrine in southern Zambia: a community randomized step-wedge control trial design |
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