CHILD (Child Health and Infection With Low Density) Malaria (CHILD Malaria)

Child Health and Infection With Low Density (CHILD) Malaria, a Randomized Controlled Trial to Assess the Long-term Health and Socioeconomic Impact of Interventions Targeting Low-density Malaria Infection (LMI) Among Children in Tanzania

This trial will assess the long-term health and socioeconomic impact of interventions targeting low-density malaria infection (LMI) among children in Tanzania

Study Overview

• Status: Completed
• Conditions: Malaria; Malaria,Falciparum
• Intervention / Treatment: Other: Active case detection using molecular testing (ACDm); Other: Passive case detection using molecular testing (PCDm); Other: Control (standard of care)

Detailed Description

This is a 3-arm open-label randomized control trial of 600 children aged 6 months to 10 years in Tanzania, where transmission is low and a high proportion of infections are low-density. Standard of care based on passive case detection (PCD) using rapid diagnostic test (control arm) will be compared to two different approaches to detect and treat P. falciparum LMI: active case detection using molecular testing (ACDm) and PCD using molecular testing (PCDm). Aims are:

1. To assess the impact of standard PCD plus ACDm vs standard PCD on long-term child health
2. To assess the impact of PCDm vs standard PCD on long-term child health
3. To evaluate the cost-effectiveness of ACDm and PCDm

• Study Type: Interventional
• Enrollment (Actual): 600
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Tanzania
  • Bagamoyo, Tanzania
    • Kiwangwa and Fukayosi clinics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 months to 10 years (Child)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. 6 months to 10 years of age of age at enrollment
2. Primary residence in the study area during the study period
3. Agree to come to study clinic for any illness
4. Agree to avoid medications outside the study, even herbal medication

Exclusion Criteria:

1. Another child from household already randomly selected for recruitment
2. Not able or does not provide informed consent
3. Need for emergency intervention
4. Known history of chronic illness requiring regular specialty care including diabetes mellitus, cancer, or Stage 3 or 4 HIV/AIDS
5. Contraindications to artemether-lumefantrine (AL) including history of allergic reaction, weight under 5 kg
6. Participation in another active/ongoing intervention trial

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Passive Case Detection using molecular testing (PCDm); Children who present with fever will receive PCD using RDT and qPCR with treatment using AL if RDT or qPCR positive. Per standard of care, children will not receive malaria ACD.	Other: Passive case detection using molecular testing (PCDm); With fevers, participants will receive PCDm, in which qPCR will be done in RDT negatives with treatment using AL if positive.
Active Comparator: Standard passive case detection (PCD); Per standard of care, children will receive PCD using RDT. Per standard of care, children will not receive malaria ACD.	Other: Control (standard of care); With fevers, participants will receive standard PCD using RDT with treatment using AL if positive.
Experimental: Active Case Detection using molecular testing (ACDm); Per standard of care, children will receive passive case detection (PCD) using rapid diagnostic test (RDT) if they present with fever. Children will receive malaria active case detection (ACD) using RDT and qPCR (quantitative polymerase chain reaction) three times yearly with treatment using artemether-lumefantrine (AL) if RDT or qPCR positive.	Other: Active case detection using molecular testing (ACDm); In the ACDm arm, children will receive ACD using RDT and qPCR 3x yearly with treatment using artemether-lumefantrine (AL) if RDT or qPCR positive. With fevers, participants will receive standard PCD using RDT.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of all-cause sick visits	Number of sick visits to health facility per person time, excluding planned admissions for medical care, elective surgery, and trauma.	24-30 months from enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of anemia	Proportion of routine Hb measurements that are low (<11 g/dL) or moderate-severe low (<8 g/dL)	24-30 months from enrollment
Prevalence of underweight status	Prevalence of underweight status will be defined as the percentage of participants with low weight for age z-scores of less than -2. The World Health Organization (WHO) anthropometric indices will be utilized for standards.	24-30 months from enrollment
Prevalence of stunting	Prevalence of stunting will be defined as the percentage of participants with low height for age z-scores of less than -2. The World Health Organization (WHO) anthropometric indices will be utilized for standards.	24-30 months from enrollment
Prevalence of wasting	Prevalence of wasting will be defined as the percentage of participants with low weight for height z-scores of less than -2. The World Health Organization (WHO) anthropometric indices will be utilized for standards.	24-30 months from enrollment
Prevalence of malnutrition	Prevalence of malnutrition will be defined as the percentage of participants with a z-score of -3 to -2 indicating moderate malnutrition or a z-score of less than -3 indicating severe malnutrition in any of the following: weight for age, height for age, or weight for height.	24-30 months from enrollment
Prevalence of vomiting following administration of study drugs	Vomiting immediately or within 30minutes following administration of study drugs and measures of non-adherence.	24-30 months from enrollment
All-cause fever episodes	Number of fever episodes (reported fever in the past 48hrs and/or axillary temperature of ≥37.5°C) per person time	24-30 months from enrollment
Incidence of clinical symptoms	Number of days with overall symptoms reported as moderate (≥3 on a 5-point scale) per person time	24-30 months from enrollment
Incidence of clinical malaria	New episodes of positive malaria test (with fever or other clinical symptoms) per person time	24-30 months from enrollment
Proportion of fever episodes with clinical failure	Proportion of fever episodes that lead to clinical failure, defined as persistent or worsening symptoms assessed 7 and 28 days after initial evaluation.	24-30 months from enrollment
Prevalence of parasitemia	Proportion of routine samples with parasites detected by microscopy or quantitative polymerase chain reaction (qPCR).	24-30 months from enrollment
Incidence in antibiotics prescribed	Number of antibiotic regimens prescribed per person time	24-30 months from enrollment
Cognitive ability among children 0-3.4 years of age on the Global Scales of Early Development (GSED)	GSED is a validated instrument that measures population-level early childhood development. The tool measures children's early skills and behaviors in four primary domains: motor, cognitive, language, and social-emotional development.Measures will be normalized within our sample to mean 0 and standard deviation 1, with higher scores indicating better test performance.	24-30 months from enrollment
Cognitive ability among children 3.5-5 years of age on the International Development and Early Learning Assessment (IDELA)	The IDELA is a validated, global tool that uses direct child assessment to measure early learning and development across 4 core domains (Emergent Literacy, Emergent Numeracy, Motor, Social-emotional). Scores range from 0-100% as a percentage of correct tasks averaged across the 4 domains. Measures will be normalized within our sample to mean 0 and standard deviation 1, with higher scores indicating better test performance.	24-30 months from enrollment
Cognitive ability among children 6-12 years of age on the East Africa Neurodevelopment Assessment Tool	The East African Neurodevelopment Assessment Tool is a locally adapted modification of the Kaufman Brief Intelligence Test 2nd Ed. The test assesses 3 core metrics including general intelligence, executive function, literacy skills - in addition to behavioral and emotional development. Measures will be normalized within our sample to mean 0 and standard deviation 1, with higher scores indicating better test performance.	24-30 months from enrollment
Sustained attention among children 5-8 years of age on the Pencil Tapping Test	The pencil tapping test is one of the tasks in the Preschool Self-Regulation Assessment (PSRA) and is used to assess inhibitory control in younger children. The child and an assessor have pencils, and child is instructed to tap one/two times(s) depending on what assessor does, with the number of correct responses scored. Measures will be normalized within our sample to mean 0 and standard deviation 1, with higher scores indicating better test performance.	24-30 months from enrollment
Sustained attention among children 9-12 years of age on the Code Transmission Test, a local adaptation of the Test of Everyday Attention for Children(TEA-Ch)	Code transmission test is a sub-test of Test of Everyday Attention for Children (TEA-Ch) used for assessment of sustained attention in children. In the test, the child must remember spoken digits, and remember the digit that comes before sequence of numbers. Child is scored on completed and correct answers. Measures will be normalized within our sample to mean 0 and standard deviation 1, with higher scores indicating better test performance.	24-30 months from enrollment
Incidence of school absenteeism	The number of days of school absenteeism for any reason including illness.	24-30 months from enrollment
School performance	School performance will be defined as the incidence of school advancement to the next grade.	24-30 months from enrollment
Socioeconomic costs to participant	Estimated long-term income loss due to impaired early childhood development	24-30 months from enrollment
Socioeconomic costs to family	Total caregiver-reported costs of sick visits and transport to sick visits plus estimated loss of income from number of days of caregiver work absenteeism.	24-30 months from enrollment
Socioeconomic costs to health system	Estimated costs of testing and treatment for caregiver-reported number of sick visits.	24-30 months from enrollment
Cost effectiveness	Cost per outcome averted (e.g., per sick visit averted, per disability adjusted life years (DALYs), and per economic dollar saved, etc.)	24-30 months from enrollment
Prevalence of systemic inflammation	Proportion of sick visits with elevated elevated C-reactive pep-tide (CRP)	24-30 months from enrollment
Proportion with antimalarial antibodies against P.falciparum	Percentage of patients with antimalarial antibodies	24-30 months from enrollment
Proportion with biomarkers of inflammation	Percentage of patients with elevated cytokines	24-30 months from enrollment
Proportion with general antibody responses to vaccines	Percentage of patients with vaccine antibodies	24-30 months from enrollment
Proportion with general antibody responses to common pathogens	Percentage of patients with common pathogen antibodies	24-30 months from enrollment
Incidence of adverse events (AEs)	Number of AEs per person time. AEs will be considered as any grade 3-4 AE or serious adverse event (SAE); individual AEs; or AEs related to study drugs.	24-30 months from enrollment
Incidence of wasting	Incidence proportion of wasting will be defined for each age range of measurement. It is defined as the proportion of children not wasted at the start of the period who became wasted during the age period (the proportion of children who had the onset of new episodes during the period). Incident wasting episodes are defined as a change in weight-for-length z-scores from above -2 Z in the prior measurement to below -2 Z in the current measurement. We will define incident severe wasting analogously using a -3 Z cutoff. We will assume a 60-day washout period before a new wasting episode could occur.	24-30 months from enrollment
Incidence of stunting	Incidence proportion of stunting will be defined for each age range of measurement. It is defined as the proportion of children not stunted at the start of the period who became stunted during the age period. Incident stunting episodes will be defined as a change in length-for-age z-scores from above -2 Z in the prior measurement to below -2 Z in the current measurement. We will define incident severe stunting analogously using a -3 Z cutoff.	24-30 months from enrollment

Collaborators and Investigators

• Sponsor: University of California, San Francisco
• Collaborators: National Institute of Allergy and Infectious Diseases (NIAID); Stanford University; Swiss Tropical & Public Health Institute; Ifakara Health Institute; Chan Zuckerberg Biohub
• Investigators: Principal Investigator: Michelle Hsiang, MD, MSc, University of California, San Francisco; Principal Investigator: Ally Olotu, MD, PhD, Ifakara Health Institute

Publications and helpful links

General Publications

• Jebiwott S, Gutapaka N, Sumari D, Loss G, Athuman T, Nyandele JP, Cummins H, Chemba M, Benjamin-Chung J, Gangar P, Wu X, Smith J, Chen I, Dorsey G, Fink G, Olotu A, Hsiang M. Child Health and Infection with Low Density (CHILD) malaria: a protocol for a randomised controlled trial to assess the long-term health and socioeconomic impacts of testing and treating low-density malaria infection among children in Tanzania. BMJ Open. 2024 Mar 27;14(3):e082227. doi: 10.1136/bmjopen-2023-082227.

Study record dates

Study Major Dates

• Study Start (Actual): July 18, 2023
• Primary Completion (Actual): November 28, 2025
• Study Completion (Actual): November 28, 2025

Study Registration Dates

• First Submitted: September 30, 2022
• First Submitted That Met QC Criteria: September 30, 2022
• First Posted (Actual): October 5, 2022

Study Record Updates

• Last Update Posted (Actual): January 29, 2026
• Last Update Submitted That Met QC Criteria: January 27, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: malaria; child health; chronic infection; fever case management; subclinical infection; patent infection; subpatent infection; active case detection; passive case detection
• Additional Relevant MeSH Terms: Vector Borne Diseases; Mosquito-Borne Diseases; Pathologic Processes; Disease Attributes; Infections; Protozoan Infections; Parasitic Diseases; Asymptomatic Diseases; Pathological Conditions, Signs and Symptoms; Persistent Infection; Malaria; Malaria, Falciparum; Asymptomatic Infections; Health Services Administration; Health Care Quality, Access, and Evaluation; Quality of Health Care; Quality Indicators, Health Care; Standard of Care
• Other Study ID Numbers: DMID protocol 21-0046; U01AI155315 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Summary results information will be submitted to ClinicalTrials.gov within 12 months of completion of follow-up of all study participants. After completion of the clinical trial, un-blinding will be performed, and results will be disseminated widely by presentation at international scientific meetings, in reports and policy meetings for local, regional, and global stakeholders, and in publications in peer-reviewed journals. Upon completion of planned analyses and publication of the main trial results, data will be made available for research purposes to other individuals in the scientific community upon request to the PI and Consortium PIs. Informed consent documents for the study will include a specific statement relating to posting and sharing of study information at ClinicalTrials.gov, and in presentations, reports, and publications, and that no individual identities will ever be used in these materials and forums.
• IPD Sharing Time Frame: Upon completion of analysis and publication of main trial results
• IPD Sharing Access Criteria: Request and approval of PIs Planned analyses completed and main trial results published
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No