Perennial Malaria Chemoprevention (PMC) in Côte d'Ivoire

Impact Evaluation of Intermittent Preventive Treatment of Malaria in Infants Plus (IPTi+) in Côte d'Ivoire: The Plus Project

The Plus Project will assess the impact, operational feasibility, efficacy, effectiveness, and cost-effectiveness of PMC. Specifically, the impact evaluation will involve monitoring a passive cohort of all children in the study area reporting all doses of SP received and the number of confirmed cases of malaria and anaemia, as well as a prospective active cohort of children who will have seven home visits over an 18-month period. The total number of participants is expected to be approximately 1568 children in the areas served by 19 health centres in Côte d'Ivoire. The results of this study will allow direct evaluation of the protective efficacy of PMC on malaria incidence, severe anaemia, and malaria mortality.

Study Overview

• Status: Recruiting
• Conditions: Anemia; Malaria
• Intervention / Treatment: Drug: Sulfadoxine pyrimethamine

Detailed Description

Despite impressive progress in recent years, malaria continues to impose a heavy morbidity and mortality burden. Ninety-five percent of the estimated 247 million malaria cases and 619,000 deaths worldwide in 2021 occurred in the World Health Organization (WHO) Africa Region [1]. The expansion of SP-IPTi to include children up to two years of age and additional entry points, referred to now as PMC, offers the potential to increase the impact of the intervention by delivering more protective doses of SP to an age group with a higher malaria burden. However, to support the development of national policies and international guidelines on the adoption and implementation of PMC at scale, more evidence is needed on where, when, how and under what circumstances PMC can be effective, cost-effective, acceptable, equitable and feasible.

The aim of the impact evaluation is to inform decision-making by policy makers and programme managers involved in national malaria control programmes by evaluating the protective efficacy of PMC with five doses versus zero doses as standard of care in Côte d'Ivoire. The design is a multi-site quantitative study of the implementation of PMC in Côte d'Ivoire. The health districts of Seguela and Kani were identified as the intervention and control districts, respectively, based on population size, number of Extended Programme of Immunisation (EPI) facilities, malaria incidence, EPI coverage and availability of an appropriate control population receiving standard care.

All children up to 36 months of age with parental consent will be recruited into a passive cohort. The investigators will also extract data on malaria and anaemia cases among children receiving PMC from health facility records.

The investigators will form and follow an active arm of the cohort in which a randomly selected subset of children in the passive cohort will be visited every three months during the study period in their homes to obtain detailed information, including details of the household, malaria risk factors, history of malaria and anaemia, health-seeking behaviour, and past EPI vaccinations. Blood will be collected for microscopy measures of parasitaemia, anaemia diagnosis by haemoglobin levels, and retrospective analysis of malaria infection (not for clinical management) by polymerase chain reaction methods. Rapid diagnostic tests will be used amongst symptomatic children to identify cases. First line antimalarial treatment will be provided to all confirmed cases. Children will be screened for malnutrition by measuring their mid-upper arm circumference (MUAC). If they are determined to have either moderate (MAM) or severe acute malnutrition (SAM), treatment will consist of standard of care which can include referral to the nearest health facility with clinical management capacity or treatment on site.

• Study Type: Observational
• Enrollment (Estimated): 1568

Contacts and Locations

• Study Contact: Name: R Matthew Chico, MPH, PhD; Phone Number: +44 2079272841; Email: matthew.chico@lshtm.ac.uk

Study Locations

• Côte D'Ivoire
  • Séguéla, Côte D'Ivoire
    • Recruiting
    • Multiple
    • Contact: William Yavo, PharmD, Ph

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Children up to 6 months of age in Seguela and Kani health districts of Côte d'Ivoire.

Description

Inclusion Criteria:

• Reside in Seguela (intervention) or Kani (control) health districts.
• Agree to take part in the census.
• Aged 10 weeks to six months at the time of enrolment.
• Parent/caregiver informed consent obtained.

Exclusion Criteria:

• Parent/caregiver refused to participate in the cohort.
• Parent/caregiver did not give informed consent.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Active cohort control; Children (aged 10 weeks to 6 months) in the control arm will receive the standard of care: 0 doses of SP.
Active cohort intervention; Children (aged 10 weeks to 6 months) in the intervention arm with receive PMC: five doses of SP at EPI visits (10 weeks, 14 weeks, 9 months, 15 months, 18 months)	Drug: Sulfadoxine pyrimethamine; Sulfadoxine-pyrimethamine paediatric formulation (250mg/12.5mg) dispersable tablets (Macleods Pharmaceuticals Ltd)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of malaria infection and clinical malaria	Incidence of: (1) malaria infection, and (2) clinical malaria in children residing in areas designated to receive PMC (intervention) versus standard care (control).	18 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of severe malaria, malaria deaths, anaemia and severe anaemia	Incidence of: (1) severe malaria, (2) malaria deaths, (3) anaemia, and (4) severe anaemia in children residing in areas designated to receive PMC (intervention) versus standard care (control).	18 months
Malaria and anaemia incidence by delivery platform, number of doses and dose schedule	Measure differences in incidence between children residing in areas designated to receive PMC (intervention) versus standard of care (control) based on differences in SP dose patterns by delivery platform, number of doses of SP, and the SP dose schedule.	18 months
Dose-response effects of SP on malaria and anaemia	Measure the dose-response effects of SP on incidence of: (1) malaria infection, (2) clinical malaria, (3) severe malaria, (4) anaemia, (5) severe anaemia, and (6) malaria mortality throughout the period of observation.	18 months
Effects of distance to health facility on malaria and anaemia	Measure the effects of distance to health facility on incidence of: (1) malaria infection, (2) clinical malaria, (3) severe malaria, (4) anaemia, (5) severe anaemia, and (6) malaria mortality throughout the period of observation.	18 months
Incidence of moderate, severe and overall malnutrition	Incidence of: (1) moderate, (2) severe, and (3) overall malnutrition among children residing in areas designated to receive PMC (intervention) versus standard care (control).	12 months

Collaborators and Investigators

• Sponsor: London School of Hygiene and Tropical Medicine
• Collaborators: Institut National de Santé Publique de Côte d'Ivoire
• Investigators: Principal Investigator: William Yavo, PharmD, PhD, Institut National de Santé Publique de Côte d'Ivoire; Principal Investigator: R Matthew Chico, MPH, PhD, London School of Hygiene and Tropical Medicine

Publications and helpful links

General Publications

• WHO Malaria Report 2022, World Health Organisation

Study record dates

Study Major Dates

• Study Start (Actual): August 11, 2023
• Primary Completion (Estimated): February 1, 2025
• Study Completion (Estimated): July 1, 2025

Study Registration Dates

• First Submitted: May 3, 2023
• First Submitted That Met QC Criteria: May 3, 2023
• First Posted (Actual): May 12, 2023

Study Record Updates

• Last Update Posted (Actual): February 5, 2024
• Last Update Submitted That Met QC Criteria: February 1, 2024
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Keywords: Malaria; Anemia; Chemoprevention; Sulfadoxine-pyrimethamine (SP); Perennial malaria chemoprevention (PMC); Intermittent preventative treatment of infants (IPTi)
• Additional Relevant MeSH Terms: Infections; Vector Borne Diseases; Parasitic Diseases; Protozoan Infections; Malaria; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Enzyme Inhibitors; Antiprotozoal Agents; Antiparasitic Agents; Antimalarials; Folic Acid Antagonists; Anti-Infective Agents, Urinary; Pyrimethamine; Sulfadoxine; Fanasil, pyrimethamine drug combination
• Other Study ID Numbers: PLUS-27988-CDI

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No