Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

Ignatius Cheng Ndong, Daniel Okyere, Juliana Yartey Enos, Benedicta A Mensah, Alexander Nyarko, Benjamin Abuaku, Alfred Amambua-Ngwa, Corinne Simone C Merle, Kwadwo Ansah Koram, Collins Stephen Ahorlu, Ignatius Cheng Ndong, Daniel Okyere, Juliana Yartey Enos, Benedicta A Mensah, Alexander Nyarko, Benjamin Abuaku, Alfred Amambua-Ngwa, Corinne Simone C Merle, Kwadwo Ansah Koram, Collins Stephen Ahorlu

Abstract

Background: 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. 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.

Methods: A 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.

Results: MTTT 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).

Conclusion: This 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 registration: NCT04167566, Date 14/11/2019. Retrospective registration.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Implementation scheme of MTTT interventions in Pakro. MTTT interventions were conducted every 4 months. Between interventions, the CBHVs conducted community-based management of malaria. The time indicates the intervention periods. This report compares the parasitaemia prevalence at baseline to evaluation

References

    1. Bhatt S, Weiss D, Cameron E, Bisanzio D, Mappin B, Dalrymple U, Battle K, Moyes C, Henry A, Eckhoff P. The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature. 2015;526:207. doi: 10.1038/nature15535.
    1. WHO . World malaria report 2014. Geneva: WHO; 2014.
    1. Lindblade KA, Steinhardt L, Samuels A, Kachur SP, Slutsker L. The silent threat: asymptomatic parasitemia and malaria transmission. Expert Rev Anti-Infect Ther. 2013;11:623–639. doi: 10.1586/eri.13.45.
    1. WHO . World malaria report 2016. Geneva: World Health Organization; 2016. p. 2017.
    1. Ndong IC, van Reenen M, Boakye DA, Mbacham WF, Grobler AF. Trends in malaria admissions at the Mbakong health Centre of the North West Region of Cameroon: a retrospective study. Malar J. 2014;13:328. doi: 10.1186/1475-2875-13-328.
    1. Brady OJ, Slater HC, Pemberton-Ross P, Wenger E, Maude RJ, Ghani AC, Penny MA, Gerardin J, White LJ, Chitnis N. Role of mass drug administration in elimination of Plasmodium falciparum malaria: a consensus modelling study. Lancet Glob Health. 2017;5:e680–e687. doi: 10.1016/S2214-109X(17)30220-6.
    1. Organization WH . Mass drug administration for falciparum malaria: a practical field manual. 2017.
    1. Adhikari B, James N, Newby G, von Seidlein L, White NJ, Day NPJ, Dondorp AM, Pell C, Cheah PY. Community engagement and population coverage in mass anti-malarial administrations: a systematic literature review. Malar J. 2016;15:523. doi: 10.1186/s12936-016-1593-y.
    1. Crowell V, Briët OJT, Hardy D, Chitnis N, Maire N, Pasquale AD, Smith TA. Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden. Malar J. 2013;12:4. doi: 10.1186/1475-2875-12-4.
    1. Poirot E, Skarbinski J, Sinclair D, Kachur SP, Slutsker L, Hwang J. Mass drug administration for malaria. Cochrane Database Syst Rev. 2013;2013(12):CD008846.
    1. Shekalaghe SA, Drakeley C, van den Bosch S, ter Braak R, van den Bijllaardt W, Mwanziva C, Semvua S, Masokoto A, Mosha F, Teelen K, et al. A cluster-randomized trial of mass drug administration with a gametocytocidal drug combination to interrupt malaria transmission in a low endemic area in Tanzania. Malar J. 2011;10:247. doi: 10.1186/1475-2875-10-247.
    1. Song J, Socheat D, Tan B, Dara P, Deng C, Sokunthea S, Seila S, Ou F, Jian H, Li G. Rapid and effective malaria control in Cambodia through mass administration of artemisinin-piperaquine. Malar J. 2010;9:57. doi: 10.1186/1475-2875-9-57.
    1. von Seidlein L, Greenwood BM. Mass administrations of antimalarial drugs. Trends Parasitol. 2003;19:452–460. doi: 10.1016/j.pt.2003.08.003.
    1. Okell LC, Griffin JT, Kleinschmidt I, Hollingsworth TD, Churcher TS, White MJ, Bousema T, Drakeley CJ, Ghani AC. The potential contribution of mass treatment to the control of Plasmodium falciparum malaria. PLoS One. 2011;6:e20179. doi: 10.1371/journal.pone.0020179.
    1. Organization WH . Mass drug administration, mass screening and treatment and focal screening and treatment for malaria. Geneva: World Health Organization; 2015.
    1. Landier J, Parker DM, Thu AM, Lwin KM, Delmas G, Nosten FH, Andolina C, Aguas R, Ang SM, Aung EP, et al. Effect of generalised access to early diagnosis and treatment and targeted mass drug administration on Plasmodium falciparum malaria in eastern Myanmar: an observational study of a regional elimination programme. Lancet. 2018;391:1916–1926. doi: 10.1016/S0140-6736(18)30792-X.
    1. Von Seidlein L, Peto TJ, Landier J, Nguyen T-N, Tripura R, Phommasone K, Pongvongsa T, Lwin KM, Keereecharoen L, Kajeechiwa L. The impact of targeted malaria elimination with mass drug administrations on falciparum malaria in Southeast Asia: a cluster randomised trial. PLoS Med. 2019;16:e1002745. doi: 10.1371/journal.pmed.1002745.
    1. Kaehler N, Adhikari B, Cheah PY, von Seidlein L, Day NP, Paris DH, Tanner M, Pell C. Prospects and strategies for malaria elimination in the greater Mekong sub-region: a qualitative study. Malar J. 2019;18:203. doi: 10.1186/s12936-019-2835-6.
    1. Kaehler N, Adhikari B, Cheah PY, Day NP, Paris DH, Tanner M, Pell C. The promise, problems and pitfalls of mass drug administration for malaria elimination: a qualitative study with scientists and policymakers. Int Health. 2018;11:166–176. doi: 10.1093/inthealth/ihy079.
    1. Newby G, Hwang J, Koita K, Chen I, Greenwood B, Von Seidlein L, Shanks GD, Slutsker L, Kachur SP, Wegbreit J. Review of mass drug administration for malaria and its operational challenges. Am J Trop Med Hyg. 2015;93:125–134. doi: 10.4269/ajtmh.14-0254.
    1. Pell CL, Adhikari B, Thwin MM, Kajeechiwa L, Nosten S, Nosten FH, Sahan KM, Smithuis FM, Nguyen T-N, Hien TT. Community engagement, social context and coverage of mass anti-malarial administration: comparative findings from multi-site research in the greater Mekong sub-region. PLoS One. 2019;14:e0214280. doi: 10.1371/journal.pone.0214280.
    1. Adhikari B, Pell C, Phommasone K, Soundala X, Kommarasy P, Pongvongsa T, Henriques G, Day NP, Mayxay M, Cheah PY. Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos) Glob Health Action. 2017;10:1366136. doi: 10.1080/16549716.2017.1366136.
    1. Chen I, Clarke SE, Gosling R, Hamainza B, Killeen G, Magill A, O’Meara W, Price RN, Riley EM. “Asymptomatic” malaria: a chronic and debilitating infection that should be treated. PLoS Med. 2016;13:e1001942. doi: 10.1371/journal.pmed.1001942.
    1. Koram KA, Ahorlu CK, editors. Towards effective disease control in Ghana: research and policy implications: volume 2 other infectious diseases and health systems: Sub-Saharan Publishers; 2014 Sep 1.
    1. Pongvongsa T, Phommasone K, Adhikari B, Henriques G, Chotivanich K, Hanboonkunupakarn B, Mukaka M, Peerawaranun P, von Seidlein L, Day NP. The dynamic of asymptomatic Plasmodium falciparum infections following mass drug administrations with dihydroarteminisin–piperaquine plus a single low dose of primaquine in Savannakhet Province, Laos. Malar J. 2018;17:405. doi: 10.1186/s12936-018-2541-9.
    1. Dierickx S, Gryseels C, Mwesigwa J, O’Neill S, Bannister-Tyrell M, Ronse M, Jaiteh F, Gerrets R, D’Alessandro U, Grietens KP. Factors associated with non-participation and non-adherence in directly observed mass drug administration for malaria in the Gambia. PLoS One. 2016;11:e0148627. doi: 10.1371/journal.pone.0148627.
    1. Silumbwe A, Zulu JM, Halwindi H, Jacobs C, Zgambo J, Dambe R, Chola M, Chongwe G, Michelo C. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa. BMC Public Health. 2017;17:484. doi: 10.1186/s12889-017-4414-5.
    1. Ndong IC, Okyere D, Enos JY, Amambua-Ngwa A, Merle CSC, Nyarko A, Koram KA, Ahorlu CS. Challenges and perceptions of implementing mass testing, treatment and tracking in malaria control: a qualitative study in Pakro sub-district of Ghana. BMC Public Health. 2019;19:695. doi: 10.1186/s12889-019-7037-1.
    1. Cissé B, Ba EH, Sokhna C, Ndiaye JL, Gomis JF, Dial Y, Pitt C, Ndiaye M, Cairns M, Faye E, et al. Effectiveness of seasonal malaria chemoprevention in children under ten years of age in Senegal: a stepped-wedge cluster-randomised trial. PLoS Med. 2016;13:e1002175. doi: 10.1371/journal.pmed.1002175.
    1. Ndong Ignatius C, Reenen Mari van, Boakye Daniel A, Mbacham Wilfred F, Grobler Anne F. Trends in malaria case management following changes in the treatment policy to artemisinin combination therapy at the Mbakong Health Centre, Cameroon 2006–2012: A retrospective study. Acta Tropica. 2015;150:100–106. doi: 10.1016/j.actatropica.2015.06.014.
    1. Bousema JT, Gouagna LC, Drakeley CJ, Meutstege AM, Okech BA, Akim IN, Beier JC, Githure JI, Sauerwein RW. Plasmodium falciparum gametocyte carriage in asymptomatic children in western Kenya. Malar J. 2004;3:18. doi: 10.1186/1475-2875-3-18.
    1. Greenwood B. Asymptomatic malaria infections—do they matter? Parasitol Today. 1987;3:206–214. doi: 10.1016/0169-4758(87)90061-5.
    1. Adhikari B, Phommasone K, Pongvongsa T, Koummarasy P, Soundala X, Henriques G, Sirithiranont P, Parker DM, von Seidlein L, White NJ, et al. Treatment-seeking behaviour for febrile illnesses and its implications for malaria control and elimination in Savannakhet Province, Lao PDR (Laos): a mixed method study. BMC Health Serv Res. 2019;19:252. doi: 10.1186/s12913-019-4070-9.
    1. Mangham LJ, Cundill B, Ezeoke O, Nwala E, Uzochukwu BS, Wiseman V, Onwujekwe O. Treatment of uncomplicated malaria at public health facilities and medicine retailers in South-Eastern Nigeria. Malar J. 2011;10:155. doi: 10.1186/1475-2875-10-155.
    1. Haldar K, Bhattacharjee S, Safeukui I. Drug resistance in Plasmodium. Nat Rev Microbiol. 2018;16:156. doi: 10.1038/nrmicro.2017.161.
    1. Ashley EA, Dhorda M, Fairhurst RM, Amaratunga C, Lim P, Suon S, Sreng S, Anderson JM, Mao S, Sam B. Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med. 2014;371:411–423. doi: 10.1056/NEJMoa1314981.
    1. Maiga H, Lasry E, Diarra M, Sagara I, Bamadio A, Traore A, Coumare S, Bahonan S, Sangare B, Dicko Y, et al. Seasonal malaria chemoprevention with Sulphadoxine-Pyrimethamine and Amodiaquine selects Pfdhfr-dhps quintuple mutant genotype in Mali. PLoS One. 2016;11:e0162718. doi: 10.1371/journal.pone.0162718.
    1. Owek CJ, Oluoch E, Wachira J, Estambale B, Afrane YA. Community perceptions and attitudes on malaria case management and the role of community health workers. Malar J. 2017;16:272. doi: 10.1186/s12936-017-1916-7.
    1. Pitt C, Ndiaye M, Conteh L, Sy O, Hadj Ba E, Cissé B, Gomis JF, Gaye O, Ndiaye J-L, Milligan PJ. Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis. Health Policy Plan. 2017;32:1256–1266. doi: 10.1093/heapol/czx084.
    1. Druetz T, Corneau-Tremblay N, Millogo T, Kouanda S, Ly A, Bicaba A, Haddad S. Impact evaluation of seasonal malaria chemoprevention under routine program implementation: a quasi-experimental study in Burkina Faso. 2017.
    1. Ahorlu CK, Koram KA, Seake-Kwawu AK, Weiss MG. Two-year evaluation of intermittent preventive treatment for children (IPTc) combined with timely home treatment for malaria control in Ghana. Malar J. 2011;10:127. doi: 10.1186/1475-2875-10-127.
    1. Otupiri E, Yar D, Hindin J. Prevalence of Parasitaemia, Anaemia and treatment outcomes of malaria among school children in a rural Community in Ghana. J Sci Technol. 2012;32:1–10.
    1. Sarpong N, Owusu-Dabo E, Kreuels B, Fobil JN, Segbaya S, Amoyaw F, Hahn A, Kruppa T, May J. Prevalence of malaria parasitaemia in school children from two districts of Ghana earmarked for indoor residual spraying: a cross-sectional study. Malar J. 2015;14:260. doi: 10.1186/s12936-015-0772-6.
    1. NMCP. Annual Report 2015: Nationala Malaria Control Programme, Ghana Health Service; 2016.
    1. Agandaa SA, Kweku M, Agboli E, Takase M, Takramah W, Tarkang E, Gyapong J. Implementation and challenges of test, treat and track (T3) strategy for malaria case management in children under five years in the Bongo District, Ghana. Clin Res Trials. 2016;2:235–241.
    1. Ahorlu CK, Koram KA, Seakey AK, Weiss MG. Effectiveness of combined intermittent preventive treatment for children and timely home treatment for malaria control. Malar J. 2009;8:292. doi: 10.1186/1475-2875-8-292.
    1. Greenwood B, Mutabingwa T. Malaria in 2002. Nature. 2002;415:670–672. doi: 10.1038/415670a.
    1. Doolan DL, Dobaño C, Baird JK. Acquired immunity to malaria. Clin Microbiol Rev. 2009;22:13–36. doi: 10.1128/CMR.00025-08.
    1. DHS . Demographic Health Survey 2014. Ghana: Statistics Service; 2014.
    1. GSS . Population and Housing Sensors Ghana Statistics Service. 2010.
    1. Ansah EK, Narh-Bana S, Epokor M, Akanpigbiam S, Quartey AA, Gyapong J, Whitty CJ. Rapid testing for malaria in settings where microscopy is available and peripheral clinics where only presumptive treatment is available: a randomised controlled trial in Ghana. BMJ. 2010;340:c930. doi: 10.1136/bmj.c930.
    1. Bousema T, Okell L, Felger I, Drakeley C. Asymptomatic malaria infections: detectability, transmissibility and public health relevance. Nat Rev Microbiol. 2014;12:833. doi: 10.1038/nrmicro3364.
    1. O’Meara WP, Bejon P, Mwangi TW, Okiro EA, Peshu N, Snow RW, Newton CR, Marsh K. Effect of a fall in malaria transmission on morbidity and mortality in Kilifi, Kenya. Lancet. 2008;372:1555–1562. doi: 10.1016/S0140-6736(08)61655-4.
    1. Halliday KE, Okello G, Turner EL, Njagi K, Mcharo C, Kengo J, Allen E, Dubeck MM, Jukes MC, Brooker SJ. Impact of intermittent screening and treatment for malaria among school children in Kenya: a cluster randomised trial. PLoS Med. 2014;11:e1001594. doi: 10.1371/journal.pmed.1001594.
    1. Ja S, Ja B, Mwangi I, et al. Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study. Lancet. 2011;378:1316–1323. doi: 10.1016/S0140-6736(11)60888-X.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner