Project Title

Determining the impact of scaling up mass testing, treatment and tracking on malaria prevalence among children in the Pakro sub district of Ghana

Project Objectives

Main objective: The main objective of this study is to define the impact of scaling up mass testing, treatment and tracking on malaria prevalence among children under fifteen years of age in the Pakro sub district of Ghana. Specific Objectives: To assess the effect of scaling-up targeted MTTT/home-based treatment on malaria parasitaemia prevalence To determine the prevalence of asymptomatic parasitaemia among afebrile participants. To document challenges which hinder the scale up of mass testing, treatment and tracking of malaria in Ghana

Host Organisation

EDCTP Project Call

Career Development Fellowship (CDF)

Study Design

Study Design: This is an Implementation Research (IR) with a longitudinal cohort design to be undertaken within a two year frame work. The interventions are designed to compare the baseline to evaluation findings following the modified protocol of (Ahorlu et al., 2011). The study will be conducted in two arms - Arm 1 will constitute the intervention communities while Arm 2 will constitute standard of care. The results from Arm 1 will be compared Arm 2. The study team will undertake 12 household surveys over a two-year surveillance period (one survey every two months). During each prevalence survey, a structured interview/questionnaire will be administered to caregivers of children under 15 years of age. In due course, all residents in the study communities will be tested, and treatment will be provided for all parasitised individuals. This is intended to reduce the parasite reservoirs. Between interventions, the teams will conduct homes-based management of malaria for all febrile cases confirmed positive for malaria parasites. The challenges faced during implementation will be documented.

Project Summary

Globally, malaria prevalence in 2020 was reported to have increased with 627,000 deaths, 96% of which occurred in sub-Sahara Africa. This reveals an increase of 69,000 deaths compared to 2019, 47,000 of which were due to disruption in the provision, diagnosis, and treatment of malaria during the COVID-19 (WHO, 2021). Individuals who carry the malaria parasite can either be symptomatic or asymptomatic. Asymptomatic malaria parasitaemia pose a very serious threat to malaria control efforts as they serve as reservoirs that fuel transmission. Therefore, interventions that target community-wide screening and clearing of asymptomatic parasitaemia can drastically reduce malaria prevalence in the population and lead to elimination especially in endemic areas. Mass parasite clearance can deplete the parasite reservoirs and lower the transmission potential over time. Efforts are ongoing to scale-up interventions that work such as use of Long-Lasting Insecticidal Nets (LLIN), Intermittent Preventive Treatment in children (IPTc), and test, treat and track (TTT). However, there is need for mass testing, treatment and tracking (MTTT) of the whole population to reduce the parasite load before implementing the aforementioned interventions. Though, Seasonal Malaria Chemoprophylaxis (SMC) is adopted for selected localities in Ghana, the impact of such interventions could be enhanced, if combined with MTTT at baseline to reduce the parasite load. IPT of children in Ghana has demonstrated a parasite load reduction from 25% to 1%. However, unanswered questions include - could this be scaled up? What can be the coverage? What is needed for MTTT scale -up? In a pilot in Ghana, during the pilot coverage of more than 75% was achieved in target communities and reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018. It is important the work is continued in order to generate time series data to better analyse and understand the prevalence trends as well as the bottlenecks. In designing interventions that aim at reducing the burden of malaria in children under five, for example, MTTT has largely been left out. Adults who are not often targeted by such interventions remain reservoirs that fuel transmission. This study explores the scale-up of interventions that work (LLIN, IPTc and IPTp) using existing community volunteer teams hypothesizing that implementing MTTT complemented by community-based management can reduce the prevalence of asymptomatic malaria parasite carriage in endemic communities. The effect of the interventions will be observed by comparing baseline data to evaluation data. This study will document the challenges and bottlenecks associated with scaling-up of MTTT to inform future efforts to scale-up the intervention.

Current Organisation

University of Ghana, Noguchi Memorial Institute for Medical Research

Current Job Title

EDCTP Career Development Fellow

Biography

Publications