Evaluating the effectiveness and sustainability of integrating helminth control with seasonal malaria chemoprevention in West African children
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Infectious and Tropical Diseases
Abstract
Malaria remains a major health problem, especially in sub-Saharan Africa where more than 90% of the disease and deaths occur in children. Adding to this high burden among children is the co-existence of parasitic worms. Existing control programmes for the worms are operating sub-optimally despite the 2012 London Declaration of eliminating some of the parasitic worms by 2020. On the other hand, a malaria prevention programme, called Seasonal Malaria Chemoprevention (SMC), introduced the same year in 2012 has achieved better coverage and prevented a substantial proportion of deaths in children. This encouraging development supports the need to explore the strategies involving the integration of worm control with successful platforms such as SMC. This would align parasitic worm and malaria control with the Sustainable Development Goals of ending diseases of poverty and promoting health and well-being for those at risk.
To achieve these goals, I implemented four different research studies to quantify the burden of mixed infections with malaria and parasitic worms among children living in poor countries of the world. I also used the findings of my research studies to test the feasibility and safety of combining malaria and worm treatment together among children living in Senegal, West Africa. The findings of this study showed that the integration of mass deworming with antimalarial drugs was feasible, well-tolerated, and acceptable to children and their parents.
To maximise the impact of my findings, I propose in this renewal fellowship, an evaluation of the effectiveness and sustainability of integrated malaria and worm control approach in a high-burden country. Having established the feasibility and safety of the integrated approach, it is now important to investigate the overall impact and cost-effectiveness of this approach in a larger population than was included in the pilot study. It is also important to obtain information on the operational costs and cost-effectiveness of an integrated delivery model for malaria and parasitic worms among children. This economic analysis will be needed to inform resource allocations, allow comparison with alternative interventions, and inform the deployment of the approach.
This fellowship renewal will focus on two main objectives: 1) to evaluate the effectiveness of combining antimalarial and deworming drugs in reducing the prevalence of anaemia and the intensity of malaria-helminth co-infections among a population of pre-school and school-age children resident in a high-burden country. 2) to determine the cost and cost-effectiveness of delivering the integrated malaria-deworming approach to children.
To achieve these objectives, I will conduct an intervention study where 1200 children in 10 villages in an endemic country in West Africa will be recruited and divided by their households into two equal groups. One group will receive the antimalarial drugs only, while the second group will receive deworming drugs along with antimalarial medications. Blood, urine and stool samples will be collected from the children in the two groups before and after giving them these medications to check whether there are any changes in their blood level (haemoglobin concentration) and malaria and worm parasite levels. To determine if this new approach is affordable and sustainable, a detailed costing analysis of the incremental financial and economic costs of implementing the integrated treatment will be done.
The findings of this new study will significantly consolidate the achievements I have made during the first part of my UKRI fellowship in developing strategic interventions for integrated malaria-neglected tropical diseases (NTD) control, which could help to eliminate malaria and parasitic worms by 2030. This will also equip me with the skill set to become established as a globally visible Research Leader in integrated malaria-NTD elimination strategies.
To achieve these goals, I implemented four different research studies to quantify the burden of mixed infections with malaria and parasitic worms among children living in poor countries of the world. I also used the findings of my research studies to test the feasibility and safety of combining malaria and worm treatment together among children living in Senegal, West Africa. The findings of this study showed that the integration of mass deworming with antimalarial drugs was feasible, well-tolerated, and acceptable to children and their parents.
To maximise the impact of my findings, I propose in this renewal fellowship, an evaluation of the effectiveness and sustainability of integrated malaria and worm control approach in a high-burden country. Having established the feasibility and safety of the integrated approach, it is now important to investigate the overall impact and cost-effectiveness of this approach in a larger population than was included in the pilot study. It is also important to obtain information on the operational costs and cost-effectiveness of an integrated delivery model for malaria and parasitic worms among children. This economic analysis will be needed to inform resource allocations, allow comparison with alternative interventions, and inform the deployment of the approach.
This fellowship renewal will focus on two main objectives: 1) to evaluate the effectiveness of combining antimalarial and deworming drugs in reducing the prevalence of anaemia and the intensity of malaria-helminth co-infections among a population of pre-school and school-age children resident in a high-burden country. 2) to determine the cost and cost-effectiveness of delivering the integrated malaria-deworming approach to children.
To achieve these objectives, I will conduct an intervention study where 1200 children in 10 villages in an endemic country in West Africa will be recruited and divided by their households into two equal groups. One group will receive the antimalarial drugs only, while the second group will receive deworming drugs along with antimalarial medications. Blood, urine and stool samples will be collected from the children in the two groups before and after giving them these medications to check whether there are any changes in their blood level (haemoglobin concentration) and malaria and worm parasite levels. To determine if this new approach is affordable and sustainable, a detailed costing analysis of the incremental financial and economic costs of implementing the integrated treatment will be done.
The findings of this new study will significantly consolidate the achievements I have made during the first part of my UKRI fellowship in developing strategic interventions for integrated malaria-neglected tropical diseases (NTD) control, which could help to eliminate malaria and parasitic worms by 2030. This will also equip me with the skill set to become established as a globally visible Research Leader in integrated malaria-NTD elimination strategies.
