Halliday Katherine E, Okello George, Turner Elizabeth L, Njagi Kiambo, Mcharo Carlos, Kengo Juddy, Allen Elizabeth, Dubeck Margaret M, Jukes Matthew C H, Brooker Simon J
Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Health Systems and Social Science Research Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
PLoS Med. 2014 Jan 28;11(1):e1001594. doi: 10.1371/journal.pmed.1001594. eCollection 2014 Jan.
Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence of the benefits of alternative school-based malaria interventions or how the impacts of interventions vary according to intensity of malaria transmission. We investigated the effect of intermittent screening and treatment (IST) for malaria on the health and education of school children in an area of low to moderate malaria transmission.
A cluster randomised trial was implemented with 5,233 children in 101 government primary schools on the south coast of Kenya in 2010-2012. The intervention was delivered to children randomly selected from classes 1 and 5 who were followed up for 24 months. Once a school term, children were screened by public health workers using malaria rapid diagnostic tests (RDTs), and children (with or without malaria symptoms) found to be RDT-positive were treated with a six dose regimen of artemether-lumefantrine (AL). Given the nature of the intervention, the trial was not blinded. The primary outcomes were anaemia and sustained attention. Secondary outcomes were malaria parasitaemia and educational achievement. Data were analysed on an intention-to-treat basis. During the intervention period, an average of 88.3% children in intervention schools were screened at each round, of whom 17.5% were RDT-positive. 80.3% of children in the control and 80.2% in the intervention group were followed-up at 24 months. No impact of the malaria IST intervention was observed for prevalence of anaemia at either 12 or 24 months (adjusted risk ratio [Adj.RR]: 1.03, 95% CI 0.93-1.13, p = 0.621 and Adj.RR: 1.00, 95% CI 0.90-1.11, p = 0.953) respectively, or on prevalence of P. falciparum infection or scores of classroom attention. No effect of IST was observed on educational achievement in the older class, but an apparent negative effect was seen on spelling scores in the younger class at 9 and 24 months and on arithmetic scores at 24 months.
In this setting in Kenya, IST as implemented in this study is not effective in improving the health or education of school children. Possible reasons for the absence of an impact are the marked geographical heterogeneity in transmission, the rapid rate of reinfection following AL treatment, the variable reliability of RDTs, and the relative contribution of malaria to the aetiology of anaemia in this setting.
www.ClinicalTrials.gov NCT00878007.
改善学龄儿童的健康状况可为认知发展和学业成就带来显著益处。然而，关于替代性校内疟疾干预措施的益处，或干预效果如何随疟疾传播强度而变化的实验证据有限。我们调查了间歇性筛查和治疗（IST）疟疾对疟疾传播程度为低至中度地区学童健康和教育的影响。
2010 - 2012年，在肯尼亚南部海岸的101所政府小学对5233名儿童实施了一项整群随机试验。干预措施针对从一年级和五年级随机选取的儿童实施，并对其进行了24个月的随访。每学期一次，由公共卫生工作者使用疟疾快速诊断检测（RDT）对儿童进行筛查，检测结果呈阳性的儿童（无论有无疟疾症状）均接受六剂蒿甲醚 - 本芴醇（AL）治疗。鉴于干预措施的性质，该试验未设盲。主要结局为贫血和持续注意力。次要结局为疟疾寄生虫血症和学业成就。数据按意向性分析原则进行分析。在干预期间，干预学校平均每次筛查88.3%的儿童，其中17.5%检测结果呈阳性。在24个月时，对照组80.3%的儿童和干预组80.2%的儿童接受了随访。在12个月或24个月时，未观察到疟疾IST干预对贫血患病率有影响（校正风险比[Adj.RR]：1.03，95%置信区间0.93 - 1.13，p = 0.621；Adj.RR：1.00，95%置信区间0.90 - 1.11，p = 0.953），对恶性疟原虫感染患病率或课堂注意力得分也无影响。未观察到IST对高年级学业成就有影响，但在9个月和24个月时对低年级拼写得分以及在24个月时对算术得分有明显的负面影响。
在肯尼亚的这种环境下，本研究实施的IST对改善学童的健康或教育无效。未产生影响的可能原因包括传播存在显著的地理异质性、AL治疗后再感染速度快、RDT的可靠性多变以及在这种环境下疟疾对贫血病因的相对贡献。
www.ClinicalTrials.gov NCT00878007
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