School-based intermittent screening and treatment programs for malaria may be unsuccessful in low to moderate transmission areas
A school-based intermittent screening and treatment program for malaria in rural coastal Kenya had no benefits on the health and education of school children, according to a study by international researchers published in this week's PLOS Medicine.
The study, led by Katherine Halliday and Simon Brooker from the London School of Hygiene & Tropical Medicine, included over 5000 children from 101 government schools. Half of the schools were randomized to receive the intermittent screening and treatment programme - screening once a school term for malaria parasites using a rapid diagnostic test followed by treatment with the anti-malarial drug artemether-lumefantrine for all children who tested positive for malaria parasitaemia (whether symptomatic or asymptomatic) .
During the intervention period, almost 90% of children in classes 1 and 5 of the intervention schools were screened at each round, of whom 17.5% tested RDT-positive for malaria. However, the authors found that there was no difference at 12 and 24 months between the proportion of children with anemia and the proportion of children who tested positive for malaria parasites in the intervention and control groups. And at 9 and 24 months, there was also no difference in class attention scores between the two groups.
The authors say: "In contrast to the beneficial impact of previous school-based malaria control our findings show there are no health or education benefits of implementing school-based intermittent screening and treatment programs with artemether-lumefantrine in a low to moderate transmission setting such as this study site."
The authors add: "Nevertheless, our results do highlight a potential role for schools as screening platforms whereby pockets of high transmission can be identified for targeted malaria control"
In an accompanying Perspective, Lorenz von Seidlein, from the Menzies School of Health Research in Casuarina, Australia, discusses the reasons that the program was unsuccessful and the wider issues involved in failure of screening and treating as a malaria elimination strategy. He suggests: "After other approaches have failed perhaps an evaluation of strategies based on presumptive treatment of targeted populations should now have the highest priority?"