Reduced risk of malaria parasitemia following household screening and treatment

A cross-sectional and longitudinal cohort study

Catherine Sutcliffe, Tamaki Kobayashi, Harry Hamapumbu, Timothy M Shields, Sungano Mharakurwa, Philip E Thuma, Thomas Louis, Gregory Glass, William J Moss

Research output: Contribution to journalArticle

Abstract

Background: In regions of declining malaria transmission, new strategies for control are needed to reduce transmission and achieve elimination. Artemisinin-combination therapy (ACT) is active against immature gametocytes and can reduce the risk of transmission. We sought to determine whether household screening and treatment of infected individuals provides protection against infection for household members. Methodology/Principal Findings: The study was conducted in two areas in Southern Province, Zambia in 2007 and 2008/2009. To determine the impact of proactive case detection, households were randomly selected either to join a longitudinal cohort, in which participants were repeatedly screened throughout the year and those infected treated with artemether-lumefantrine, or a cross-sectional survey, in which participants were visited only once. Cross-sectional surveys were conducted throughout the year. The prevalence of RDT positivity was compared between the longitudinal and cross-sectional households at baseline and during follow-up using multilevel logistic regression. In the 2007 study area, 174 and 156 participants enrolled in the cross-sectional and longitudinal groups, respectively. In the 2008/2009 study area, 917 and 234 participants enrolled in the cross-sectional and longitudinal groups, respectively. In both study areas, participants and households in the longitudinal and cross-sectional groups were similar on demographic characteristics and prevalence of RDT positivity at baseline (2007: OR = 0.97; 95% CI:0.46, 2.03 {pipe} 2008/2009: OR = 1.28; 95% CI:0.44, 3.79). After baseline, the prevalence of RDT positivity was significantly lower in longitudinal compared to cross-sectional households in both study areas (2007: OR = 0.44; 95% CI:0.20, 0.96 {pipe} 2008/2009: OR = 0.16; 95% CI:0.05, 0.55). Conclusions/Significance: Proactive case detection, consisting of screening household members with an RDT and treating those positive with ACT, can reduce transmission and provide indirect protection to household members. A targeted test and treat strategy could contribute to the elimination of malaria in regions of low transmission.

Original languageEnglish (US)
Article numbere31396
JournalPLoS One
Volume7
Issue number2
DOIs
StatePublished - Feb 3 2012

Fingerprint

Parasitemia
parasitemia
cohort studies
malaria
Malaria
Longitudinal Studies
households
Screening
Cohort Studies
screening
artemisinin
Pipe
pipes
cross-sectional studies
Cross-Sectional Studies
Logistics
Zambia
gametocytes
therapeutics
sociodemographic characteristics

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

@article{8b543384a58e4980bb233abdfb3e9023,
title = "Reduced risk of malaria parasitemia following household screening and treatment: A cross-sectional and longitudinal cohort study",
abstract = "Background: In regions of declining malaria transmission, new strategies for control are needed to reduce transmission and achieve elimination. Artemisinin-combination therapy (ACT) is active against immature gametocytes and can reduce the risk of transmission. We sought to determine whether household screening and treatment of infected individuals provides protection against infection for household members. Methodology/Principal Findings: The study was conducted in two areas in Southern Province, Zambia in 2007 and 2008/2009. To determine the impact of proactive case detection, households were randomly selected either to join a longitudinal cohort, in which participants were repeatedly screened throughout the year and those infected treated with artemether-lumefantrine, or a cross-sectional survey, in which participants were visited only once. Cross-sectional surveys were conducted throughout the year. The prevalence of RDT positivity was compared between the longitudinal and cross-sectional households at baseline and during follow-up using multilevel logistic regression. In the 2007 study area, 174 and 156 participants enrolled in the cross-sectional and longitudinal groups, respectively. In the 2008/2009 study area, 917 and 234 participants enrolled in the cross-sectional and longitudinal groups, respectively. In both study areas, participants and households in the longitudinal and cross-sectional groups were similar on demographic characteristics and prevalence of RDT positivity at baseline (2007: OR = 0.97; 95{\%} CI:0.46, 2.03 {pipe} 2008/2009: OR = 1.28; 95{\%} CI:0.44, 3.79). After baseline, the prevalence of RDT positivity was significantly lower in longitudinal compared to cross-sectional households in both study areas (2007: OR = 0.44; 95{\%} CI:0.20, 0.96 {pipe} 2008/2009: OR = 0.16; 95{\%} CI:0.05, 0.55). Conclusions/Significance: Proactive case detection, consisting of screening household members with an RDT and treating those positive with ACT, can reduce transmission and provide indirect protection to household members. A targeted test and treat strategy could contribute to the elimination of malaria in regions of low transmission.",
author = "Catherine Sutcliffe and Tamaki Kobayashi and Harry Hamapumbu and Shields, {Timothy M} and Sungano Mharakurwa and Thuma, {Philip E} and Thomas Louis and Gregory Glass and Moss, {William J}",
year = "2012",
month = "2",
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doi = "10.1371/journal.pone.0031396",
language = "English (US)",
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journal = "PLoS One",
issn = "1932-6203",
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T1 - Reduced risk of malaria parasitemia following household screening and treatment

T2 - A cross-sectional and longitudinal cohort study

AU - Sutcliffe, Catherine

AU - Kobayashi, Tamaki

AU - Hamapumbu, Harry

AU - Shields, Timothy M

AU - Mharakurwa, Sungano

AU - Thuma, Philip E

AU - Louis, Thomas

AU - Glass, Gregory

AU - Moss, William J

PY - 2012/2/3

Y1 - 2012/2/3

N2 - Background: In regions of declining malaria transmission, new strategies for control are needed to reduce transmission and achieve elimination. Artemisinin-combination therapy (ACT) is active against immature gametocytes and can reduce the risk of transmission. We sought to determine whether household screening and treatment of infected individuals provides protection against infection for household members. Methodology/Principal Findings: The study was conducted in two areas in Southern Province, Zambia in 2007 and 2008/2009. To determine the impact of proactive case detection, households were randomly selected either to join a longitudinal cohort, in which participants were repeatedly screened throughout the year and those infected treated with artemether-lumefantrine, or a cross-sectional survey, in which participants were visited only once. Cross-sectional surveys were conducted throughout the year. The prevalence of RDT positivity was compared between the longitudinal and cross-sectional households at baseline and during follow-up using multilevel logistic regression. In the 2007 study area, 174 and 156 participants enrolled in the cross-sectional and longitudinal groups, respectively. In the 2008/2009 study area, 917 and 234 participants enrolled in the cross-sectional and longitudinal groups, respectively. In both study areas, participants and households in the longitudinal and cross-sectional groups were similar on demographic characteristics and prevalence of RDT positivity at baseline (2007: OR = 0.97; 95% CI:0.46, 2.03 {pipe} 2008/2009: OR = 1.28; 95% CI:0.44, 3.79). After baseline, the prevalence of RDT positivity was significantly lower in longitudinal compared to cross-sectional households in both study areas (2007: OR = 0.44; 95% CI:0.20, 0.96 {pipe} 2008/2009: OR = 0.16; 95% CI:0.05, 0.55). Conclusions/Significance: Proactive case detection, consisting of screening household members with an RDT and treating those positive with ACT, can reduce transmission and provide indirect protection to household members. A targeted test and treat strategy could contribute to the elimination of malaria in regions of low transmission.

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