Abstract
Background: Malaria transmission is highly heterogeneous in most settings, resulting in the formation of recognizable malaria hotspots. Targeting these hotspots might represent a highly efficacious way of controlling or eliminating malaria if the hotspots fuel malaria transmission to the wider community.Methods/design: Hotspots of malaria will be determined based on spatial patterns in age-adjusted prevalence and density of antibodies against malaria antigens apical membrane antigen-1 and merozoite surface protein-1. The community effect of interventions targeted at these hotspots will be determined. The intervention will comprise larviciding, focal screening and treatment of the human population, distribution of long-lasting insecticide-treated nets and indoor residual spraying. The impact of the intervention will be determined inside and up to 500 m outside the targeted hotspots by PCR-based parasite prevalence in cross-sectional surveys, malaria morbidity by passive case detection in selected facilities and entomological monitoring of larval and adult Anopheles populations.Discussion: This study aims to provide direct evidence for a community effect of hotspot-targeted interventions. The trial is powered to detect large effects on malaria transmission in the context of ongoing malaria interventions. Follow-up studies will be needed to determine the effect of individual components of the interventions and the cost-effectiveness of a hotspot-targeted approach, where savings made by reducing the number of compounds that need to receive interventions should outweigh the costs of hotspot-detection.Trial registration: NCT01575613. The protocol was registered online on 20 March 2012; the first community was randomized on 26 March 2012.
Original language | English (US) |
---|---|
Article number | 36 |
Journal | Trials |
Volume | 14 |
Issue number | 1 |
DOIs | |
State | Published - Feb 2 2013 |
Externally published | Yes |
Keywords
- Anopheles
- Elimination
- Epidemiology
- Eradication
- Falciparum
- Heterogeneity
- Immunology
- Malaria
- Molecular
- Transmission
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Pharmacology (medical)