Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
Impact of Intermittent Screening and Treatment for Malaria among School Children in Kenya: A Cluster Randomised Trial
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DOI：
10.1371/journal.pmed.1001594
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发表时间：
2014-01-01
期刊：
影响因子：
15.8
通讯作者：
Brooker, Simon J.
中科院分区：
文献类型：
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作者：
Halliday, Katherine E.;Okello, George;Brooker, Simon J.
背景：改善学龄儿童的健康可以对认知发展和教育成绩产生巨大的好处。然而，关于替代学校疟疾干预措施的好处或干预措施的影响如何根据疟疾传播强度而变化的实验证据有限。我们调查了疟疾间歇性筛查和治疗 (IST) 对低度至中度疟疾传播地区学童健康和教育的影响。方法和结果：2010-2012 年，对肯尼亚南海岸 101 所公立小学的 5,233 名儿童进行了一项整群随机试验。干预对象是从 1 班和 5 班随机选出的儿童，并对他们进行了 24 个月的随访。学期结束后，公共卫生工作者会使用疟疾快速诊断测试 (RDT) 对儿童进行筛查，发现 RDT 阳性的儿童（无论有或没有疟疾症状）均接受六剂量的蒿甲醚-本芴醇 (AL) 治疗方案。鉴于干预的性质，试验并未采用盲法。主要结局是贫血和持续注意力。次要结果是疟原虫血症和教育成绩。数据是在意向治疗的基础上进行分析的。干预期间，干预学校每轮平均有88.3%的儿童接受筛查，其中17.5%的儿童RDT呈阳性。对照组中 80.3% 的儿童和干预组中 80.2% 的儿童在 24 个月时进行了随访。没有观察到疟疾 IST 干预对 12 个月或 24 个月时贫血患病率的影响（调整后风险比 [Adj.RR]：1.03，95% CI 0.93-1.13，p = 0.621 和 Adj.RR：1.00，95% CI 0.90-1.11，p = 0.953）或疟原虫患病率。恶性疟原虫感染或课堂注意力分数。没有观察到 IST 对高年级班级的教育成绩有影响，但对低年级 9 个月和 24 个月时的拼写成绩以及 24 个月时的算术成绩有明显的负面影响。结论：在肯尼亚的这种情况下，本研究中实施的 IST 对于改善学童的健康或教育并没有效果。没有影响的可能原因是传播的明显地理异质性、AL 治疗后的再感染率很快、RDT 的可靠性可变，以及疟疾在这种情况下对贫血病因的相对贡献。
Background: 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.Methods and Findings: 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.Conclusion: 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.