Investigating the feasibility and effectiveness of integrating helminth control with seasonal malaria chemoprevention (SMC) in West African children

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Malaria and worms commonly affect children in poor countries in Africa. Both infections can cause anaemia which can, acting alone or together, lead to preventable deaths. Given natural co-existence of the two infections in many African children, holistic approach to treatment has potential to improve child survival and development. Previous efforts on mass deworming reached only a third of the children, leaving out school-aged children who form substantial proportions of the population-at-risk, whereas, a malaria prevention platform called seasonal malaria chemoprevention (SMC) successfully implemented in Sahel region, has a very high coverage and significantly reduced malaria death. The approved deworming and SMC drugs work well with minimal side-effects when used separately. Though, combined use of the two drugs are not known to have significant reactions; they have not been previously used together in clinical studies. This fellowship therefore aims to explore the feasibility and effectiveness of an integrated treatment approach for malaria and worms using existing SMC platform to deliver deworming medications. A three-stage study is designed to achieve this goal. First, a systematic literature review on the burden of malaria and worm co-infections in African children will be conducted. Findings of this review would strengthen the rationale for evaluating innovative platforms for integrated management of malaria-helminth co-infections in vulnerable populations.This will be followed by a survey to determine the magnitude of burden of malaria-helminth co-infections among pre-school and school-age children in Senegal. Senegal is the first country in Sahel region which has successfully implemented SMC in school-aged children. South-eastern Senegal is also known to harbour substantial proportions of children at high risk of malaria-helminth co-infections; the effects of which have contributed to school absenteeism, poor cognitive function and poor academic performance.Finger-prick blood samples will be collected from eligible children for malaria microscopy and specialised molecular tests for species determination. An improved diagnostic performance of the circulating antigen assay by parallel testing for circulating anodic and cathodic antigens in serum and urine will be used in the detection and quantification of Schistosomes. Furthermore, stool samples will be collected to detect intestinal helminths using a highly specific multiplex real-time polymerase chain reaction which targets several intestinal helminths including schistosomesInformation generated from the second stage will serve as baseline data and will be used to develop a follow-up study that will investigate the feasibility and effectiveness of integrating SMC with helminth control in the pre-school and school-aged children. As SMC drugs are given monthly for three-to-four cycles during malaria seasons, antihelminth drugs will be co-administered with the first course of SMC in all study children. Adverse symptoms will be collected using augmented passive surveillance system following administration of SMC and anti-helminthic drugs. Haemoglobin concentration and parasite density will be determined at the end of SMC course. Also, stool and urine samples will be collected to determine the effectiveness of the anti-helminthic drugs. Cognitive skills of the study children will also be assessed. As feasibility may include acceptability, qualitative interviews will be conducted among parents of the study children on their perceptions about effectiveness, practicalities, acceptability and barrier to using the integrated treatment approach. Also, key informant interviews will be held among SMC providers to further explore these factors. To enhance the capabilities of the applicant to become an independent researcher in malaria and NTDs, capacity building on molecular detection of malaria-helminth species and cognitive skills assessment will be included