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

调查西非儿童将蠕虫控制与季节性疟疾化学预防 (SMC) 相结合的可行性和有效性

• 批准号: MR/S03286X/1
• 负责人: Muhammed Afolabi
• 金额: $ 152.32万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS03286X%2F1
• 关键词: Investigating; feasibility; effectiveness; integrating; helminth

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

疟疾和蠕虫通常影响非洲贫穷国家的儿童。这两种感染都可引起贫血，单独或共同作用，可导致可预防的死亡。鉴于这两种感染在许多非洲儿童中自然共存，综合治疗方法有可能改善儿童的生存和发展。此前的大规模驱虫工作仅惠及三分之一的儿童，而学龄儿童在高危人口中占很大比例，而一个名为季节性疟疾化学预防（SMC）的疟疾预防平台在萨赫勒地区成功实施，覆盖率非常高，并显着减少了疟疾死亡。经批准的驱虫药和SMC药物在单独使用时效果良好，副作用最小。虽然，联合使用这两种药物并不知道有显着的反应;他们以前没有在临床研究中一起使用。因此，该研究金旨在探索利用现有SMC平台提供驱虫药物的疟疾和蠕虫综合治疗方法的可行性和有效性。为实现这一目标，设计了一项三阶段研究。首先，将对非洲儿童疟疾和蠕虫合并感染的负担进行系统的文献审查。这次审查的结果将加强对脆弱人群疟疾和蠕虫合并感染综合管理创新平台进行评价的理由，随后将进行一项调查，以确定塞内加尔学龄前和学龄儿童疟疾和蠕虫合并感染的负担程度。塞内加尔是萨赫勒地区第一个在学龄儿童中成功实施幼儿保育的国家。众所周知，塞内加尔东南部也有相当大比例的儿童处于疟疾和蠕虫混合感染的高风险之中;其影响导致缺课、认知功能差和学习成绩差，将从符合条件的儿童中采集手指刺血样本，进行疟疾显微镜检查和专门的分子测试，以确定物种。通过平行检测血清和尿液中的循环阳极和阴极抗原，提高了循环抗原检测的诊断性能，将用于血吸虫的检测和定量。此外，将收集粪便样本，使用高度特异性的多重实时聚合酶链反应检测肠道蠕虫，该反应针对几种肠道蠕虫，包括寄生虫。第二阶段产生的信息将作为基线数据，并将用于开展后续研究，以探讨将SMC与蠕虫控制结合在学龄前和学龄儿童中的可行性和有效性。由于SMC药物在疟疾季节每月给药三到四个周期，因此所有研究儿童的抗蠕虫药物将与SMC的第一个疗程联合给药。在SMC和抗蠕虫药物给药后，将使用增强的被动监测系统收集不良症状。血红蛋白浓度和寄生虫密度将在SMC课程结束时测定。此外，将收集粪便和尿液样本，以确定抗蠕虫药物的有效性。还将评估研究儿童的认知技能。由于可行性可能包括可接受性，因此将对研究儿童的父母进行定性访谈，了解他们对使用综合治疗方法的有效性、实用性、可接受性和障碍的看法。此外，将在SMC供应商中进行关键的线人访谈，以进一步探讨这些因素。为提升申请人成为疟疾和NTD独立研究员的能力，将包括疟疾蠕虫物种分子检测和认知技能评估的能力建设

项目成果

Caregivers' perception of risk for malaria, helminth infection and malaria-helminth co-infection among children living in urban and rural settings of Senegal: a qualitative study

照顾者对塞内加尔城乡儿童疟疾、蠕虫感染和疟疾-蠕虫混合感染风险的认知：一项定性研究

• DOI: 10.1101/2022.05.10.22274631
• 发表时间: 2022
• 作者: Afolabi M

Malaria and helminth co-infections in children living in endemic countries: A systematic review with meta-analysis.

• DOI: 10.1371/journal.pntd.0009138
• 发表时间: 2021-03
• 期刊: PLoS neglected tropical diseases
• 影响因子: 3.8
• 作者: Afolabi MO;Ale BM;Dabira ED;Agbla SC;Bustinduy AL;Ndiaye JLA;Greenwood B
• 通讯作者: Greenwood B

Provider and User Acceptability of Integrated Treatment for the Control of Malaria and Helminths in Saraya, South-Eastern Senegal.

• DOI: 10.4269/ajtmh.23-0113
• 发表时间: 2023-11-01
• 期刊: The American journal of tropical medicine and hygiene
• 作者: Afolabi MO;Diaw A;Fall EHB;Sall FB;Diédhiou A;Seck A;Camara B;Niang D;Manga IA;Mbaye I;Sougou NM;Sow D;Greenwood B;Ndiaye JLA
• 通讯作者: Ndiaye JLA

Caregivers' perception of risk for malaria, helminth infection and malaria-helminth co-infection among children living in urban and rural settings of Senegal: A qualitative study.

• DOI: 10.1371/journal.pgph.0000525
• 发表时间: 2022
• 期刊: PLOS global public health
• 作者: Afolabi, Muhammed O;Sougou, Ndeye Mareme;Diaw, Aminata;Sow, Doudou;Manga, Isaac A;Mbaye, Ibrahima;Greenwood, Brian;Ndiaye, Jean Louis A
• 通讯作者: Ndiaye, Jean Louis A

What factors are associated with paediatric admissions and their outcomes in a rural hospital in northern Sierra Leone? Insights from a pilot observational study

哪些因素与塞拉利昂北部乡村医院的儿科入院及其结果相关？

• DOI: 10.1136/bmjph-2023-000545
• 发表时间: 2023
• 期刊: BMJ Public Health
• 作者: Afolabi M