Evaluating the effectiveness and sustainability of integrating helminth control with seasonal malaria chemoprevention in West African children

疟疾仍然是一个主要的健康问题，特别是在撒哈拉以南非洲，那里90%以上的疾病和死亡发生在儿童中。给儿童带来沉重负担的是寄生虫的共存。尽管2012年《伦敦宣言》要求在2020年前消灭部分寄生虫，但现有的蠕虫控制计划的运行情况并不理想。另一方面，2012年推出的一项名为季节性疟疾化学预防的疟疾预防方案实现了更好的覆盖面，防止了相当大比例的儿童死亡。这一令人鼓舞的发展支持了探索将蠕虫控制与SMC等成功平台相结合的战略的必要性。这将使寄生虫和疟疾控制与可持续发展目标保持一致，可持续发展目标旨在消除贫困疾病，促进高危人群的健康和福祉。为了实现这些目标，我实施了四项不同的研究，以量化生活在世界贫困国家的儿童中混合感染疟疾和寄生虫的负担。我还利用我的研究结果来测试在西非塞内加尔的儿童中将疟疾和蠕虫治疗结合起来的可行性和安全性。这项研究的结果表明，大规模驱虫与抗疟疾药物的结合是可行的，耐受性良好，并为儿童及其家长所接受。为了最大限度地发挥我的研究成果的影响，我在本次更新奖学金中建议对一个高负担国家的疟疾和蠕虫综合控制方法的有效性和可持续性进行评估。在确定了综合办法的可行性和安全性之后，现在必须调查这一办法在比试点研究所包括的更多人口中的总体影响和成本效益。还必须获得关于疟疾和儿童寄生虫综合传播模式的业务费用和成本效益的信息。将需要这种经济分析来为资源分配提供信息，允许与替代干预措施进行比较，并为该方法的部署提供信息。本次研究金续期将侧重于两个主要目标：1)评估联合使用抗疟疾和驱虫药物在降低居住在高负担国家的学龄前儿童和学龄儿童中贫血患病率和疟疾-蠕虫混合感染强度方面的有效性。2)确定向儿童提供综合疟疾驱虫方法的成本和成本效益。为了实现这些目标，我将进行一项干预研究，将在西非一个流行疾病的国家招募10个村庄的1200名儿童，并将其家庭分为两个平等的小组。其中一组将只接受抗疟疾药物，而第二组将在接受抗疟疾药物的同时接受驱虫药物。在给两组儿童服用这些药物前后，将采集他们的血液、尿液和粪便样本，以检查他们的血液水平(血红蛋白浓度)以及疟疾和寄生虫水平是否有任何变化。为了确定这种新方法是否负担得起和可持续，将对实施综合治疗的增量财务和经济成本进行详细的成本分析。这项新研究的结果将极大地巩固我在UKRI奖学金的第一部分所取得的成果，即为被忽视的疟疾(NTD)综合控制制定战略干预措施，这可能有助于在2030年前消除疟疾和寄生虫。这也将使我具备成为全球可见的疟疾-非传染性疾病综合消除战略研究领导者的技能集。

Malaria remains a major health problem, especially in sub-Saharan Africa where more than 90% of the disease and deaths occur in children. Adding to this high burden among children is the co-existence of parasitic worms. Existing control programmes for the worms are operating sub-optimally despite the 2012 London Declaration of eliminating some of the parasitic worms by 2020. On the other hand, a malaria prevention programme, called Seasonal Malaria Chemoprevention (SMC), introduced the same year in 2012 has achieved better coverage and prevented a substantial proportion of deaths in children. This encouraging development supports the need to explore the strategies involving the integration of worm control with successful platforms such as SMC. This would align parasitic worm and malaria control with the Sustainable Development Goals of ending diseases of poverty and promoting health and well-being for those at risk.To achieve these goals, I implemented four different research studies to quantify the burden of mixed infections with malaria and parasitic worms among children living in poor countries of the world. I also used the findings of my research studies to test the feasibility and safety of combining malaria and worm treatment together among children living in Senegal, West Africa. The findings of this study showed that the integration of mass deworming with antimalarial drugs was feasible, well-tolerated, and acceptable to children and their parents. To maximise the impact of my findings, I propose in this renewal fellowship, an evaluation of the effectiveness and sustainability of integrated malaria and worm control approach in a high-burden country. Having established the feasibility and safety of the integrated approach, it is now important to investigate the overall impact and cost-effectiveness of this approach in a larger population than was included in the pilot study. It is also important to obtain information on the operational costs and cost-effectiveness of an integrated delivery model for malaria and parasitic worms among children. This economic analysis will be needed to inform resource allocations, allow comparison with alternative interventions, and inform the deployment of the approach. This fellowship renewal will focus on two main objectives: 1) to evaluate the effectiveness of combining antimalarial and deworming drugs in reducing the prevalence of anaemia and the intensity of malaria-helminth co-infections among a population of pre-school and school-age children resident in a high-burden country. 2) to determine the cost and cost-effectiveness of delivering the integrated malaria-deworming approach to children. To achieve these objectives, I will conduct an intervention study where 1200 children in 10 villages in an endemic country in West Africa will be recruited and divided by their households into two equal groups. One group will receive the antimalarial drugs only, while the second group will receive deworming drugs along with antimalarial medications. Blood, urine and stool samples will be collected from the children in the two groups before and after giving them these medications to check whether there are any changes in their blood level (haemoglobin concentration) and malaria and worm parasite levels. To determine if this new approach is affordable and sustainable, a detailed costing analysis of the incremental financial and economic costs of implementing the integrated treatment will be done.The findings of this new study will significantly consolidate the achievements I have made during the first part of my UKRI fellowship in developing strategic interventions for integrated malaria-neglected tropical diseases (NTD) control, which could help to eliminate malaria and parasitic worms by 2030. This will also equip me with the skill set to become established as a globally visible Research Leader in integrated malaria-NTD elimination strategies.