Negligible impact of mass screening and treatment on mesoendemic malaria transmission at west timor in eastern Indonesia: A cluster-randomized trial

Inge Sutanto, Ayleen Kosasih, Iqbal R.F. Elyazar, Deddy R. Simanjuntak, Tri A. Larasati, M. Sopiyudin Dahlan, Isra Wahid, Ivo Mueller, Cristian Koepfli, Rita Kusriastuti, Asik Surya, Ferdinand J. Laihad, William A. Hawley, Frank H. Collins, J. Kevin Baird, Neil F. Lobo

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Abstract

Background Mass screening and treatment (MST) aims to reduce malaria risk in communities by identifying and treating infected persons without regard to illness. Methods A cluster-randomized trial evaluated malaria incidence with and without MST. Clusters were randomized to 3, 2, or no MST interventions: MST3, 6 clusters (156 households/670 individuals); MST2, 5 clusters (89 households/423 individuals); and MST0, 5 clusters (174 households/777 individuals). All clusters completed the study with 14 residents withdrawing. In a cohort of 324 schoolchildren (MST3, n = 124; MST2, n = 57; MST0, n = 143) negative by microscopy at enrollment, we evaluated the incidence density of malaria during 3 months of MST and 3 months following. The MST intervention involved community-wide expert malaria microscopic screening and standard therapy with dihydroartemisinin-piperaquine and primaquine for glucose-6 phosphate dehydrogenase-normal subjects. All blood examinations included polymerase chain reaction assays, which did not guide on-site treatment. Results The risk ratios for incidence density of microscopically patent malaria in MST3 or MST2 relative to that in MST0 clusters were 1.00 (95% confidence interval [CI],.53-1.91) and 1.22 (95% CI,.42-3.55), respectively. Similar results were obtained with molecular analysis and species-specific (P. falciparum and P. vivax) infections. Microscopically subpatent, untreated infections accounted for 72% of those infected. Conclusions Two or 3 rounds of MST within 3 months did not impact the force of anopheline mosquito-borne infection in these communities. The high rate of untreated microscopically subpatent infections likely explains the observed poor impact. Clinical Trials Registration NCT01878357.

Original languageEnglish
Pages (from-to)1364-1372
Number of pages9
JournalClinical Infectious Diseases
Volume67
Issue number9
DOIs
Publication statusPublished - 15 Oct 2018

Keywords

  • Indonesia
  • cluster-randomized trial
  • malaria control
  • mass screening and treatment

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    Sutanto, I., Kosasih, A., Elyazar, I. R. F., Simanjuntak, D. R., Larasati, T. A., Dahlan, M. S., Wahid, I., Mueller, I., Koepfli, C., Kusriastuti, R., Surya, A., Laihad, F. J., Hawley, W. A., Collins, F. H., Baird, J. K., & Lobo, N. F. (2018). Negligible impact of mass screening and treatment on mesoendemic malaria transmission at west timor in eastern Indonesia: A cluster-randomized trial. Clinical Infectious Diseases, 67(9), 1364-1372. https://doi.org/10.1093/cid/ciy231