Screening and treating malaria in schools ‘not useful’

Pre-schoolgoing children
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  • Experts say Africa lacks effective malaria control interventions in schools
  • Anew study in Kenya shows malaria treatment in schools do not benefit children
  • An expert advises donors to fund effective malaria control strategies

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[NAIROBI] A new study in Kenya on how school-based malaria interventions affect the health of children and their education has recommended that intermittent screening and treatment (IST) should not be implemented in low- to- moderate malaria transmission settings.
Researchers from Kenya, United Kingdom and the United States say previous studies in high malaria transmission areas indicated beneficial effects of IST, but there is limited evidence of the effectiveness of such interventions in low-to-moderate malaria transmission areas.
The researchers selected more than 5,000 children in 101 government primary schools in the south coast of Kenya in January 2010. Half of the schools were randomly selected to receive IST or no intervention. The IST involved using rapid diagnostic test to screen children in classes one to five once a term for malaria parasites and a follow-up treatment with the anti-malarial drug arthemeter-lumefantrine for those who tested positive.

“Although children found to be infected were treated, a substantial proportion of the school population and the wider community were untested and untreated, contributing to re-infection.”

Simon Brooker, London School of Hygiene and Tropical Medicine

For both schools with or without the IST, the researchers measured the proportion of children with anaemia and malaria at 12 months and 24 months and the class educational achievement tests at 9 months and 24 months, according to the study published on 28 January this year in PLOS Medicine.
Simon Brooker, a co-author of the study and professor of epidemiology at the UK-based London School of Hygiene and Tropical Medicine, tells SciDev.Net that IST for malaria had no benefits on the percentage of children infected with malaria parasites or on levels of anaemia, sustained attention or educational achievement.
“Although children found to be infected were treated, a substantial proportion of the school population and the wider community were untested and untreated, contributing to re-infection,” Brooker explains.
But he identifies the benefits of the research: “The results highlight a potential role for schools in detecting pockets of high malaria transmission [for targeted malaria control]”.
Brooker notes that studies carried out throughout Africa show that infection with malaria parasites can negatively affect children’s health and educational performance, but says “the region lacks a clear policy and technical guidance as to the most effective malaria intervention which can be delivered through schools in different settings”.
Brooker calls for more research to identify alternative malaria interventions which can be included in an integrated school health programme across Africa. 
Waqo Ejersa, an official from Kenya’s National Malaria Control Programme, says his outfit has accepted the outcome of the study and thus advises donors and interested partners not to fund IST of malaria but to be more involved in promoting effective malaria control strategies.

He says Kenya is intensifying the campaign on malaria treatment and vector control.
“We have managed to reduce the percentage rate of malaria cases from 60 per cent in the 1990s to less than five per cent through the application of different interventions,” Ejersa adds, citing provision of institutional spraying, health education and bed nets as some of the interventions.

Link to full article/paper inPLOS Medicine

This article has been produced by SciDev.Net's Sub-Saharan Africa desk.


PLOS Medicinedoi10.1371/journal.pmed.1001594 (2014)