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A controlled, parallel, cluster-randomized trial of community-wide screening and treatment of asymptomatic carriers of Plasmodium falciparum in Burkina Faso
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BACKGROUND: In malaria-endemic countries, large proportions of infected individuals are asymptomatic, constituting a reservoir of parasites for infection of newly hatched mosquitoes. This study evaluated the impact of screening and treatment of asymptomatic carriers of Plasmodium falciparum. METHODS: Eighteen villages were randomized (1:1) to study arms and inhabitants participated in four community screening campaigns: three before the rainy season ~1 month apart, and the fourth after the rains at ~12 months. On day 1 of campaigns 1-3, asymptomatic carriers in the intervention arm were identified by rapid diagnostic test and treated with artemether-lumefantrine. Outcomes were symptomatic malaria with parasite density >5,000/μL per person-year in children < 5 years and change in haemoglobin between days 1 and 28 of campaign 1. RESULTS: At 12 months, the number of symptomatic malaria episodes with a parasite density >5,000/μL per person-year in children < 5 years was not significantly different between arms (1.69 vs 1.60, p = 0.3482). Mean haemoglobin change in asymptomatic carriers during campaign 1 was greater in the intervention vs control arm (+0.53 g/dL vs -0.21 g/dL, p < 0.0001). ANCOVA demonstrated that mean asymptomatic carriage at the cluster level was lower in the intervention vs control arm at day 1 of campaigns 2 (5.0% vs 34.9%, p < 0.0001) and 3 (3.5% vs 31.5%, p < 0.0001), but showed only a small difference at day 1 of campaign 4 (34.6% vs 37.6%, p = 0.2982). Mean gametocyte carriage was lower in the intervention vs control arm at day 1 of campaigns 2 and 3 (0.7% vs 5.4%, p < 0.0001; 0.5% vs 5.8%, p < 0.0001), but was similar at day 1 of campaign 4 (4.9% vs 5.1%, p = 0.7208). CONCLUSIONS: Systematic screening and treatment of asymptomatic carriers at the community level did not reduce clinical malaria incidence in the subsequent transmission season, indicating greater levels of parasite clearance are required to achieve a sustained impact in this setting.
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“a community trial in Burkina Faso with 12 months of follow-up demonstrated that active detection strategy has no effect on the prevalence of Plasmodium spp. or the incidence of malaria [33,37] owing to the low sensitivity of the diagnosis.”
From Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia (2023) · cites this paper as [37]
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Metadata
- Authors
- Tiono, A. B., Ouédraogo, A., Ogutu, B., Diarra, A., Coulibaly, S., Gansané, A., Sirima, S. B., O’Neil, G., Mukhopadhyay, A., & Hamed, K.
- Affiliations
- Centre National de Recherche et de Formation sur le Paludisme (BF)
- Kenya Medical Research Institute (KE)
- Novartis (Switzerland) (CH)
- Novartis (India) (IN)
- Corresponding author
- Tiono, Alfred B
- ORCID
- Venue
- Malaria Journal
- Published
- 2013-02-27
- Volume
- 12
- Issue
- 1
- Pages
- 79-79
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC3599538
- OpenAlex
- W2097232649
- Cited by
- 118
- References
- 24
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 8 · 2022: 2 · 2021: 2 · 2020: 19 · 2019: 7 · 2018: 6 · 2017: 13 · 2016: 16 · 2015: 15 · 2014: 15 · 2013: 6
- FWCI
- 17.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Malaria Journal (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Novartis Pharma
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Life Sciences › Immunology and Microbiology › Parasitology › Bird parasitology and diseases
- Health Sciences › Medicine › Genetics (clinical) › Hemoglobinopathies and Related Disorders
- Keywords
- Plasmodium falciparum, asymptomatic malaria, asymptomatic carriers, artemether-lumefantrine, gametocyte carriage, malaria transmission, malaria reservoir, hemoglobin, children under five, rapid diagnostic tests, malaria elimination, Burkina Faso, malaria-endemic countries
- MeSH terms
- Artemether, Lumefantrine Drug Combination, Adolescent, Adult, Aged, Aged, 80 and over, Antimalarials, Burkina Faso, Carrier State, Child, Child, Preschool, Drug Combinations, Ethanolamines, Female, Fluorenes, Humans, Infant, Male, Mass Screening, Middle Aged, Pregnancy, Rural Population, Incidence, Malaria, Falciparum, Treatment Outcome, Clinical Laboratory Techniques, Artemisinins, Young Adult, Asymptomatic Diseases
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