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| ID | Type | Description | Link |
|---|---|---|---|
| ZAMREC/0001/January/2016 | Other Identifier | Zanzibar Medical Research Ethical Committee |
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| Name | Class |
|---|---|
| Mahidol Oxford Tropical Medicine Research Unit | OTHER |
| RTI International | OTHER |
| The President's Malaria Initiative | UNKNOWN |
| University of California, San Francisco |
The overall aim of this study is to determine the effectiveness of two rounds of mass drug administration (MDA) with dihydroartemisinin-piperaquine (DHAp) + single low dose (SLD) primaquine for reducing seasonal malaria transmission in Shehias considered hotspots on Unguja Island, Zanzibar.
Study design: This is a cluster-randomised controlled study with two arms: an intervention arm with two rounds of MDA with dihydroartemisinin-piperaquine (DHAp) + single low dose (SLD) primaquine, and a control arm with no MDA.
Study site and study population: The study will be conducted in 16 hotspot Shehias (8 Shehias randomly allocated to each arm), in three districts (West, Central and South districts) in Unguja Island, Zanzibar. Hotspot Shehias [Shehia being the smallest administrative structure in Zanzibar] are defined as Shehias with an annual malaria incidence of >0.8%, calculated as the number of confirmed malaria infections notified at health facilities and during active case detection in 2015 / Shehia projected population for 2015. The study population will include all consenting residents of the selected Shehias, reaching approximately 24000 people.
Study implementation: Two rounds of MDA with DHAp (D-ARTEPP, Guilin Pharmaceutical (Shanghai) Co., Ltd., China) and SLD (0.25mg/kg) primaquine (Primaquine, Remedica Ltd.,Cyprus ) will be conducted approximately four weeks apart in the intervention Shehias, at the anticipated lowest point of malaria transmission prior to the onset of malaria transmission associated with the main rains in April-June 2016. The first drug dose including DHAp and SLD primaquine will be given under supervision whenever possible; the other two doses of the standard once daily DHAp regimen will be taken unsupervised at home. Labelled packets containing all three doses will be left with the head of household with clear instructions for individuals not present at the time of the household visit.
Study objectives: The primary objective of the study is to determine the effectiveness of two rounds of MDA with DHAp + SLD primaquine for reducing seasonal malaria transmission in Shehias considered hotspots on Unguja Island, Zanzibar. The secondary objectives of the study include determining MDA coverage, compliance, and safety after one and two rounds of DHAp + SLD primaquine.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| MDA with DHAp and SLD Primaquine | Experimental | MDA will be conducted at two time points with an approximate four-week interval. All consenting and eligible community members will be administered age-appropriate treatment dose of dihydroartemisinin-piperaquine (D-ARTEPP, Guilin Pharmaceutical (Shanghai) Co., Ltd., China) and single low dose (0.25mg/kg) primaquine (Primaquine, Remedica Ltd., Cyprus) in house-to-house campaigns. |
|
| Control | No Intervention | The control arm (no MDA) will have the standard care offered by the Ministry of Health and Social welfare which applies to both arms. This includes passive case detection of individuals seeking treatment at local health facilities, and universal coverage of long lasting insecticide treated bed nets and indoor residual spraying in the study areas. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MDA with DHAp and SLD Primaquine | Drug |
|
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| Measure | Description | Time Frame |
|---|---|---|
| Cumulative notified malaria incidence in the MDA and control Shehias | Cumulative notified malaria incidence determined as the number of confirmed malaria cases notified at health facilities (monitored through the malaria case notification system during the period of six months) over the Shehia population size determined by population enumeration at the time of the intervention. | 6 months after second round of MDA |
| Measure | Description | Time Frame |
|---|---|---|
| PCR determined community prevalence of Plasmodium infections in the MDA and control Shehias | PCR determined community prevalence of Plasmodium infections determined by cross-sectional screening in every other household in the study area at the time of the first round of MDA, and at six months after the second round of MDA. | Baseline and 3 months after second round of MDA |
| Measure | Description | Time Frame |
|---|---|---|
| Population coverage of the MDA intervention at each round | MDA coverage determined as the number of administered DHAp and SLD primaquine doses during the first and second round of MDA, over over the Shehia population size determined by population enumeration at the time of the intervention. | Through completion of first and second round of MDA, i.e. 15 days and 48 days after initiation of MDA, respectively. |
Inclusion Criteria:
Exclusion Criteria:
Additional exclusion criteria for treatment with SLD Primaquine:
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| Name | Affiliation | Role |
|---|---|---|
| Anders Björkman, MD, PhD | Karolinska Institutet | Principal Investigator |
| Abdullah S Ali, Programme Manager | Zanzibar Malaria Elimination Programme | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zanzibar Malaria Elimination Programme | Mwanakwerekwe | Urban District, Zanzibar | Tanzania |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34585740 | Derived | Shah MP, Hwang J, Choi L, Lindblade KA, Kachur SP, Desai M. Mass drug administration for malaria. Cochrane Database Syst Rev. 2021 Sep 29;9(9):CD008846. doi: 10.1002/14651858.CD008846.pub3. | |
| 30526588 | Derived | Morris U, Msellem MI, Mkali H, Islam A, Aydin-Schmidt B, Jovel I, Shija SJ, Khamis M, Ali SM, Hodzic L, Magnusson E, Poirot E, Bennett A, Sachs MC, Tarning J, Martensson A, Ali AS, Bjorkman A. A cluster randomised controlled trial of two rounds of mass drug administration in Zanzibar, a malaria pre-elimination setting-high coverage and safety, but no significant impact on transmission. BMC Med. 2018 Dec 10;16(1):215. doi: 10.1186/s12916-018-1202-8. |
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| ID | Term |
|---|---|
| D008288 | Malaria |
| ID | Term |
|---|---|
| D011528 | Protozoan Infections |
| D010272 | Parasitic Diseases |
| D007239 | Infections |
| D000096724 | Mosquito-Borne Diseases |
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| ID | Term |
|---|---|
| D000074381 | Mass Drug Administration |
| D012847 | Single Person |
| D011319 | Primaquine |
| ID | Term |
|---|---|
| D018890 | Chemoprevention |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D060740 | Disease Eradication |
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| OTHER |
| Uppsala University | OTHER |
| Zanzibar Malaria Elimination Programme | OTHER_GOV |
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| Proportion of population receiving two rounds of MDA | The proportion of the population having received zero, one or two rounds of MDA. Refusal and reason for refusal to participate will be recorded. | Through completion of the second round of MDA, i.e. 48 days after initiation of MDA. |
| Population compliance to the MDA intervention at each round | MDA compliance, i.e. the proportion of the population that have taken one, two or all three doses of DHAp + SLD primaquine, will be evaluated in a subset of the population by post-MDA surveys conducted seven days after the initiation of each MDA round. The post MDA surveys will include both a questionnaire and finger prick blood sampling for measuring piperaquine blood concentrations. | 7 days after both first and second round of MDA |
| Occurence of adverse events after MDA with DHAp and SLD primaquine | A brief questionnaire will be conducted in a subset of the population during post-MDA surveys conducted seven days after the initiation of each MDA round. The questionnaire will include specific questions regarding adverse events such as vomiting, nausea, gastrointestinal upset, rash and fatigue. Severe adverse events, especially symptoms of haemolysis, will be captured at health facilities where haemoglobin and dark urine (representing haemolysis) will be measured and reported using the pharmacovigilance forms and the Primaquine Roll Out Monitoring Pharmacovigilance Tool (PROMPT) developed by the Global Health Group at University of California San Francisco. | 14 days after both first and second round of MDA |
| Cumulative notified malaria incidence in the MDA and control Shehias during the following high transmission season. | Cumulative notified malaria incidence during the following high transmission season, monitored through the malaria case notification system, to assess the long-term effectivness of MDA. | 15 months after second round of MDA |
| D000079426 |
| Vector Borne Diseases |
| D011634 |
| Public Health |
| D004778 | Environment and Public Health |
| D003140 | Communicable Disease Control |
| D015980 | Public Health Practice |
| D017533 | Marital Status |
| D005191 | Family Characteristics |
| D003710 | Demography |
| D011154 | Population Characteristics |
| D012959 | Socioeconomic Factors |
| D000634 | Aminoquinolines |
| D011804 | Quinolines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |