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

评估西非儿童蠕虫控制与季节性疟疾化学预防相结合的有效性和可持续性

• 批准号: MR/X023133/1
• 负责人: Muhammed Afolabi
• 金额: $ 68.32万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FX023133%2F1
• 关键词: Evaluating; effectiveness; sustainability; integrating; helminth

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.

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地区，那里 90% 以上的疾病和死亡发生在儿童身上。寄生虫的共存加剧了儿童的沉重负担。尽管 2012 年《伦敦宣言》提出到 2020 年消除部分寄生虫，但现有的疟疾控制计划运行效果不佳。另一方面，同年于 2012 年推出了名为季节性疟疾化学预防 (SMC) 的疟疾预防计划实现了更好的覆盖范围并避免了很大一部分儿童死亡。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策略的需要。这将使寄生虫和疟疾控制与消除贫困疾病和促进高危人群的健康和福祉的可持续发展目标保持一致。为了实现这些目标，我实施了四项不同的研究来量化疟疾混合感染的负担以及生活在世界贫困国家儿童中的寄生虫。我还利用我的研究结果来测试西非塞内加尔儿童将疟疾和蠕虫治疗结合起来的可行性和安全性。本研究结果表明，大规模驱虫与抗疟药物相结合是可行的，耐受性良好，并且为儿童及其家长所接受。为了最大限度地发挥我的研究结果的影响，我建议在这个更新奖学金中，对高负担国家疟疾和蠕虫综合控制方法的有效性和可持续性进行评估。在确定了综合方法的可行性和安全性后，现在重要的是在比试点研究中纳入的更大的人群中调查该方法的总体影响和成本效益。获取有关儿童疟疾和寄生虫综合传播模式的运营成本和成本效益的信息也很重要。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。此次奖学金更新将侧重于两个主要目标：1）评估抗疟药和驱虫药相结合在降低学龄前和学龄儿童贫血患病率和疟疾-蠕虫混合感染强度方面的有效性居住在高负担国家。 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，招募西非一个流行病国家 10 个村庄的 1200 名儿童，并按其家庭分为两个平等组。一组将仅接受抗疟药物，而第二组将接受驱虫药物和抗疟药物。两组儿童在服药前后均采集血液、尿液和粪便样本，检查其血液水平（血红蛋白浓度）以及疟疾和蠕虫寄生虫水平是否有变化。为了确定这种新方法是否负担得起且可持续，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第一部分中取得的成就。我的 UKRI 奖学金旨在制定综合控制疟疾被忽视的热带病 (NTD) 的战略干预措施，这有助于到 2030 年消除疟疾和寄生虫。这也将使我具备成为全球知名人士的技能疟疾-被忽视的热带疾病综合消除策略的研究领导者。