Effectiveness of Mass Drug Administration for Reducing Seasonal Malaria Transmission in Zanzibar

NCT ID: NCT02721186

Last Updated: 2017-10-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

22500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-04-30

Study Completion Date

2017-09-30

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Malaria Plasmodium Infections

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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MDA with DHAp and SLD Primaquine

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.

Group Type EXPERIMENTAL

MDA with DHAp and SLD Primaquine

Intervention Type DRUG

Control

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.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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MDA with DHAp and SLD Primaquine

Intervention Type DRUG

Other Intervention Names

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Mass drug administration with DHAp and SLD Primaquine MDA with Dihydroartemisinin-Piperaquine and SLD Primaquine MDA with D-ARTEPP and single low dose Primaquine

Eligibility Criteria

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Inclusion Criteria

* Permanent or temporary resident of study Shehias (i.e., persons who stayed in the selected household the night before the interview)
* Provision of informed consent (refusal must be recorded)
* Age \>6 months

Exclusion Criteria

* Women pregnant in first trimester (assessed by a specific set of questions designed to exclude pregnancy)
* Severe disease that requires immediate referral to health facility or hospital
* Concurrent antimalarial treatment at time of MDA or during the last 14 days
* Inability to take oral medication


* Pregnancy (all trimesters, assessed by a specific set of questions designed to exclude pregnancy)
* Women breast feeding infants aged \< 6months
Minimum Eligible Age

6 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Mahidol Oxford Tropical Medicine Research Unit

OTHER

Sponsor Role collaborator

RTI International

OTHER

Sponsor Role collaborator

The President's Malaria Initiative

UNKNOWN

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role collaborator

Uppsala University

OTHER

Sponsor Role collaborator

Zanzibar Malaria Elimination Programme

OTHER_GOV

Sponsor Role collaborator

Ulrika Morris

OTHER

Sponsor Role lead

Responsible Party

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Ulrika Morris

Postdoc, Study Coordinator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Anders Björkman, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Karolinska Institutet

Abdullah S Ali, Programme Manager

Role: PRINCIPAL_INVESTIGATOR

Zanzibar Malaria Elimination Programme

Locations

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Zanzibar Malaria Elimination Programme

Mwanakwerekwe, Urban District, Zanzibar, Tanzania

Site Status

Countries

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Tanzania

References

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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.

Reference Type DERIVED
PMID: 34585740 (View on PubMed)

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.

Reference Type DERIVED
PMID: 30526588 (View on PubMed)

Other Identifiers

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ZAMREC/0001/January/2016

Identifier Type: OTHER

Identifier Source: secondary_id

MaDrAZ-001

Identifier Type: -

Identifier Source: org_study_id