University Ceikh Anta Diop: Randomized trial of spatially targetted control to virtually eliminate malaria

The purpose of thistrial is to evaluate the extent to which a targetted malaria control strategy combining vectorcontrol with indoor residual spraying (IRS) and chemotherapy, delivered by district health staff tovillages reporting clinical cases, can virtually eliminate malaria, in an area in central Senegalwhere malaria incidence is very low and patchy. Secondly we will determine whether, as part ofthis strategy, chemotherapy should be delivered to all members of targetted communities or onlythose who have been tested and are known to be infected. Strategies to target communities withhigh incidence of malaria in order to achieve community-wide malaria control have beenadvocated (Carter et al., 2000), and have a sound basis in population theory (Nold 1980;Hasibeder and Dye 1988; Smith et al. 2007), but have not been evaluated in randomized trials.Such strategies become increasingly relevant as malaria incidence declines and the geographicaldistribution becomes very patchy. Treatment of asymptomatic carriers is acknowledged to be anessential component of elimination programmes but it is an open question as to whetheradministration of antimalarial drugs to all members of the community (mass drug administration,MDA) or screening and treatment of positives (mass screening and treatment, MSAT) should beused. Removing carriers of infection by screening and treating those who are positive is inprinciple preferable to a policy of treating everyone without testing, but requires a sensitive testand good coverage and acceptability of the screening. Mass drug administration, treating allmembers of the community whether or not they are infected, aims to reach as many carriers aspossible, is simpler to deliver, and provides all members of the community with prophylaxis, buthas the drawback of potentially unnecessary drug intake and the risk of creating increasedselection pressure for drug resistance. Which of these approaches is more acceptable tocommunities, and the relative costs, is also not known

Programme: Joint Global Health Trials Award

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