Impact of Malaria Prevention on Health and Education in Kenyan Schoolchildren

NCT00878007 | Completed DMC

• 1 other identifier: 5503
• Study Type: interventional
• Target: 5,177
• Locations: 1 country
• Sites: 1

Brief Summary

While malaria represents one of the main health problems afflicting schoolchildren, the evidence base for policy development and programme implementation for school-based malaria control remains inadequate. A recent study in western Kenya showed that delivering intermittent preventive treatment (IPT) to schoolchildren improved rates of anaemia and classroom concentration, but did not improve school performance. This study aims to (i) investigate the impact of malaria prevention using a strategy of periodic screening using malaria rapid diagnostic tests and treatment positives using artemether-lumefantrine (AL) on health and education among schoolchildren and (ii) determine the interaction between health and improved literacy instruction. The study hypothesis is that that school-based malaria prevention will reduce rates of anaemia or improve educational outcomes in Kenyan schoolchildren, when compared to comparison schools. In addition, a programme of training for primary school teachers to improve literacy instruction will improve literacy rates and there will be no interaction between the malaria intervention and the education intervention, such that learning will not be improved when teaching is effective and children are healthy. The study will be undertaken in 101 randomly selected primary schools in Kwale District. The malaria intervention consists of screening all children using rapid diagnostic tests (RDTs) for malaria. Children (with or without clinical malaria symptoms) found to be RDT-positive will be treated with AL according to national guidelines. Screening and treatment will be administered by district public health staff once a school term, observed by the evaluation research team. This intervention has been changed from IPT due to the withdrawal of amodiaquine in Kenya. The education intervention includes a programme of training for primary school teachers to improve literacy instruction. The study is designed to detect a 25% reduction in anaemia and an improvement of 0.2 standard deviations in mathematics and literacy tests. Additional outcomes will also be measured including malaria parasitaemia, classroom attention and school attendance. Cost-effectiveness and community acceptability of the interventions will be assessed. Anaemia and educational outcomes will be assessed before interventions and 12 and 24 months later. Malaria parasitaemia using blood slides will only be assessed at follow-up.

Conditions

Anaemia; Malaria

Keywords

Anaemia; Malaria; Literacy; Kenya

Outcome Measures

Primary Outcomes (2)

• Anaemia

  2 years

• Education achievement assessed by a battery of tests of reading, writing and arithmetic

  2 years

Secondary Outcomes (6)

• Prevalence of malaria parasitemia

  2 years

• Concentration as assessed by classroom-based tests of sustained attention

  2 years

• School attendance as assessed by class attendance registers

  2 years

• Examination results as assessed by government examination scores

  2 years

• Cost-effectiveness

  2 years

Study Arms (4)

1

EXPERIMENTAL

Intermittent screening and treatment (IST) for malaria. This intervention is a change from a previous intervention based on intermittent preventive treatment for malaria owning to the withdrawal of amodiaquine (one of the previous IPT drugs) in Kenya in 2009.

Drug: Intermittent screening and treatment for malaria

2

EXPERIMENTAL

Enhanced teacher training on literacy instruction.

Behavioral: Teacher training on literacy instruction

3

EXPERIMENTAL

Intermittent screening and treatment (IST) for malaria and enhanced teacher training on literacy instruction

Other: IST plus literacy instruction programme

4

NO INTERVENTION

Interventions

Intermittent screening and treatment for malaria DRUG

All children will be screened for malaria using rapid diagnostic tests (RDTs) once a term (thrice yearly). Children (with or without clinical malaria symptoms) found to be RDT-positive will be treated with artemether-lumefantrine according to national guidelines. Screening and treatment will be administered by district public health staff once a school term, observed by the evaluation research team.

1

Teacher training on literacy instruction BEHAVIORAL

Education intervention designed to improved early grade literacy instruction, focusing on phonological awareness \& vocabulary and relationship between letters and sounds in a systematic and explicit fashion. Specific interventions will include training on (i) how to monitor students' progress in large classes (ii) developing and using instructional materials for reading (iii) lesson planning for explicit teaching of letter-sound relationships (iv) instructional techniques for large classes.

2

IST plus literacy instruction programme OTHER

Schools will receive both IST and the literacy instruction programme

3

Eligibility Criteria

• Age: 5 Years - 18 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Pupil enrolled at participating schools in classes 1 and 5;
• Provision of informed consent from parent or guardian;
• Provision of assent by student

You may not qualify if:

• Pupils unwilling to participate in the study;
• Known allergy or history of adverse reaction to study medications;
• Known or suspected sickle-cell trait

Sponsors & Collaborators

• London School of Hygiene and Tropical Medicine: lead
• World Bank: collaborator

Study Sites (1)

KEMRI-Wellcome Trust Programme

Nairobi, P.O. Box 43640 - 00100, Kenya

Location

Related Publications (6)

• Brooker S, Okello G, Njagi K, Dubeck MM, Halliday KE, Inyega H, Jukes MC. Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya. Trials. 2010 Oct 7;11:93. doi: 10.1186/1745-6215-11-93.

  PMID: 20929566 BACKGROUND

• Okello G, Jones C, Bonareri M, Ndegwa SN, McHaro C, Kengo J, Kinyua K, Dubeck MM, Halliday KE, Jukes MC, Molyneux S, Brooker SJ. Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya. Trials. 2013 May 16;14:142. doi: 10.1186/1745-6215-14-142.

  PMID: 23680181 BACKGROUND

• Halliday KE, Okello G, Turner EL, Njagi K, Mcharo C, Kengo J, Allen E, Dubeck MM, Jukes MC, Brooker SJ. Impact of intermittent screening and treatment for malaria among school children in Kenya: a cluster randomised trial. PLoS Med. 2014 Jan 28;11(1):e1001594. doi: 10.1371/journal.pmed.1001594. eCollection 2014 Jan.

  PMID: 24492859 RESULT

• Halliday KE, Karanja P, Turner EL, Okello G, Njagi K, Dubeck MM, Allen E, Jukes MC, Brooker SJ. Plasmodium falciparum, anaemia and cognitive and educational performance among school children in an area of moderate malaria transmission: baseline results of a cluster randomized trial on the coast of Kenya. Trop Med Int Health. 2012 May;17(5):532-49. doi: 10.1111/j.1365-3156.2012.02971.x.

  PMID: 22950512 RESULT

• Drake TL, Okello G, Njagi K, Halliday KE, Jukes MCh, Mangham L, Brooker S. Cost analysis of school-based intermittent screening and treatment of malaria in Kenya. Malar J. 2011 Sep 20;10:273. doi: 10.1186/1475-2875-10-273.

  PMID: 21933376 RESULT

• Okello G, Ndegwa SN, Halliday KE, Hanson K, Brooker SJ, Jones C. Local perceptions of intermittent screening and treatment for malaria in school children on the south coast of Kenya. Malar J. 2012 Jun 8;11:185. doi: 10.1186/1475-2875-11-185.

  PMID: 22681850 RESULT

MeSH Terms

Conditions

Anemia; Malaria; Literacy

Interventions

Therapeutics

Condition Hierarchy (Ancestors)

Hematologic Diseases; Hemic and Lymphatic Diseases; Protozoan Infections; Parasitic Diseases; Infections; Mosquito-Borne Diseases; Vector Borne Diseases; Communication; Behavior

Study Officials

• Simon Brooker, DPhil

  London School of Hygiene and Tropical Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 7, 2009
• First Posted: April 8, 2009
• Study Start: January 1, 2010
• Primary Completion: April 1, 2012
• Study Completion: April 1, 2012
• Last Updated: February 17, 2014

Record last verified: 2014-02

Locations

KE (1)