Evaluation of the Implementation and Effectiveness of Intermittent Preventive Treatment for Malaria Using Dihydroartemisinin-piperaquine on Reducing Malaria Burden in School Aged Children in Tanzania

NCT04245033 | Completed Phase 4

• 1 other identifier: IPTsc version 1
• Study Type: interventional
• Target: 4,100
• Locations: 1 country
• Sites: 1

Brief Summary

In Tanzania, according to the National Malaria Control Programme (NMCP), malaria prevalence has declined from an average of 18.1% in 2008 to 7% in 2017, marked as an epidemiological transition from meso-endemic to hypo-endemic levels with variation across and within regions and/or councils. Children of school-age have become increasingly more vulnerable as compared to those aged less than five years. In high-transmission settings, up to 70% of school-aged children harbour malaria parasites which is mostly asymptomatic, accounting for around 50% of the mortality, 13-50% of all school absenteeism. The NMCP developed a supplementary malaria midterm strategic plan (SMMSP 2018-2020) to customise malaria interventions by stratifying the burden of malaria in Tanzania mainland and recommended use of Dihydroartemisinin-Piperaquine (DP) for intermittent preventive treatment in school children (IPTsc) in high malaria strata. The investigators plan to evaluate the implementation of IPTsc using DP, given three times a year, for evidence on the operational feasibility and effectiveness of IPTsc on clinical malaria incidence at a high endemic area in Handeni District Council (DC), Handeni Town Council (TC) and Kilindi DC of Tanga region, Tanzania. The study is an effectiveness-implementation hybrid trial to assess feasibility and effectiveness of IPTsc using DP against standard of care (control). Wards in the three study districts (Handeni DC, Handeni TC and Kilindi DC) will be the randomisation unit (clusters). Each ward will be randomised to implement IPTsc or not (control). In all wards in the IPTsc arm, the interventional drugs (DP) will be given at an interval of four months, three times a year. For study evaluation of the impact of intervention, in each district representative randomly selected wards, will provide randomly selected school per ward (24 in total) to formulate part of evaluable children per intervention. Mixed design methods will be used to assess the feasibility and acceptability of implementing IPTsc as part of a more comprehensive school children health package. The study is expected to be operationally feasible given existing school health programme for Neglected Tropical Disease (NTD) control and the school net programme (SNP). IPTsc is expected to increase malaria case management effectiveness and to have additional effect in reducing the burden of disease on top of optimal access to malaria case management (MCM) and malaria vector control (MVC) initiatives e.g. early diagnosis and treatment, and insecticide-treated nets (ITNs) coverage, respectively.

Conditions

Malaria

Outcome Measures

Primary Outcomes (2)

• Efficiency of school health teachers to deliver antimalarial drugs to school children in high endemic regions

  Efficiency in terms of percentage of children given a complete dose in each round.

  1 year from start of intervention

• Clinical malaria incidence

  Malaria incidence will be collected in terms of number of episodes a child gets malaria.

  from month 0 till month 12 of follow up

Secondary Outcomes (5)

• Change in malaria incidence per 1000 population at local health facility level

  from month 0 till month 12 of follow up

• Change from baseline in haemoglobin concentration

  measured at month 12

• Number of participants with treatment-related adverse events

  through study completion, an average of 1 year"

• Cardio safety profile by QTc prolongation from baseline

  Day 1, 2,3 and 7 after before and after dosing

• Acceptability of IPTsc in communities with high malaria endemicities

  At month 8 of implementation

Other Outcomes (1)

• Proportion of school children with malnutrition

  at month 0 (baseline) and at month 12.

Study Arms (2)

IPTsc arm

EXPERIMENTAL

Dihydroartemisinin-Piperaquine (DP) for intermittent preventive treatment in school children (IPTsc) will be given in all wards in the IPTsc arm at an interval of four months, three times a year.

Drug: Dihydroartemisinin-Piperaquine (DP)

Control

NO INTERVENTION

No intervention will be given to wards randomised in this arm

Interventions

Dihydroartemisinin-Piperaquine (DP) DRUG

Dihydroartemisinin-Piperaquine (DP) for intermittent preventive treatment of malaria in school children (IPTsc).

IPTsc arm

Eligibility Criteria

• Age: 5 Years - 15 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Includes parental/guardian informed consent
• Assent by primary school children aged 11 years and above.
• Aged 5-15 years.
• Currently, lives within the pre-defined catchment area of study district; and
• Will remain within the same area throughout the study period (preferably class five and below).

You may not qualify if:

• Students at class 7
• Currently enrolled in another study or participated in another investigational drug study within the last 30 days.
• Known to have heart disease or a known cardiac ailment.
• Reports known hypersensitivity to the study drugs.
• Not willing to undergo all study procedures including physical examination and to provide blood samples as per this study protocol.
• Having clinical features of severe anaemia
• Febrile due to non-malaria illness at the time of recruitment.
• Has apparent severe infection or any condition that requires hospitalization
• Illness or conditions like hematologic, cardiac, renal, hepatic diseases which in the judgement of the investigator would place the subject at undue risk or interfere with the results of the study, including known G6PD deficiency and SS sickle cell.
• Body weight \< 12 kg

Sponsors & Collaborators

• National Institute for Medical Research, Tanzania: lead
• National Malaria Control Program, Tanzania: collaborator

Study Sites (1)

Handeni Town Council, Handeni and Kilindi Districts

Tanga, Tanzania

Location

Related Publications (2)

• Makenga G, Mmbando B, Seth MD, Baraka V, Challe DP, Francis F, Mhina AD, Liheluka E, Minja DTR, Chiduo M, Mtove G, Mandara C, Gesase S, Segeja MD, Kamugisha M, Hayuma PM, Mbwana JR, Sebukoto H, Malabeja A, Tupa JB, Ngede SJ, Lusasi A, Chacky F, David A, Thawer SG, Mohamed A, Aaron S, Lazaro S, Molteni F, Nkayamba A, Bastiaens H, Van Geertruyden JP, Lusingu JPA. Implementation and effectiveness of intermittent preventive treatment in school aged children using dihydroartemisinin-piperaquine to reduce malaria burden: an implementation research of a cluster randomised trial in Tanzania. EClinicalMedicine. 2025 Nov 7;90:103628. doi: 10.1016/j.eclinm.2025.103628. eCollection 2025 Dec.

  PMID: 41278241 DERIVED

• Makenga G, Seth MD, Baraka V, Mmbando BP, Challe DP, Francis F, Mhina A, Minja DTR, Chiduo M, Mandara C, Liheluka E, Gesase S, Segeja M, Mtove G, Kamugisha M, Lusasi A, Chacky F, David A, Thawer S, Mohamed A, Lazaro S, Molteni F, Nkayamba A, Van Geertruyden JP, Lusingu JPA. Implementation research of a cluster randomized trial evaluating the implementation and effectiveness of intermittent preventive treatment for malaria using dihydroartemisinin-piperaquine on reducing malaria burden in school-aged children in Tanzania: methodology, challenges, and mitigation. Malar J. 2023 Jan 6;22(1):7. doi: 10.1186/s12936-022-04428-8.

  PMID: 36609279 DERIVED

MeSH Terms

Conditions

Malaria

Condition Hierarchy (Ancestors)

Protozoan Infections; Parasitic Diseases; Infections; Mosquito-Borne Diseases; Vector Borne Diseases

Study Officials

• John P.A Lusingu, MD, PhD

  National Institute for Medical Research, Tanga, Tanzania

  STUDY DIRECTOR

• Ally Mohamed, MD

  National Malaria Control Programme, Tanzania

  STUDY DIRECTOR

• Geofrey Makenga, MD, Msc, PhD fellow

  National Institute for Medical Research, Tanzania

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Scientist

Model Details: The study is an effectiveness-implementation hybrid trial to assess feasibility and effectiveness of IPTsc using DP against standard of care (control). Wards in the three study districts (Handeni DC, Handeni TC and Kilindi DC) will be the randomisation unit (clusters). Each ward will be randomised to implement IPTsc or not (control).

Study Record Dates

• First Submitted: January 20, 2020
• First Posted: January 28, 2020
• Study Start: July 20, 2020
• Primary Completion: May 31, 2021
• Study Completion: June 28, 2021
• Last Updated: November 20, 2024

Record last verified: 2024-11

Locations

TA (1)