Intermittent preventive treatment of malaria in school children: from research into policy.

Malaria remains a major public health threat despite considerable progress on control in the past decade. We, and others, demonstrated that the burden of malaria in school aged children is substantial with significant consequences later on in life. Recent decreases in the malaria burden puts school-aged children increasingly more at risk for malaria. The mainstay for malaria control includes use of insecticide-treated nets (ITNs), indoor residual spraying (IRS), prompt diagnosis and treatment with an effective antimalarial drug . Malaria control interventions often target vulnerable populations, pregnant women and children under-fives or targets the population at large. Yet, these interventions have a weak coverage in school aged children and no malaria control interventions specifically target in school-aged children. In 2012, we started field work on this theme in DR Congo, a high malaria endemic setting, and proved that Intermittent preventive treatment in school children (IPTsc) is an efficacious and feasible intervention. These findings are confirmed by others and at present, we're conducting similar research in different sociocultural and epidemiological settings in Ethiopia and North East Tanzania. This PhD proposal will provide required additional information to translate evidence gathered in previous research into policy. We will identify models of within-host dynamics of Plasmodium falciparum that have been fitted to parasite density profiles from malaria therapy patients, and simulations of P. falciparum epidemiology fitted to field malariologic datasets from a large ensemble of settings across Africa. We will use this models to assess the relative and absolute contribution of schoolchildren (6-12 yrs) on malaria transmission in different malaria endemic settings taking into account the (effectiveness of) other interventions. We hypothese that school aged children, who represent 26.8% of the population though over 40% of both the malaria reservoir and burden, are a main driver of malaria transmission. Further, will the selected integrated mathematical models be used for predicting the epidemiologic and economic effects of IPTsc both at the individual and population level. The models will provide a unique platform for predicting both the short- and long-term effects of IPTsc on the burden of disease, allowing for the temporal dynamics of effects on immunity and transmission. We'll perform a sensitivity analyses taking into account adherence, school attendance rates, drug resistance rated and thus assess the impact of IPTsc on the malaria burden and transmission at population (i.c. impact on population level R0-rates). It should be mentioned that in the last decades school attendance rates have raised to over 95% in most LMICs (though drop-out rates are still substantial). Finally, the chosen model will obtain robust cost-effectiveness estimates for IPTsc delivery strategies in different eco-epidemiologic settings. We will be able to rank IPTsc amongst other health interventions and stipulate its contributing role to attain several Sustainable Development Goals' (SDGs). In parallel, this PhD-program will be involved in 4 case studies in 4 different settings (Ethiopia, Tanzania, DR Congo and Burkina Faso) in which we will assess the possible institutional implementation modalities. This health (and educational) system analysis is a key element. Many evidence based policy recommendations have suboptimal coverage or are, in practice not implemented as it is not clear which department or control program should take up this additional intervention, determine the possible supply channels, reporting, training programs and resources needed. We will also at least explore how an IPTsc could be the nucleus, together with existing helminth control programs, for a comprehensive (institutionalized) school health program (i.e. including immunization activities, oral health, vision screening, health education, etc…).

Keywords:POLICY SUPPORTING, MALARIA, HEALTH CARE COST, SCHOOL CHILDREN

Disciplines:Health economy, Health management, Preventive medicine, Epidemiology, Tropical medicine