This study aims to evaluate the effectiveness of the use of adapted insecticide-treated mosquito nets combined with extended DHA-PQ-based seasonal chemoprevention for all ages and behavior change communication in reducing the burden of malaria in relation to standards of protection and care among students (taalibés) in the daaras (Koranic schools) of Touba, Senegal.
In Senegal, young children (mostly boys) may be sent to religious schools (daaras) to learn about the Koran and moral and cultural values. The students (talibés) often live and sleep in crowded conditions and as a result, insecticide-treated net (ITN) use is consistently low due to challenges faced in hanging ITNs as well as difficulty covering multiple children sleeping together. This study will consist of a two-arm cluster-randomized controlled trial to evaluate the effectiveness of an intervention package in urban daaras in Touba City, Diourbel region, Senegal. The intervention package will include vector control through meganets (multiple insecticide-treated mosquito nets sewn together and adapted based on the needs and sleeping situation of the daara), seasonal malaria chemoprevention (SMC) extended to all ages using DHA-PQ, and behavior change communication. Prior to evaluating an intervention, there will be 1) a mapping of the daaras in Touba City, Diourbel Region of Senegal to observe the various structures and types of daaras in order to select typical daaras for the entomological component, and to inform randomization, 2) human behavior observation (HBO) of students (talibes) and teachers (marabouts) in 2-3 daaras selected through the mapping to help tailor the intervention package, and 3) analysis of mosquito behavior observed through human landing catches. Two cross-sectional surveys will be conducted, before and after the intervention, which will include an electronic questionnaire to be sent to the taalibés themselves or to their guardians, a temperature reading, an RDT for participants with a fever at the time of the survey, and a fingertip blood sample to assess parasite prevalence (microscopy and PCR). Qualitative surveys will be carried out using a mixed-method design, consisting of a literature review, in-depth individual interviews, focus groups, and on-site observations. Meganet monitoring surveys will be carried out after meganet distribution to assess the attrition and physical integrity of the nets. Malaria incidence will be determined from records of community health workers assigned to the daaras who have been trained by the Ministry of Health to identify febrile students, test them for malaria using a rapid diagnostic test and treat confirmed cases with an antimalarial medicine. Additional data on students who seek care from health centers in their neighborhood will supplement the data obtained from community health workers.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
4,600
Intervention package will include vector control through meganets (multiple insecticide-treated mosquito nets sewn together), seasonal malaria chemoprevention (SMC) extended to all ages using DHA-PQ, and behavior change communication.
Daaras in Touba
Touba, Senegal
Difference in cumulative incidence of clinical malaria confirmed by rapid diagnostic test (RDT) between arms
Cumulative incidence will be defined as the number of RDT-confirmed malaria cases per 1000 population in each daara. Cases will be identified from both PECAdaara and health facility registries
Time frame: monthly basis over 12 months
Difference in change in prevalence of microscopy-confirmed infection between arms
Prevalence will be defined as the proportion of individuals with microscopy-confirmed infection assessed during the endline survey
Time frame: 12 months
Difference in pre-post change in prevalence of PCR-confirmed infection between arms
Prevalence will be defined as the proportion of individuals with PCR-confirmed infection, assessed during cross-sectional surveys
Time frame: 12 months
Difference in cumulative incidence of grade 3+ adverse events after drug administration between arms
Defined as the number of grade 3+ AEs divided by the participant population who received at least one dose of drug.
Time frame: 12 months
Difference in the cumulative incidence of serious adverse events (SAE) after SMC administration between arms
Adverse events will be classified as serious or non-serious based on standardized AE grading scale
Time frame: 12 months
Difference in human behavior on net use before and after ITN/meganet distribution
ITN use (e.g., sleeping under net in the previous night, sleeping indoors versus outdoors) will be assessed during cross-sectional surveys
Time frame: 12 months
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Difference in indoor and outdoor adjusted human biting rates between arms
The human landing rate will be used as a proxy for the human biting rate (HBR). The HBR data will be integrated with the human behavior observation (HBO) data on net use and sleep patterns data by calculating the hourly adjusted HBR.
Time frame: 12 months
Difference in Anopheles biting trends between arms
Anopheles biting trends will be examined by measuring the Anopheles biting times (including peak biting time), biting locations (indoors and outdoors), and vector density (defined as mean number of bites received by one person in one night) during human landing catches
Time frame: 12 months
Acceptability of intervention package
Perceptions of intervention package and reasons for participation assessed through qualitative studies conducted throughout the study period
Time frame: 12 months
Difference in proportion of refusals between arms
Refusals will be defined as the number of those who refused a specific intervention divided by the number of participants who were targeted and eligible to receive the specific intervention (i.e., chemoprevention and meganets).
Time frame: 12 months
Difference in distribution coverage of chemoprevention strategies between arms
Distribution coverage will be defined as the number of persons who received intervention divided by number of those targeted and eligible
Time frame: 12 months
Difference in crude coverage of chemoprevention strategies between arms
Crude coverage will be defined using WHO criteria as number of persons who received the intervention divided by number of those who were targeted (regardless of eligibility)
Time frame: 12 months
Cost per malaria case averted
Total intervention costs will be calculated in both arms and compared with efficacy measures of malaria incidence to generate the incremental cost effectiveness ratio.
Time frame: 12 months