Malaria Chemoprevention Strategies

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "Vector-Borne Diseases".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 23297

Special Issue Editors


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Guest Editor
Department of Medicine, Diagnostics Unit, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland
Interests: molecular epidemiology; diagnostics; clinical trials; surveillance; malaria chemoprevention; pharmacokinetics; antimalarial drug efficacy; mode of action of antimalarial; antimalarial drug resistance

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Guest Editor
Global and Tropical Health Divisions, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
Interests: vivax malaria; malaria; clinical trials; epidemiology; drug resistance; translational research
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College St, New Haven, CT 06520, USA
Interests: antimalarial; pharmacokinetics; pharmacodynamics; clinical trials; drug resistance; epidemiology; endectocides; seasonal malaria chemoprevention

Special Issue Information

Dear Colleagues,

Malaria remains a global public health problem despite a dramatic decrease in both morbidity and mortality over the last twenty years. However, sustained efforts are required to achieve the ambitious goals set up in the Global Technical Strategy (GTS) for malaria by the World Health Organization (WHO), aiming at reducing malaria prevalence by 90% in 2030 compared to 2015, and eliminating malaria in at least 35 countries. Malaria control programs rely mainly on vector control by the use of long-lasting insecticide-treated bednets (LLINs), and prompt diagnosis and case management with highly efficacious antimalarial drugs. Those interventions have proven to be highly effective, but progress has stalled over the last few years, mainly in high-burden countries, and additional strategies are urgently needed to avoid a rebound and further decrease malaria-associated morbidity and mortality. Moreover, all those gains are hampered by the emergence of resistant parasites to first-line antimalarial treatements, i.e., artemisinin-based combination therapies (ACTs), and vector resistance to most widely used insecticides. Chemoprevention strategies are expected to contribute significantly to malaria control and elimination if largely deployed in malaria endemic settings. Intervention such as intermittent preventive treatment in pregnant women (IPTp) and seasonal malaria chemoprevention (SMC) have proven to be highly effective, even though development of resistance to the current regimens (sulfadoxine-pyrimethamine and amodiaquine) warrants the implementation of alternative antimalarial drugs in the near future. Intermittent preventive treatement in infants (IPTi) has been shown to have a substantial impact on morbidity and malaria-related anemia, but its full impact is yet to be investigated in large-scale implementation studies. As transmission decreases in some settings, there is an age shifting of disease burden in older infants, and intermittent preventive treatment in schoolchildren (IPTc) is being explored in some countries. Mass drug administration (MDA) is another strategy, mainly used in elimination settings that has been shown to work in some settings, but not in others. Specific strategies are also needed for P.vivax, as the implementation of radical cure drug-based strategies is associated with potential lethal hemolysis in G6PD-deficient patients. To maximize the impact of all those interventions, new antimalarial drugs will be required, as the effectiveness of those currently used is either descreasing or may decrease in the near future. In the meantime, innovative strategies must be implemented to extend the useful therapeutic lifespan of the antimalarial drugs we currently have, and different drugs should be used for chemoprevention and case management to reduce drug pressure and minimize the chances of drug resistance development. This Special Issue focuses on the different chemoprevention strategies available for malaria control and elimination, their potential impact in reducing both malaria morbidity and mortality, and challenges associated with their large-scale deployment in malaria endemic settings.

Dr. Christian Nsanzabana
Dr. Kamala Thriemer
Prof. Dr. Sunil Parikh
Guest Editors

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Keywords

  • Malaria
  • P. falciparum
  • P. vivax
  • Case management
  • Chemotherapy
  • Drug
  • Chemoprevention
  • Intermittent preventive treatment
  • Mass drug administration
  • Surveillance
  • Antimalarial
  • Resistance
  • Control
  • Elimination
  • Radical cure
  • G6PD deficiency
  • Eradication
  • Amodiaquine
  • Sulfadoxine–pyrimethamine

Published Papers (6 papers)

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Research

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13 pages, 411 KiB  
Article
Factors Influencing Second and Third Dose Observance during Seasonal Malaria Chemoprevention (SMC): A Quantitative Study in Burkina Faso, Mali and Niger
by Anyirékun Fabrice Somé, Issaka Zongo, Issaka Sagara, Alkassoum Ibrahim, Césaire Damien Ahanhanzo, Edoh Eddie Agbanouvi-agassi, Dona Alain Sayi, Lea Pare Toe, Zachari Kabré, Frédéric Nikiéma, Thomas Bazié, Sylvin Ouédraogo, Issiaka Sombié, Alassane Dicko, Eric Adehossi, Jean-Bosco Ouédraogo and Kounbobr Roch Dabiré
Trop. Med. Infect. Dis. 2022, 7(9), 214; https://doi.org/10.3390/tropicalmed7090214 - 29 Aug 2022
Cited by 2 | Viewed by 1971
Abstract
This study aims to evaluate the factors influencing the adherence to the 2nd and 3rd doses of Amodiaquine (AQ) during seasonal malaria chemoprevention (SMC) in Burkina Faso, Mali, and Niger. Overall, 3132 people were interviewed during surveys between 2019 and 2020 in 15 [...] Read more.
This study aims to evaluate the factors influencing the adherence to the 2nd and 3rd doses of Amodiaquine (AQ) during seasonal malaria chemoprevention (SMC) in Burkina Faso, Mali, and Niger. Overall, 3132 people were interviewed during surveys between 2019 and 2020 in 15 health districts. In Burkina Faso, Mali, and Niger, the proportions of non-adherence were 4.15%, 5.60%, and 13.30%, respectively, for the 2nd dose and 3.98%, 5.60% and 14.39% for the 3rd dose. The main cause of non-adherence to the 2nd and 3rd doses was other illnesses in 28.5% and 29.78%, respectively, in Burkina Faso, 5.35% and 5.35% in Mali and 1.6% and 0.75% in Niger. It was followed by vomiting in 12.24% and 10.63% for Burkina and 2.45% and 3.78% in Niger. The last cause was refusal in 6.12% and 4.25% in Burkina, 33.9% and 15.25% in Mali and 0.8% and 1.51% in Niger. Non-adherence of doses related to parents was primarily due to their absence in 28.5% and 27.65% in Burkina, 16.07% and 16.07% in Mali and 7.37% and 6.06% in Niger. Traveling was the second cause related to parents in 12.24% and 12.76% in Burkina, 19.64% and 19.64% in Mali and 0.81% and 0.75% in Niger. Non-adherence related to community distributors was mainly due to missing the doses in 4.08% and 4.25% in Burkina, 23.21% and 23.21% in Mali, 77.04% and 76.51% in Niger. Our study reported very small proportions of non-adherence to 2nd and 3rd doses of SMC and identified the main causes of non-adherence. These findings will provide helpful information for policymakers and public health authorities to improve adherence to SMC Full article
(This article belongs to the Special Issue Malaria Chemoprevention Strategies)
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10 pages, 258 KiB  
Communication
Survey and Analysis of Chemoprophylaxis Policies for Domestic Travel in Malaria-Endemic Countries
by John Kevin Baird, Marian Warsame and Judith Recht
Trop. Med. Infect. Dis. 2022, 7(7), 121; https://doi.org/10.3390/tropicalmed7070121 - 29 Jun 2022
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Abstract
The prevention of malaria in travelers with the use of antimalarials often occurs in connection with international travel to areas of significant risk of infection. Although these travelers sometimes cause outbreaks in their malaria-free home countries, the cardinal objective of prescribed chemoprophylaxis is [...] Read more.
The prevention of malaria in travelers with the use of antimalarials often occurs in connection with international travel to areas of significant risk of infection. Although these travelers sometimes cause outbreaks in their malaria-free home countries, the cardinal objective of prescribed chemoprophylaxis is to protect the traveler from patent malaria during travel. Here we consider the chemoprophylaxis of domestic travelers from malaria-free but -receptive areas within malaria-endemic countries. The main objective in this setting is the protection of those areas from reintroduced malaria transmission. In order to better understand policy and practices in this regard, we surveyed malaria prevention and treatment guidelines of 36 malaria-endemic countries and 2 that have recently eliminated malaria (Sri Lanka, China) for recommendations regarding malaria chemoprophylaxis for domestic travel. Among them, just 8 provided specific and positive recommendations, 1 recommended without specific guidance, and 4 advised against the practice. Most nations (25/38; 66%) did not mention chemoprophylaxis for domestic travel, though many of those did offer guidance for international travel. The few positive recommendations for domestic travel were dominated by the suppressive prophylaxis options of daily doxycycline or atovaquone-proguanil or weekly mefloquine. The incomplete protection afforded by these strategies, along with impractical dosing in connection with the typically brief domestic travel, may in part explain the broad lack of policies and practices across malaria-endemic nations regarding chemoprophylaxis. Full article
(This article belongs to the Special Issue Malaria Chemoprevention Strategies)
16 pages, 1656 KiB  
Article
Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: An End User Perspective Study
by Céline Audibert and André-Marie Tchouatieu
Trop. Med. Infect. Dis. 2021, 6(2), 75; https://doi.org/10.3390/tropicalmed6020075 - 11 May 2021
Cited by 8 | Viewed by 5968
Abstract
Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Although a large number of publications have reported on the efficacy and safety profile of these interventions, little literature exists on end-user experience. The objective of this study was [...] Read more.
Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Although a large number of publications have reported on the efficacy and safety profile of these interventions, little literature exists on end-user experience. The objective of this study was to provide insights on the perceptions and attitudes towards seasonal malaria chemoprevention (SMC) and intermittent preventive treatment of infants (IPTi) to identify drivers of and barriers to acceptance. A total of 179 in-depth qualitative interviews were conducted with community health workers (CHWs), health center managers, parents of children receiving chemoprevention, and national decision makers across eight countries in sub-Saharan Africa. The transcribed verbatim responses were coded and analyzed using a thematic approach. Findings indicate that, although SMC is largely accepted by end users, coverage remained below 100%. The main causes mentioned were children’s absenteeism, children being sick, parents’ reluctance, and lack of staff. Regarding IPTi, results from participants based in Sierra Leone showed that the intervention was generally accepted and perceived as efficacious. The main challenges were access to water, crushing the tablets, and high staff turnover. SMC and IPTi are perceived as valuable interventions. Our study identified the key elements that need to be considered to facilitate the expansion of these two interventions to different geographies or age groups. Full article
(This article belongs to the Special Issue Malaria Chemoprevention Strategies)
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13 pages, 1231 KiB  
Article
Impact of Three-Year Intermittent Preventive Treatment Using Artemisinin-Based Combination Therapies on Malaria Morbidity in Malian Schoolchildren
by Hamma Maiga, Breanna Barger, Issaka Sagara, Abdoulaye Guindo, Oumar B. Traore, Mamadou Tekete, Antoine Dara, Zoumana I. Traore, Modibo Diarra, Samba Coumare, Aly Kodio, Ousmane B. Toure, Ogobara K. Doumbo and Abdoulaye A. Djimde
Trop. Med. Infect. Dis. 2020, 5(3), 148; https://doi.org/10.3390/tropicalmed5030148 - 17 Sep 2020
Cited by 5 | Viewed by 2821
Abstract
Previous studies have shown that a single season of intermittent preventive treatment in schoolchildren (IPTsc) targeting the transmission season has reduced the rates of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Efficacy over the course of multiple years of IPTsc has [...] Read more.
Previous studies have shown that a single season of intermittent preventive treatment in schoolchildren (IPTsc) targeting the transmission season has reduced the rates of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Efficacy over the course of multiple years of IPTsc has been scantly investigated. Methods: An open, randomized-controlled trial among schoolchildren aged 6–13 years was conducted from September 2007 to January 2010 in Kolle, Mali. Students were included in three arms: sulphadoxine-pyrimethamine+artesunate (SP+AS), amodiaquine+artesunate (AQ+AS), and control (C). All students received two full doses, given 2 months apart, and were compared with respect to the incidence of clinical malaria, all-cause clinic visits, asymptomatic parasitemia, and anemia. Results: A total of 296 students were randomized. All-cause clinic visits were in the SP+AS versus control (29 (20.1%) vs. 68 (47.2%); 20 (21.7%) vs. 41 (44.6%); and 14 (21.2%) vs. 30 (44.6%); p < 0.02) in 2007, 2008, and 2009, respectively. The prevalence of asymptomatic parasitemia was lower in the SP+AS compared to control (38 (7.5%) vs. 143 (28.7%); and 47 (12.7%) vs. 75 (21.2%); p < 0.002) in 2007 and 2008, respectively. Hemoglobin concentration was significantly higher in children receiving SP+AS (11.96, 12.06, and 12.62 g/dL) than in control children (11.60, 11.64, and 12.15 g/dL; p < 0.001) in 2007, 2008, and 2009, respectively. No impact on clinical malaria was observed. Conclusion: IPTsc with SP+AS reduced the rates of all-cause clinic visits and anemia during a three-year implementation. Full article
(This article belongs to the Special Issue Malaria Chemoprevention Strategies)
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Review

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19 pages, 359 KiB  
Review
Drugs for Intermittent Preventive Treatment of Malaria in Pregnancy: Current Knowledge and Way Forward
by Antia Figueroa-Romero, Clara Pons-Duran and Raquel Gonzalez
Trop. Med. Infect. Dis. 2022, 7(8), 152; https://doi.org/10.3390/tropicalmed7080152 - 28 Jul 2022
Cited by 4 | Viewed by 3291
Abstract
Malaria infection during pregnancy is an important driver of maternal and neonatal health in endemic countries. Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for malaria prevention at each scheduled antenatal care visit, starting at the second trimester, in areas [...] Read more.
Malaria infection during pregnancy is an important driver of maternal and neonatal health in endemic countries. Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for malaria prevention at each scheduled antenatal care visit, starting at the second trimester, in areas of high and moderate transmission. However, the increased resistance to SP in some endemic areas challenges its effectiveness. Furthermore, SP is contraindicated in the first trimester of pregnancy and in HIV-infected women on co-trimoxazole prophylaxis due to potential drug–drug interactions. Thus, in recent last decades, several studies evaluated alternative drugs that could be used for IPTp. A comprehensive literature review was conducted to summarize the evidence on the efficacy and safety of antimalarial drugs being evaluated for IPTp. Chloroquine, amodiaquine, mefloquine and azithromycin as IPTp have proven to be worse tolerated than SP. Mefloquine was found to increase the risk of mother-to-child transmission of HIV. Dihydroartemisin-piperaquine currently constitutes the most promising IPTp drug alternative; it reduced the prevalence of malaria infection, and placental and clinical malaria in studies among HIV-uninfected women, and it is currently being tested in HIV-infected women. Research on effective antimalarial drugs that can be safely administered for prevention to pregnant women should be prioritized. Malaria prevention in the first trimester of gestation and tailored interventions for HIV-infected women remain key research gaps to be addressed. Full article
(This article belongs to the Special Issue Malaria Chemoprevention Strategies)
18 pages, 724 KiB  
Review
Development of New Strategies for Malaria Chemoprophylaxis: From Monoclonal Antibodies to Long-Acting Injectable Drugs
by Joerg J. Moehrle
Trop. Med. Infect. Dis. 2022, 7(4), 58; https://doi.org/10.3390/tropicalmed7040058 - 7 Apr 2022
Cited by 4 | Viewed by 5197
Abstract
Drug discovery for malaria has traditionally focused on orally available drugs that kill the abundant, parasitic blood stage. Recently, there has also been an interest in injectable medicines, in the form of monoclonal antibodies (mAbs) with long-lasting plasma half-lives or long-lasting depot formulations [...] Read more.
Drug discovery for malaria has traditionally focused on orally available drugs that kill the abundant, parasitic blood stage. Recently, there has also been an interest in injectable medicines, in the form of monoclonal antibodies (mAbs) with long-lasting plasma half-lives or long-lasting depot formulations of small molecules. These could act as prophylactic drugs, targeting the sporozoites and other earlier parasitic stages in the liver, when the parasites are less numerous, or as another intervention strategy targeting the formation of infectious gametocytes. Generally speaking, the development of mAbs is less risky (costly) than small-molecule drugs, and they have an excellent safety profile with few or no off-target effects. Therefore, populations who are the most vulnerable to malaria, i.e., pregnant women and young children would have access to such new treatments much faster than is presently the case for new antimalarials. An analysis of mAbs that were successfully developed for oncology illustrates some of the feasibility aspects, and their potential as affordable drugs in low- and middle-income countries. Full article
(This article belongs to the Special Issue Malaria Chemoprevention Strategies)
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