Volume 98, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Malaria and neglected tropical diseases (NTDs), including schistosomiasis and soil transmitted helminths, threaten the health of school aged in sub-Saharan Africa. Established school-based mass drug administration (MDA) programs are used to control NTDs. Recent clinical trials have shown benefit of mass treatment of malaria in schools. The potential of adding malaria treatment to existing NTD programs has not been thoroughly evaluated. We offered malaria treatment with artemether-lumefantrine during routine NTD MDA and developed peer education programs in two primary schools in southern Malawi. We assessed participation, safety, and tolerability of coadministration of artemether-lumefantrine with praziquantel and albendazole. Results were compared with two schools conducting standard NTD MDA with additional monitoring by study staff. A total of 3,387 students (68%) received the standard NTD MDA. Among parents who came to schools on the day of the MDA, malaria treatment was well accepted; 87% of students who received the standard NTD MDA in intervention schools also consented for treatment with artemether-lumefantrine. The most frequent treatment emergent adverse events (AEs) were headache and vomiting. However, AEs were rare and were not more frequent in students who received artemether-lumefantrine in addition to praziquantel and albendazole. In this study, we found that the addition of malaria treatment to NTD MDA is well-received and safe. Such integrated programs may leverage existing infrastructures to reduce intervention costs and could become the framework for further integrated school-based health programs.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Karagiannis-Voules D-A, 2015. Spatial and temporal distribution of soil-transmitted helminth infection in sub-Saharan Africa: a systematic review and geostatistical meta-analysis. Lancet Infect Dis 15: 7484. [Google Scholar]
  2. Lai Y-S, 2015. Spatial distribution of schistosomiasis and treatment needs in sub-Saharan Africa: a systematic review and geostatistical analysis. Lancet Infect Dis 15: 927940. [Google Scholar]
  3. WHO, 2016. World Malaria Report 2015. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/publications/world-malaria-report-2015/report/en/. Accessed November 25, 2016.
  4. Brooker SJ, Pullan RL, Gitonga CW, Ashton RA, Kolaczinski JH, Kabatereine NB, Snow RW, , 2012. Plasmodium-helminth coinfection and its sources of heterogeneity across east Africa. J Infect Dis 205: 841852. [Google Scholar]
  5. Nankabirwa J, Wandera B, Kiwanuka N, Staedke SG, Kamya MR, Brooker SJ, , 2013. Asymptomatic Plasmodium infection and cognition among primary schoolchildren in a high malaria transmission setting in Uganda. Am J Trop Med Hyg 88: 11021108. [Google Scholar]
  6. Thuilliez J, Sissoko MS, Toure OB, Kamate P, Berthélemy J-C, Doumbo OK, , 2010. Malaria and primary education in Mali: a longitudinal study in the village of Donéguébougou. Soc Sci Med 71: 324334. Available at: http://www.sciencedirect.com/science/article/pii/S0277953610001905. Accessed November 30, 2013. [Google Scholar]
  7. Fernando D, De Silva D, Carter R, Mendis KN, Wickremasinghe R, , 2006. A randomized, double-blind, placebo-controlled, clinical trial of the impact of malaria treatment on the educational attainment of school children. Am J Trop Med Hyg 74: 386393. [Google Scholar]
  8. Clarke SE, Jukes MC, Njagi JK, Khasakhala L, Cundill B, Otido J, Crudder C, Estambale BB, Brooker S, , 2008. Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial. Lancet 372: 127138. [Google Scholar]
  9. Jukes MCH, 2002. Heavy schistosomiasis associated with poor short-term memory and slower reaction times in Tanzanian schoolchildren. Trop Med Int Health 7: 104117. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11841700. Accessed May 8, 2017. [Google Scholar]
  10. de Clercq D, Sacko M, Behnke J, Gilbert F, Vercruysse J, , 1998. The relationship between Schistosoma haematobium infection and school performance and attendance in Bamako, Mali. Ann Trop Med Parasitol 92: 851858. Available at: http://www.ncbi.nlm.nih.gov/pubmed/10396345. Accessed May 8, 2017. [Google Scholar]
  11. World Health Organization, 2013. Schistosomiasis: Progress Report 2001–2011, Strategic Plan 2012–2020. Geneva, Switzerland: WHO.
  12. World Health Organization, 2012. Soil-Transmitted Helminthiases: Eliminating as Public Health Problem Soil-Transmitted Helminthiases in Children: Progress Report 2001–2010 and Strategic Plan 2011–2020. Geneva, Switzerland: WHO. Available at: http://www.who.int/iris/handle/10665/44804.
  13. Nankabirwa J, Brooker SJ, Clarke SE, Fernando D, Gitonga CW, Schellenberg D, Greenwood B, , 2014. Malaria in school-age children in Africa: an increasingly important challenge. Trop Med Int Health 19: 12941309. [Google Scholar]
  14. Walldorf JA, 2015. School-age children are a reservoir of malaria infection in Malawi. PLoS One 10: e0134061. [Google Scholar]
  15. Mathanga DP, 2015. The high burden of malaria in primary school children in southern Malawi. Am J Trop Med Hyg 93: 779789. [Google Scholar]
  16. Nankabirwa JI, Wandera B, Amuge P, Kiwanuka N, Dorsey G, Rosenthal PJ, Brooker SJ, Staedke SG, Kamya MR, , 2014. Impact of intermittent preventive treatment with dihydroartemisinin-piperaquine on malaria in Ugandan schoolchildren: a randomized, placebo-controlled trial. Clin Infect Dis 58: 14041412. [Google Scholar]
  17. Weiss WR, Oloo AJ, Johnson A, Koech D, Hoffman SL, , 1995. Daily primaquine is effective for prophylaxis against falciparum malaria in Kenya: comparison with mefloquine, doxycycline, and chloroquine plus proguanil. J Infect Dis 171: 15691575. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7769294. Accessed March 16, 2016. [Google Scholar]
  18. Nankabirwa J, 2010. Efficacy, safety, and tolerability of three regimens for prevention of malaria: a randomized, placebo-controlled trial in Ugandan schoolchildren. PLoS One 5: e13438. [Google Scholar]
  19. Matangila JR, Doua JY, Mitashi P, da Luz RI, Lutumba P, Van Geertruyden JP, , 2017. Efficacy and safety of intermittent preventive treatment in schoolchildren with sulfadoxine/pyrimethamine (SP) and SP plus piperaquine in Democratic Republic of the Congo: a randomised controlled trial. Int J Antimicrob Agents 49: 339347. [Google Scholar]
  20. Barger B, Maiga H, Traore OB, Tekete M, Tembine I, Dara A, Traore ZI, Gantt S, Doumbo OK, Djimde AA, , 2009. Intermittent preventive treatment using artemisinin-based combination therapy reduces malaria morbidity among school-aged children in Mali. Trop Med Int Health 14: 784791. [Google Scholar]
  21. Clarke SE, 2017. Impact of a malaria intervention package in schools on Plasmodium infection, anaemia and cognitive function in schoolchildren in Mali: a pragmatic cluster-randomised trial. BMJ Glob Heal 2: e000182. [Google Scholar]
  22. Opoku EC, Olsen A, Browne E, Hodgson A, Awoonor-Williams JK, Yelifari L, Williams J, Magnussen P, , 2016. Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in northern Ghanaian schoolchildren. Glob Health Action 9: 32197. [Google Scholar]
  23. Midzi N, 2011. Efficacy of integrated school based de-worming and prompt malaria treatment on helminths-Plasmodium falciparum co-infections: a 33 months follow up study. BMC Int Health Hum Rights 11: 9. [Google Scholar]
  24. DAIDS Regulatory Support Center, 2014. Division of AIDS (DAIDS) Table for Grading the Severity of Adult and Pediatric Adverse Events, Version 2.0. Available at: https://rsc.tech-res.com/clinical-research-sites/safety-reporting/daids-grading-tables. Accessed May 4, 2017.
  25. WHO Evidence Review Group, 2015. Malaria Policy Advisory Committee Meeting Report: Malaria in Pregnancy. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/mpac/mpac-sept2015-erg-mip-report.pdf?ua=1. Accessed September 22, 2017.
  26. Okello G, 2013. Challenges for consent and community engagement in the conduct of cluster randomized trial among school children in low income settings: experiences from Kenya. Trials 14: 142. [Google Scholar]
  27. Gyapong JO, Gyapong M, Yellu N, Anakwah K, Amofah G, Bockarie M, Adjei S, , 2010. Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities. Lancet 375: 160165. [Google Scholar]
  28. Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Ehrlich Sachs S, Sachs JD, , 2006. Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and Malaria. PLoS Med 3: e102. [Google Scholar]

Data & Media loading...

  • Received : 24 Jul 2017
  • Accepted : 29 Sep 2017
  • Published online : 06 Nov 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error