Malaria prevention drugs in pupils ‘the silver bullet’

Malaria is a burden across the globe.

In Kenya, it is the second biggest killer based on the 2020 Economic Survey. Last year, more than four million malaria cases were confirmed in public health facilities in Kenya.

Despite various interventions such as bed nets, indoor residual sprays, treatment drugs and the recent advent of vaccines, the disease remains a major killer globally.

According to the World Health Organisation (WHO), an estimated 3.4 billion people are at risk of contracting malaria, and 400,000 die of it yearly.

Health experts are continuously searching for more innovative approaches that can propel the world towards malaria elimination.

A recent study indicates that allowing certain segments of the population to receive malaria preventive drugs can be a game-changer.

The new research, published in the Lancet Journal, provides evidence indicating that offering school children — above five years — malaria preventive drugs can lessen the burden.

It says malaria prevention drugs cut the prevalence among school children by 46 percent and subsequent cases of clinical malaria by 50 percent.

Currently, the WHO only recommends providing malaria prevention drugs to pregnant women, infants and young children in hotspots.

This group is the most vulnerable to adverse health effects of malaria, including death. Other segments of the population in high-risk malaria areas are usually less prone to the impacts.

This is due to the fact that as children grow older in malaria hotspots, they tend to develop some level of immunity. They will thus remain asymptomatic despite being infected.

These children may have high levels of malaria-causing parasites in their bodies but they will not be sick. Many will continue leading normal lives, oblivious of the fact that they are infected. Nevertheless, scientists caution that older children — above five years — usually act as reservoirs of malaria causing parasites.

When mosquitoes bite them and suck blood, they pick up parasites and proceed to infect populations that are vulnerable to the adverse effects of the disease such as children below five and pregnant women.

Giving school-going children malaria prevention drugs helps with killing and ‘clearing’ any disease-causing parasites that they may have in the blood. This averts transmission.

Due to the growing evidence that the use of these preventive mediations help in averting infections, the researchers note that the WHO should consider issuing recommendations for their use in school-going children.

This study was conducted by an international consortium of researchers, led by the London School of Hygiene and Tropical Medicine, as well as the University of Maryland School of Medicine. The researchers reviewed various studies that assessed the impact of preventive malaria treatments among school-age children in many African countries, including Kenya.

The team pooled data from 11 different clinical studies that tested malaria preventive medications in 15,000 children aged five to 15 who were living in seven different countries across sub-Saharan Africa.

Half were given preventive malaria treatment, whereas the other half were either given a placebo (dummy medicine) or not treated as a control.

Doses of preventive drugs were given as often as once a month, or as infrequently as once a year.

The children were monitored for an average 43 weeks. Six of the clinical trials evaluated cognitive (brain) function between children who received the malaria prevention drugs and those who did not.

Overall, the team found that preventive treatment cut prevalence among school children and averted cases significantly.

Preventive treatment provided consistent protection for school children regardless of transmission setting — from areas where the underlying prevalence was greater than 50 percent to where it was less than 10 percent

"School-aged children in malaria-endemic areas of sub-Saharan Africa are at substantial risk of infection, and often need treatment. Furthermore, this age group is a major reservoir for human-human transmission,” said Dr Matthew Chico, a senior author of the study from the London School of Hygiene and Tropical Medicine.

He stated: "Our study shows that preventive treatment of malaria among school-aged children reduces the burden of malaria in this age group. Combined with a malaria vaccine and insecticide treated bed nets, a three-pronged approach might just produce the silver bullet we need for malaria elimination."

Dr Lauren Cohee, the first author of the study from the Malaria Research Programme at the University of Maryland School of Medicine said “using schools as a platform to deliver preventive treatment improves the feasibility of this intervention and builds upon the ever increasing rates of primary school enrolment across the malaria endemic world”.