Please select the eligibility criteria that correspond to the clinical trial below.
Title: Targeted Parasite Elimination in the Human and Mosquito to Reduce Malaria Transmission: A Cluster Randomised Controlled Factorial Design Trial of Reactive Focal Drug Administration (rfMDA) Versus Reactive Case Detection (RACD), With and Without Reactive Vector Control (RAVC), From the Low Endemic Setting of Namibia
Brief Summary: This is a cluster randomised controlled trial with factorial study design comparing the impact of reactive community-based malaria interventions: 1) presumptive treatment (or rfMDA, reactive focal mass drug administration) versus reactive case detection (RACD), and 2) reactive IRS (indoor residual spraying) versus control on the incidence of malaria in Namibia.


Options:
A: Inclusion Criteria:

For the Household

* Having a children from 6 months to 14 years old in the household
* Provide written consent For the children
* Having between 6 months to 14 years
* Permanent residence in a selected household

Exclusion Criteria:

* Children severely ill
B: Inclusion Criteria:

* Individuals who consent to participate in the study
* Residents in the study area
* Older than 6 months of age (or weighing more than 5Kg)
* Women in the second or third trimester who are not on IPTp

Exclusion Criteria:

* Individuals who do not consent to participate in the study
* Younger than 6 months of age (or weighing more than 5Kg)
* Women in the first trimester of pregnancy
* Severely ill individuals
* Individuals on contra-indicated medication
C: Inclusion Criteria:

1. Index Case Investigation Inclusion Criteria:

   * Malaria infection (either locally transmitted or imported) detected at a health facility via passive surveillance, and
   * Resides in a study Enumeration Area (EA), and
   * Provides informed consent
2. RACD Intervention Inclusion Criteria:

   * Provides informed consent, and
   * Index case resides in study EA, and
   * All non-index cases that reside or spent at least one night in the Target Area in the past 4 weeks, and
   * Residents of the six houses closest to the index case, and
   * If 25 people are not enrolled in the study at the first six houses, plus the index case household, after the second visit then additional houses can be approached on the third visit.
3. rfMDA Intervention Inclusion Criteria:

   * Provides informed consent, and
   * Index case resides in study EA, and
   * All non-index cases that reside or spent at least one night in the Target Area in the past 4 weeks, and
   * Residents of the six houses closest to the index case, and
   * If 25 people are not enrolled in the study at the first six houses, plus the index case household, after the second visit then additional houses can be approached on the third visit.
4. Artemether/Lumefantrine (A-L) (combination medication) Inclusion Criteria:

   * Consent to take A-L medication
   * Does not meet A-L Exclusion Criteria under item #4 below
5. Pill count Inclusion Criteria:

   * Provides consent, and
   * People who receive any number of RACD or rfMDA drug dose(s)
6. Reactive Vector Control Inclusion Criteria:

   * Informed consent provided by head of household or person in otherwise in charge of household, and
   * Index case resides in study EA, and
   * Index household and 6 non-index households closest to index household
7. Endline Survey, Individual, Inclusion Criteria:

   * Provides informed consent, and
   * Resides or spent at least 1 night in the EA in the preceding 4 weeks
8. Acceptability Assessment: Individual Interviews with study participants, Inclusion Criteria:

   * Provides informed consent, and
   * Resident of index household or of neighbouring households
9. Acceptability Assessment: Individual Interviews with key stakeholders, Inclusion Criteria:

   * In leadership position within Zambezi region, and
   * Provides informed consent
10. Acceptability Assessment: Individual Interview with refusers, Inclusion Criteria:

    * Refused to participate in rfMDA, RACD, and/or RAVC, and
    * Provides informed consent to take part in the anonymous survey
11. Acceptability Assessment: Focus group discussions with study participants, Inclusion Criteria:

    * Provides informed consent, and
    * Was eligible to be enrolled in the study in participant's Target Area, and
    * Either took part in RACD or rfMDA intervention (+/- RAVC), OR refused these interventions

Exclusion Criteria:

1. Index Case Investigation Exclusion Criteria:

   * Malaria infection identified through active case detection
   * Refusal to participate
2. RACD Intervention Exclusion Criteria:

   * Index case does not reside in study EA, or
   * Refusal to participate in RACD, or
   * Household received the intervention in the previous 5 weeks, or
   * Household \> 500 m from the index case, or
   * Severe or complicated malaria as assessed by study nurse (this will lead to referral for further evaluation at health facility but not enrolment in study)
3. rfMDA Intervention Exclusion Criteria:

   * Index case does not reside in study EA, or
   * Refusal to participate in rfMDA, or
   * Household received the intervention in the previous 5 weeks, or
   * Household \> 500 m from the index case, or
   * Severe or complicated malaria as assessed by study nurse (this will lead to referral for further evaluation at health facility but not enrolment in study)
4. Artemether/Lumefantrine (combination medication) Exclusion Criteria:

   * Pregnancy in first trimester, or
   * Previous regular menstruation, with no menstruation for most recent 4 weeks, or
   * Weight \< 5 kg\*, or
   * Severe malaria, or
   * Known allergy to A-L, or
   * Refusal of the offered A-L

     * Note regarding A-L weight exclusion: Because of the pre-set required field at the top of the Eligibility section of this Application, the investigators have indicated a 6 month minimum age limit, primarily to note to the reader that there will be a lower age limit to infants enrolled. Yet during the actual conduct of this trial the investigators will utilize 5 kg weight as the cutoff, rather than using age. A lower weight cutoff of 5 kg is in accordance with A-L's manufacturer (Novartis)'s guidance on supporting pediatric data.
5. Pill count Exclusion Criteria:

   * Refusal to participate in pill count, or
   * Individuals who did not receive any drug doses through RACD or rfMDA
6. Reactive Vector Control Exclusion Criteria:

   * Refusal by head of household to participate in RAVC, or
   * Already received RAVC during current transmission season, or
   * Household is \> 500 m from index case household (note: refusal to participate in RACD or rfMDA is not an exclusion criterion for RAVC)
7. Endline Survey, Individual, Exclusion Criteria:

   • Refusal to participate in Endline Survey (note: lack of participation in rfMDA or RACD is not an exclusion criterion)
8. Acceptability Assessment: Individual Interviews with study participants, Exclusion Criteria:

   * Refusal to participate in Acceptability Assessment, or
   * Speaks language not understood or able to be translated, or
   * Key stakeholder \[see below\]
   * Age \< 15 years
9. Acceptability Assessment: Individual Interviews with key stakeholders, Exclusion Criteria:

   * Refusal to participate in Acceptability Assessment, or
   * Speaks language not understood or able to be translated, or
   * Not in leadership position
10. Acceptability Assessment: Individual Interview with refusers, Exclusion Criteria:

    * Refusal to participate in Acceptability Assessment, or
    * Speaks language not understood or able to be translated, or
    * Age \< 15 years
11. Acceptability Assessment: Focus group discussions with study participants, Exclusion Criteria:

    * Refusal to participate in Acceptability Assessment, or
    * Speaks language not understood or able to be translated, or
    * Key stakeholder or in another leadership position, or
    * Age \< 15 years
D: Inclusion Criteria:

* all consenting adults, assenting minors (12-18) and caregivers of children under 12

Exclusion Criteria:

* all infants 0-6 months of age

Answer: C