DOI: 10.5061/dryad.fxpnvx117
title: The impact of weekly fever-screening and treatment and monthly RDT testing and treatment on the infectious reservoir of malaria in Burkina Faso: results from a cluster-randomised trial

description: The majority of malaria infections in endemic countries are asymptomatic
 and a source of onward transmission to mosquitoes. Malaria transmission
 and disease burden could be reduced by improving early detection and
 treatment of these infections with active screening
 approaches. In an 18-month cluster-randomized study in Sapone,
 Burkina Faso, households were enrolled and randomised to 1 of 3 arms: arm
 1 - control; arm 2 - active weekly screening for febrile individuals and
 treatment if rapid diagnostic test (RDT) positive; or arm 3 – active
 weekly fever-screening (as arm 2) plus monthly RDT-testing regardless of
 symptoms. The primary outcome was parasite prevalence by qPCR in the
 end-of-study cross-sectional survey. Secondary outcomes included parasite
 and gametocyte prevalence and density in all three end-of-season
 cross-sectional surveys, incidence of infection, and the transmissibility
 of infections to mosquitoes. A total of 906 individuals were enrolled
 during 2 phases. In Phase 1, 412 individuals were enrolled between August
 9 and 17, 2018, and in Phase 2, 494 individuals were enrolled between
 January 10 and 31, 2019. In the end-of-study cross-sectional survey,
 malaria parasite prevalence by qPCR was statistically significantly lower
 in arm 3 (29·26% 79/270), but not in arm 2 (45·66% 121/265), when compared
 to arm 1 (48·72% 133/273) (RR = 0·65, 95%CI = 0·52 to 0·81, P=0·0001).
 Total parasite and gametocyte prevalence and density were also
 significantly lower in arm 3 in all surveys. The largest differences were
 seen at the end of the dry season, with gametocyte prevalence 78·38 % and
 transmission potential 98·20% lower in arm 3 vs arm 1. Active
 monthly RDT testing and treatment can reduce parasite carriage and the
 infectious reservoir of malaria to &lt;2% when used during the dry
 season. This insight may inform approaches for malaria control and
 elimination.
description: Participants were permanent residents in the  Sapone Marche and
 Pissy LHF catchment areas and were enrolled in a total of 181 households.
 Households were randomized into 3 study arms that received different
 levels of care. Standard of care with Passive case
 detection (PCD) (performed in arms 1, 2 & 3):<strong>
 </strong>All participants received unique identification cards for
 use when attending two designated local health facilities. Clinical
 malaria episodes were passively monitored, with axillary temperature and
 medical history recorded, and malaria diagnosed by conventional Rapid
 Diagnostic Test (RDT; First Response Malaria Ag. pLDH/HRP2, specific for
 <em>P. falciparum</em> and/or other <em>Plasmodium
 </em>species).  Weekly fever screening, testing,
 and treatment (arms 2 & 3): All participants in arms 2 and 3 were
 visited weekly by a community health worker to screen for fever.
 Participants with a current fever (≥ 37.5°C) or a history of fever in the
 last 24 hours were referred to a health facility and an RDT was
 performed. Monthly Mass Testing and Treatment (MTAT;
 arm 3): In arm 3, one weekly fever screening visit per month was replaced
 by MTAT,  where participants presented at a central meeting point for
 testing by conventional RDT. RDT-positive participants were referred to a
 health facility for treatment. At the start and end of
 each transmission season, a cross-sectional survey was conducted on all
 study participants (4 surveys in total). Finger-prick blood samples were
 taken for molecular assessment of parasite and gametocyte prevalence and
 density, and axillary temperature was measured. Participants with a
 current fever (≥37·5°C) or a history of fever in the last 24 hours were
 referred to an LHF for malaria diagnosis by RDT and treatment.
description: # The impact of weekly fever-screening and treatment and monthly RDT
 testing and treatment on the infectious reservoir of malaria in Burkina
 Faso: results from a cluster-randomised trial
 [https://doi.org/10.5061/dryad.fxpnvx117](https://doi.org/10.5061/dryad.fxpnvx117) In an 18-month cluster-randomized study in Sapone, Burkina Faso, households were enrolled and randomised to 1 of 3 arms: arm 1 - control; arm 2 - active weekly screening for febrile individuals and treatment if rapid diagnostic test (RDT) positive; or arm 3 – active weekly fever-screening (as arm 2) plus monthly RDT-testing regardless of symptoms. The primary outcome was parasite prevalence by quantitive PCR (qPCR) in the end-of-study cross-sectional survey. The study protocol is provided in detail in doi: 10.1136/bmjopen-2019-030598 ## Description of the data and file structure The dataset is an Excel file where each line is an observation from an individual (idind). There is a hierarchical structure in the dataset where multiple people come from the same household (indicated as hh_ident) and households are randomized in clusters (cluster). Individuals have parasite density (parasites_mL) and gametocyte density (gametocytes_mL) measured repeatedly by qPCR. Densities are per mL. The round is indicated in the variable survey (survey round (1=start of study, 2=end of first transmission season; 3=end of dry season; 4=end of second transmission season) Variables with variable labels. | hh\_ident | household identifier | | :--------------------- | :--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | idind | individual identification number | | dateenrolled | date individual was enrolled | | agecat | age in categories | | cluster | cluster name | | studygrp | study group; study arm: 1 = standard of care; 2 = standard of care plus weekly fever screening and treatment; 3 = standard of care plus weekly fever screening and treatment plus monthly testing and treatmebnt | | survey | survey round (1=start of study, 2=end of first transmission season; 3=end of dry season; 4=end of second transmission season) | | date\_survey | date of sampling | | bednet\_last\_night | use of a bednet in the last night (yes/no) | | fever\_last\_week | reported fever  in the last week (yes/no) | | fever\_last\_24h | reported fever  in the last 24 hours (yes/no) | | measured\_temperature | temperature during the survey by | | rdt\_taken | rapid diagnostic test (RDT) taken; based on (reported) fever | | rdt\_result | RDT result (positive, negative, NA=not applicable) | | treatment\_adminstered | treatment provided (yes/no) | | treatment\_type | type of treatment provided: AL = artemether-lumefantrine | | parasites\_mL | parasite density per mL as determined by qPCR | | gametocytes\_mL | gametocyte density per mL as determined by RT-qPCR | ## Sharing/Access information Not applicable ## Code/Software Not applicable