# **Introduction**

In many malaria endemic countries, successful control programs have recently reduced the level of malaria transmission [1-3] and as a consequence, immunity to malaria is acquired more slowly and the burden of clinical malaria is shifting from the very young to older children [4,5]. Recent success in malaria control has also prompted a renewed emphasis on malaria elimination, leading to a shift in focus from targeting only clinical malaria to also identifying and treating asymptomatic malaria parasitaemia [1,6]. Infection rates are typically highest among school-aged children [7,8] who, due to recent improvements in primary school access, are increasingly enrolled in school [9,10]. Tackling such parasitaemia, whether or not it results in clinical disease, is important for two reasons. First, an increasing body of evidence is showing that chronic untreated _Plasmodium_ infections can negatively affect children’s health [11,12] and cognitive function [13-15], including sustained attention [16] and ultimately, their educational achievement [17,18]. Second, with the move towards elimination in low-moderate transmission settings [19,20], there is a need to tackle untreated reservoirs of infection, to which school children are important contributors [21,22]. Yet, surprisingly, there remains a lack of consistent policy and technical guidance [23] on which interventions can reduce the burden of malaria among school children and which can costeffectively be delivered through existing school systems.

Previous studies have highlighted the beneficial impact of school-based intermittent preventive treatment (IPT) on health and cognitive function in high [24] and high, seasonal [25] malaria transmission settings. However, the recent withdrawal of the primary drugs for IPT, sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ), in many East African countries precluded further investigation of IPT using SP+AQ. A possible alternative to IPT is intermittent screening and treatment (IST), whereby individuals are periodically screened for _Plasmodium_ infection using a rapid diagnostic test (RDT) and those infected (whether symptomatic or not) are treated with a full course of first-line drug treatment, artemetherlumefantrine (AL). The potential of IST was first highlighted by modeling work, [26,27] and its comparable efficacy to IPT in antenatal care [28] has been evaluated, although a recent trial in Burkina Faso indicated no impact of IST on community-wide malaria transmission [29]. This paper reports the results of a cluster randomized trial investigating the impact of IST in schools on health and education outcomes in school children in a low-moderate transmission setting on the south coast of Kenya [30].

# **Methods**

The original protocol for the trial (Protocol S1) and the supporting CONSORT checklist (Checklist S1) are provided as supporting information. Trial instruments and data are available on the World Bank Microdata catalogue at: http://microdata.worldbank.org/index.php/catalog/671 .

## **_Ethics Statement_**

The study was approved by the Kenya Medical Research Institute and National Ethics Review Committee (SSC No. 1543), the London School of Hygiene & Tropical Medicine Ethics Committee (5503), and the Harvard University Committee on the Use of Human Subjects in Research (F17578-101). Prior to the randomization, meetings were held with community and school leaders and parents/guardians in each school to explain the study objectives and procedures. Parents/guardians of 3