School-based screening and treatment may reduce P. falciparum transmission

AbstractIn areas where malaria remains entrenched, novel transmission-reducing interventions are essential for malaria elimination. We report the impact of screening-and-treatment of asymptomatic schoolchildren (N=705) on gametocyte - the parasite stage responsible for human-to-mosquito transmission - carriage and use concomitant household-based surveys to predict the potential reduction in transmission in the surrounding community. Among 179 students with gametocyte-containing infections, 84% had positive malaria rapid diagnostic tests. While gametocyte burden remained constant in untreated children, treatment with artemether-lumefantrine reduced the gametocyte prevalence (p<0.0001) from 51.8% to 9.7% and geometric mean gametocyte density (p=0.008) from 0.52 to 0.05 gametocytes/microliter. Based on these estimates, the gametocyte burden in the community could be reduced by 25-55% depending on the season and the measure used to characterize gametocyte carriage. Thus, school-based interventions to treat asymptomatic infections may be a high-yield approach to not only improve the health and education of schoolchildren, but also decrease malaria transmission.