Tanzania

Abstract

Malaria remains a major public health threat despite considerable progress on control in the past decade. We, and others, demonstrated that the burden of malaria in school aged children is substantial with significant consequences later on in life. Recent decreases in the malaria burden puts school-aged children increasingly more at risk for malaria. The mainstay for malaria control includes use of insecticide-treated nets (ITNs), indoor residual spraying (IRS), prompt diagnosis and treatment with an effective antimalarial drug . Malaria control interventions often target vulnerable populations, pregnant women and children under-fives or targets the population at large. Yet, these interventions have a weak coverage in school aged children and no malaria control interventions specifically target in school-aged children. In 2012, we started field work on this theme in DR Congo, a high malaria endemic setting, and proved that Intermittent preventive treatment in school children (IPTsc) is an efficacious and feasible intervention. These findings are confirmed by others and at present, we're conducting similar research in different sociocultural and epidemiological settings in Ethiopia and North East Tanzania. This PhD proposal will provide required additional information to translate evidence gathered in previous research into policy. We will identify models of within-host dynamics of Plasmodium falciparum that have been fitted to parasite density profiles from malaria therapy patients, and simulations of P. falciparum epidemiology fitted to field malariologic datasets from a large ensemble of settings across Africa. We will use this models to assess the relative and absolute contribution of schoolchildren (6-12 yrs) on malaria transmission in different malaria endemic settings taking into account the (effectiveness of) other interventions. We hypothese that school aged children, who represent 26.8% of the population though over 40% of both the malaria reservoir and burden, are a main driver of malaria transmission. Further, will the selected integrated mathematical models be used for predicting the epidemiologic and economic effects of IPTsc both at the individual and population level. The models will provide a unique platform for predicting both the short- and long-term effects of IPTsc on the burden of disease, allowing for the temporal dynamics of effects on immunity and transmission. We'll perform a sensitivity analyses taking into account adherence, school attendance rates, drug resistance rated and thus assess the impact of IPTsc on the malaria burden and transmission at population (i.c. impact on population level R0-rates). It should be mentioned that in the last decades school attendance rates have raised to over 95% in most LMICs (though drop-out rates are still substantial). Finally, the chosen model will obtain robust cost-effectiveness estimates for IPTsc delivery strategies in different eco-epidemiologic settings. We will be able to rank IPTsc amongst other health interventions and stipulate its contributing role to attain several Sustainable Development Goals' (SDGs). In parallel, this PhD-program will be involved in 4 case studies in 4 different settings (Ethiopia, Tanzania, DR Congo and Burkina Faso) in which we will assess the possible institutional implementation modalities. This health (and educational) system analysis is a key element. Many evidence based policy recommendations have suboptimal coverage or are, in practice not implemented as it is not clear which department or control program should take up this additional intervention, determine the possible supply channels, reporting, training programs and resources needed. We will also at least explore how an IPTsc could be the nucleus, together with existing helminth control programs, for a comprehensive (institutionalized) school health program (i.e. including immunization activities, oral health, vision screening, health education, etc…).

Researcher(s)

• Promotor: Van geertruyden Jean-Pierre
• PhD student: Manda Geoffrey

Period

01/10/2021 - 30/09/2025

Abstract

Despite the use of ivermectin (IVM) once annually for control of onchocerciasis (oncho) (= river blindness) in Mahenge Tanzania, the prevalence of oncho and epilepsy remains high. There is increasing evidence that epilepsy is a complication of oncho and that treatment of oncho can not only eliminate blindness but also reduce epilepsy. Our proposed project aims to: 1) strengthen the multi-disciplinary research capacity for the prevention of oncho and epilepsy in Tanzania. We will establish an oncho-associated epilepsy (OAE) research group to support a master and a PhD-level student in the development of research protocols addressing OAE in the Mahenge region; 2) reduce the prevalence of oncho and the incidence of epilepsy in the Mahenge area by: a) establishing a surveillance system for early diagnosis of epilepsy; b) strengthening and implementing an effective community distribution of IVM; 3) Implement evidence-based guidelines to treat OAE by training local health care workers; 4) introduce community advocacy on epilepsy, epilepsy-associated stigma and discrimination.

Funding(s)

VLIR UOS TEAM programme: 300.000€

Researcher(s)

Promotor: Colebunders Robert

Co-promotor: Weckhuysen Sarah

Period

01/01/2018 - 31/12/2021

Abstract

Malaria and anaemia are major causes of morbidity and mortality in children. Declining malaria has changed the shifted the burden of malaria to school children. Chemoprevention strategies using sulfadoxine-pyrimethamine (SP) was shown to prevent the incidence of malaria and anaemia in infants and school children in an area with low SP resistance. However, it is not clear whether this observation can be generalised to areas with high SP resistance. High levels of SP resistance are recorded in Eastern and Southern Africa and therefore alternative options needs evaluation as SP resistance continue to spread in the continent. There is, therefore, an urgent need to identify alternative drugs that could be used for IPTsc instead of SP. In addition , soil transmitted helminths co-morbidities continues to be unacceptably high in school-aged children, thus strategies for interrupting transmission needs to be optimized . We propose a randomized clinical trial to comparing the efficacy and safety of IPTc using dihydroartemisinin plus piperaquine and SP with piperaquine versus SP in high SP-resistance area.

Funding(s)

VLIR UOS, TEAM programme, 300000€

Researcher(s)

Flemish promoter: Jean-Pierre Van geertruyden (University of Antwerp)
Local promoter: John LUsingu (National Institute for Medical Research)

Period

01/01/2017-01/12/2020

Abstract

This project represents a formal research agreement between UA and on the other hand VLIR. UA provides VLIR research results mentioned in the title of the project under the conditions as stipulated in this contract.

Funding(s)

VLIR

Researcher(s)

Principal investigator: Van geertruyden Jean-Pierre

Period

01/07/2014-30/06/2016