Efficacy
malaria, infection, Infection
MALARIA, INFECTION, SECONDARY, INFECTION
Infection incidence in the most vulnerable age group (children under 5 years of age) for 6 months from the moment of the first MDA round in their community.Infection incidence has been chosen as the primary endpoint based on the WHOs PPC for endectocides, which states that in areas of moderate to high transmission, the minimally acceptable efficacy criterion would be “at least 20% reduction in the incidence of clinical malaria (as primary outcome) and incidence of infection (as secondary outcome) in children under 5, lasting for at least 1 month following a single regimen.” The monthly frequency of visits has been chosen given that infected children will receive treatment with Coartem (artemether-lumefantrine), which has an established post-treatment prophylaxis period of 2 weeks [Infection incidence will be determined in a cohort of children in the target age that is followed prospectively for 6 months post-receipt of the first dose in the community by a dedicated field team. Each child will be tested at home using RDTs (Parasite Lactate Dehydrogenase (pLDH) and HRP2 based). Two different tests will be used given the known persistence of HRP2 antigen after treatment with up to 50% residual positivity after 6 weeks while LDH-based tests become negative in just 48 h [