Designing an innovative malaria elimination strategy based on reactive case and community participation: a mixed-­‐methods study

This PhD application addresses a key priority in the malaria research field by contributing to the design of a malaria elimination strategy based on reactive case detection and community participation that will be tested in a cluster--‐randomized control trial. This fits with the WHO recommendation of accelerating efforts towards elimination by introducing novel strategies to reduce the number of undetected cases [1]. In addition, the application addresses a key capacity building priority in medical anthropology in The Gambia as there is limited expertise in this discipline. Current malaria elimination approaches share the limitation of involving the relatively arbitrary and indiscriminate selection of large numbers of non--‐infected people for screening and/or treatment, leading to high costs, potential population exhaustion, acceptability problems, increased risk for parasite resistance, a heavy burden on health facilities and little efforts to contextualize strategies, including community involvement. To overcome these limitations, an innovative intervention will be designed and evaluated in a cluster--‐randomized trial in The Gambia. The intervention consists of targeted treatment of potential asymptomatic malaria carriers within a malaria patient’s household, in combination with strong community involvement i.e. reactive household-­based self-­administered treatment (RHOST) (project funded by the Joint Global Health Trials Scheme supported by MRC, Wellcome Trust and DfID). The aim of this PHD research is to design the most effective, socially acceptable strategy for implementing this intervention. Through the social science research that forms the basis of this PhD application, implementation of household-­based self-­administered treatment and community participation will be continuously evaluated and improved for 2 years. The final iteration of the intervention will be tested in a cluster--‐randomized trial with malaria prevalence at the end of the malaria transmission season as the primary endpoint (outside the scope of this PhD). Local acceptability, adequacy, feasibility and community participation will also be assessed during the trial.

Trefwoorden:B680-volksgezondheid