Anthropological research and community participation to facilitate mass drug administration of iverctmetin and dyhidroartemisin-piperaquine as an additional intervention for malaria elimination

  • D'Alessandro, Umberto (Promotor)
  • Baltussen, R. (Copromotor)
  • Slater, Hannah (Copromotor)
  • Nwakanma, Davis (Copromotor)
  • Drakely, Chris (Copromotor)
  • Bousema, Teun (Copromotor)
  • Kandeh, B. (Copromotor)
  • Bradley, John (Copromotor)
  • Peeters, Koen (Copromotor)
  • Nieto Sanchez, Claudia (Researcher)
  • Muela Ribera, Joan (Copromotor)
  • Bastiaens, Guido (Copromotor)
  • Affara, Muna (Copromotor)
  • Achan, Jane (Copromotor)
  • Everaert, Renilde (Administrator)

Project Details


We propose to evaluate a novel approach to decrease and possibly stop residual malaria transmission; it consists of mass drug administration (MDA) with an artemisinin-based combination treatment, dihydroartemisinin-piperaquine (DP), and a systemic endectocidal drug, ivermectin (IVM), toxic to Anopheles mosquitoes when biting treated individuals. This intervention will be tested through a community-based, cluster-randomized trial to be implemented in the Upper River Region of The Gambia where there is still residual malaria transmission despite high coverage of standard malaria control activities. Thirty two villages (clusters) at least 3-4 km apart and with 200-600 inhabitants will be randomized to either the intervention or the control arm. MDA with IVM and DP will be implemented in 16 intervention villages and a buffer zone of 2 km around each of them, and will consist of 3-monthly rounds per year during the malaria transmission season for two years.
At the peak of each transmission season, a cross-sectional survey to determine malaria prevalence (200 individuals per cluster) will be carried out in both study arms. The vector population will be monitored throughout the transmission season.
In addition, qualitative social science data on coverage, potential bottlenecks for the intervention, adherence and acceptability will be collected; a health economics study on the cost-effectiveness of the intervention will be carried out.
The primary outcomes will be malaria prevalence (by molecular methods) in all age groups and vector's parous rates after 2 MDA seasonal cycles (3 rounds each). Secondary outcomes will include incidence of clinical malaria, serological markers of recent infection or recent exposure to the vector, other entomological variables, intervention coverage, and costeffectiveness
of the intervention.

ITM participates in the anthropological component of the trial, a mixed methods design triangulating ethnographic qualitative methods (including in-depth interviews and participant observation) and quantitative survey research will be carried out to determine sociocultural factors associated to the intervention’s effectiveness, including local acceptability. In a first phase, prior to the initial MDA campaign, potential bottlenecks for the intervention will be assessed and recommendations will be made to improve the implementation. This will help fine-tuning the intervention to local realities in addition to engaging stakeholders to facilitate participation and long-term sustainability. Subsequently, community members and stakeholders will be involved in the process of developing/adapting the MDA strategy to increase sustainability of the intervention. A comprehensive stakeholder assessment will be carried out at the beginning of the project, aiming to identify formal and informal groups and organizations active in the communities.
Effective start/end date1/01/1830/09/20


  • Medical Research Council: €287,417.83