title: Seasonal malaria chemoprevention in an area of extended seasonal transmission in Ashanti, Ghana: an individually randomised clinical trial.
abstract: OBJECTIVE
  To investigate the effectiveness of seasonal malaria chemoprevention (SMC) and community case management with long-acting artemisinin-based combination therapies (ACTs) for the control of malaria in areas of extended seasonal malaria transmission.
  
  
  METHODS
  Individually randomised, placebo-controlled trial in the Ashanti Region of Ghana. A total of 2400 children aged 3-59 months received either: (i) a short-acting ACT for case management of malaria (artemether-lumefantrine, AL) plus placebo SMC, or (ii) a long-acting ACT (dihydroartemisinin-piperaquine, DP) for case management plus placebo SMC or (iii) AL for case management plus active SMC with sulphadoxine-pyrimethamine and amodiaquine. SMC or placebo was delivered on five occasions during the rainy season. Malaria cases were managed by community health workers, who used rapid diagnostic tests to confirm infection prior to treatment.
  
  
  RESULTS
  The incidence of malaria was lower in children given SMC during the rainy season. Compared to those given placebo SMC and AL for case management, the adjusted hazard ratio (aHR) was 0.62 (95% CI: 0.41, 0.93), P = 0.020 by intention to treat and 0.53 (95% CI: 0.29, 0.95), P = 0.033 among children given five SMC courses. There were no major differences between groups given different ACTs for case management (aHR DP vs. AL 1.18 (95% CI 0.83, 1.67), P = 0.356).
  
  
  CONCLUSIONS
  SMC may have an important public health impact in areas with a longer transmission season, but further optimisation of SMC schedules is needed to maximise its impact in such settings.
authors.affiliation: School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.|Centre for Global Health Research, Juaben, Ghana.
authors.forename: Harry
authors.initials: H
authors.lastname: Tagbor
authors.affiliation: Centre for Global Health Research, Juaben, Ghana.
authors.forename: Gifty Dufie
authors.initials: GD
authors.lastname: Antwi
authors.affiliation: Centre for Global Health Research, Juaben, Ghana.
authors.forename: Princess Ruhama
authors.initials: PR
authors.lastname: Acheampong
authors.affiliation: National Malaria Control Programme, Ghana Health Service, Accra, Ghana.
authors.forename: Constance
authors.initials: C
authors.lastname: Bart Plange
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.affiliation: MRC Tropical Epidemiology Group, London School of hygiene and tropical medicine, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cairns
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods*; D002675:Child, Preschool; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use; D005869:Ghana; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000078102:Lumefantrine; D008288:Malaria / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D011739:Pyrimethamine / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use; D011891:Rain; D012621:Seasons; D013413:Sulfadoxine / Q000627:therapeutic use; D010879:Piperazines
chemical_list: D000655:Amodiaquine; D000962:Antimalarials; D000077549:Artemether; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D000078102:Lumefantrine; D011739:Pyrimethamine; D011804:Quinolines; D013413:Sulfadoxine; C001205:fanasil, pyrimethamine drug combination; C039060:artenimol; C031327:artemisinin; C034759:piperaquine; D010879:Piperazines
keywords: Ashanti; Ghana; aleatorización individual; artemisinin-based combination therapies; chimioprévention saisonnier du paludisme; community case management; ensayo controlado con placebo; essai contrôlé par placebo; individually randomised; malaria; manejo de casos comunitario; placebo-controlled trial; prise en charge communautaire des cas; quimioprevención de la malaria estacional (QME); randomisé individuellement; seasonal malaria chemoprevention; terapias de combinación de fármacos basados en artemisinina (ACTs); thérapies de combinaison à base d'artémisinine