Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sunil Parikh

Second Advisor

Joshua Warren

Abstract

Malaria is a major cause of mortality globally, but particularly in Africa and among children. As the growth of drug resistance threatens current malaria control and treatment strategies, novel interventions are needed to combat the recent increase in cases. Ivermectin is an endectocide that has been historically used to treat neglected tropical parasitic diseases through mass drug administration (MDA). Recently, it has been demonstrated to have a lethal effect on mosquitos, suggesting its potential as a valuable vector control strategy. RIMDAMAL II is a cluster randomized control trial that was conducted in southwestern Burkina Faso in 2019-2020 to evaluate the impact of ivermectin MDA on malaria transmission. Villages randomly assigned to the treatment arm were given monthly ivermectin MDA during the transmission season, July-October of both years. Blood samples from active case detection by monthly sampling of 206 children <10 years of age in both arms were screened for Plasmodium infection and then speciated using multiplex real-time PCR. Ivermectin MDA had a small, insignificant impact on malaria infections in children. The odds of detecting malaria infection in children in the control villages are 12% higher than those in the villages receiving ivermectin (OR = 1.12, 95% CI [0.701, 1.786]). 8% of all samples tested identified a mixed infection with P. falciparum and at least one non-falciparum species. This is a higher contribution of non-falciparum species to overall infections than expected, though the proportion of each species present did not not differ by treatment (X2 = .31, df = 2, p= 0.856). Additionally, while the proportion of species detected cannot be statistically compared between individual villages, there was notable variation in the amount of mixed infections and each species observed by village. This surprising diversity of Plasmodium spp. infections elucidates the need for further sampling and speciation to determine the true prevalence of non-falciparum infections across Burkina Faso, as there is currently very limited data. Accurate identification of P. ovale is particularly important, as this may have implications for the inclusion of primaquine in treatment guidelines. Although this study did not find ivermectin MDA to significantly reduce malaria infections in children, additional research is needed to investigate potential environmental confounders and methods to optimize implementation of ivermectin MDA.

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This is an Open Access Thesis.

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