Impact of Early Childhood Malaria Prevention on Malaria Risk at School Entry (ERASE)

April 07,2025 | Ongoing Project | Reading time: 6 min

Introduction

Kintampo Health Research Centre (KHRC), in collaboration with University of Maryland and the Research and Development Division (RDD) of the Ghana Health Service, is conducting this new malaria study called “Impact of Early Childhood Malaria Prevention on Malaria Risk at School Entry (ERASE)”. The study is investigating how early malaria interventions including seasonal malaria chemoprevention (SMC) and malaria vaccination, affect the risk of malaria when children start school. The study is being conducted in the Kintampo North and South districts of the Bono East Region in Ghana. Preparation for the implementation of the project started in April 2024 with recruitment starting in February 2025, and will run for five years.

The study seeks to understand how interventions given early in a child’s life can affect the risk of malaria as the child grow older. Even though interventions like insecticide-treated nets and vaccines have helped reduce malaria, school-aged children are still at risk because they no longer receive these treatments once they turn a certain age.

Study Investigators

The study is led by Prof. Kwaku Poku Asante, Prof. Miriam Laufer, Dr. Dennis Adu-Gyasi, Prof. Andrea Buchwald, Prof. Shannon Takala-Harrison, and Prof. DeAnna Friedman-Klabanoff.

Background

Malaria remains a global health challenge, particularly in children where it accounts globally for more than 400,000 deaths every year. While significant progress has been made in reducing malaria cases, the incidence of Plasmodium falciparum malaria in some countries remain high. The introduction of insecticide-treated nets (ITNs), seasonal malaria chemoprevention (SMC), and malaria vaccine has helped reduce severe malaria in young children, but new challenges have emerged, particularly for school-aged children who are no longer eligible for these interventions.

Objectives of the Study

The primary objective of the study is to evaluate the impact of seasonal malaria chemoprevention (SMC) and RTS,S vaccination in young children on susceptibility to Plasmodium falciparum (Pf) malaria infection and disease in two districts in the Bono East Region of Ghana.

The study also aims to:
1. Evaluate how SMC and the RTS,S vaccine affect a child’s chances of getting malaria when they start school.

2. Identify immune responses that help protect children from Plasmodium falciparum infection and clinical disease after receiving SMC and the RTS,S vaccine.

3. Assess whether continuously giving SMC and RTS,S vaccine to children could change the genetic nature of Plasmodium falciparum and how the parasite infect children.

Study Methodology

The study will seek the consent of parents/caregivers and recruit at least 1,950 children from Kintampo North and South districts of the Bono East Region of Ghana. These children, aged five to seven years, will be selected based on their previous exposure to malaria prevention interventions. Participants will be divided into three groups, each consisting of 650 children. The first group will include children who have received both RTS,S and SMC, the second group will include those who received only RTS,S, and the third group will consist of children who have not been exposed to either intervention. Selection of participants will be done randomly from an existing database of children involved in a previous malaria study.

After enrollment, the children will be followed for two years, during which their health will be closely monitored. Regular assessments will be conducted to track malaria infection rates and clinical diseases. These assessments will involve collecting blood, stool, and urine samples to detect malaria parasites, anemia, and other infections. In addition to these, data on socioeconomic status, nutrition, and other factors that might influence malaria risk will also be collected. Aside from scheduled check-ups at enrollment, 12 months, and 24 months, study teams will follow up on participants whenever they fall ill to collect samples and screen for the presence or otherwise of malaria parasites and to diagnose malaria.

As part of the study, staff are stationed at selected local health centres in the study areas and community health workers are also placed throughout the districts to monitor any illnesses that may require malaria diagnostic evaluation and assist participants in seeking appropriate care.

Expected Outcomes

The ERASE study is expected to achieve the following outcomes:
1. To gain better understanding of the impact of SMC and RTS,S vaccination on the risk of Plasmodium falciparum malaria infections and disease after these interventions stop.

2. To provide valuable data to shape future malaria control and elimination policies, especially regarding school-aged children

Public Health Importance/Impact

ERASE study is crucial for improving malaria prevention strategies, especially for school-aged children who are often underserved by current malaria interventions and programmes. This study will support the development of new approaches to protect children from malaria as they grow older, by addressing gaps in the current understanding of how SMC and RTS,S vaccination work over the long term.

Funder

This study is funded by the US National Institutes of Health (NIH)

Study Duration: Five (5) Years

Start Date: July 2024

End Date: May 2029