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“Introduction Recent application of malaria control strategies has succeeded in reducing the malaria burden in endemic regions [1–5], yet malarial anemia remains a major cause of morbidity and mortality [6, 7]. Plasmodium falciparum malaria in Kenyan children was reported to account for up to 75% of anemia-associated deaths and 9% of all deaths Selleckchem Ro 61-8048 [7]. Furthermore, children with severe malarial anemia had a mortality rate of 8.6%, compared with 3.6% in children with severe anemia due to other causes [7]. Malarial anemia is well known as a major complication of symptomatic parasitemia. Less well known is that it is also significantly associated with low-density asymptomatic parasitemia in children [8, 9]. This, coupled with the fact that a large proportion (dependant on factors such as population age,
natural immunity, and transmission rate) of infections in endemic areas are asymptomatic [10–14], means that the potential to further reduce the burden of malarial anemia through the selleckchem treatment of asymptomatic carriers is promising. It is already known that interventions
that reduce malaria transmission, such as insecticide-treated nets and chemoprophylaxis, can improve VX-765 hemoglobin (Hb) levels in children [15–17], and that treatment of asymptomatic children can improve their cognitive ability, possibly as a result of raised Hb levels [18]. either However, little is known about the effect of community-level treatment of asymptomatic carriers on Hb levels. Reducing malaria transmission within a population through the systematic screening and treatment of asymptomatic persons could potentially improve Hb levels. This cluster-randomized trial of 18 villages in Saponé, Burkina Faso, investigated whether systematic screening and treatment of asymptomatic carriers of P. falciparum with artemether–lumefantrine (AL) during three community screening campaigns (Campaigns 1–3) could reduce the burden of malaria and whether this intervention, in addition to the routine treatment of symptomatic P. falciparum carriers with AL, could improve Hb levels and reduce the prevalence of anemia. Primary outcomes were the number of microscopy-confirmed cases of symptomatic malaria with a parasite density >5,000/μl per person-year in infants and children <5 years of age and the change in Hb level from Day 1 to Day 28 of Campaign 1 in asymptomatic carriers >6 months of age, between the intervention and control arm.