Table 2.
GRADE Summary of findings
| Outcomes | Anticipated Absolute Effects* (95% CI) | Relative Effect (95% CI) | No. of Participants (studies) | Certainty of the Evidence (GRADE) | Comments | |
|---|---|---|---|---|---|---|
| Risk with No MTaT | Risk with MTaT | |||||
| 0–12 months: incidence of malaria infection | 1,646 per 1,000 | 1,564 per 1,000 (1,432–1,712) | Rate ratio: 0.95 (0.87–1.04) | 1,296 (Two RCTs)17,19 | ⨁⨁⨁◯ Moderate† | MTaT likely results in little to no difference in incidence of malaria infection |
| 2–9 months: prevalence of infection | 379 per 1,000 | 329 per 1,000 (254–382) | RR: 0.83 (0.67–1.01) | 7,309 (Three RCTs)18,20,21 | ⨁⨁⨁◯ Moderate‡ | MTaT results in little to no difference in prevalence of malaria infection |
| 0–12 months: incidence of clinical malaria | 242 per 1,000 | 199 per 1,000 (170–230) |
RR: 0.82 (0.70–0.95) | 334,944 (Three RCTs)17,20,21 | ⨁⨁⨁◯ Moderate | MTaT likely reduces incidence of clinical malaria slightly |
| AE (group targeted by the intervention) | Most common AEs during treatment were fever (0.023/person-day), headache (0.008/person-day), vomiting (0.006/person-day), cough (0.004/person-day), shivering (0.003/person-day), and nasal congestion (0.002/person-day) | (One RCT)19 | ⨁⨁◯◯ Low§ | The evidence is very uncertain about the effect of MTaT on AEs | ||
| SAE (group targeted by the intervention) | 0 per 1,000 | 0 per 1,000 (0–0) | Not estimable | 6,373 (One RCT)21 | ⨁⨁◯◯ Low‖¶ | The evidence is very uncertain about the effect of MTaT on SAEs |
| Prevalence of infection (NRS) | Three rounds of MTaT were conducted to determine prevalence in the asymptomatic reservoir; MTaT was compared with detection through passive surveillance prevalence; first round: moderate- to high-burden areas−50/28,527 (i.e., 0.18% vs. 0.06% from passive surveillance); second round: low- to high-burden areas−7/11,363 (i.e., 0.06% vs. 0.03% from passive surveillance); third round: RCD of cryptic cases in 50 households −3/8,467 (i.e., 0.03%) | (One observational study)24 | ⨁◯◯◯ Very low# | The evidence is very uncertain about the effect of MTaT on the prevalence of infection | ||
| 2 months: prevalence of infection (NRS) | 34 per 1,000 | 1 per 1,000 (1–2) | OR: 0.03 (0.02–0.07) | 8,508 (One observational study)22 | ⨁◯◯◯ Very low#**†† | The evidence is very uncertain about the effect of MTaT on the prevalence of infection |
| 12 months: prevalence of infection (NRS) | 438 per 1,000 | 415 per 1,000 (343–519) | OR: 0.91 (0.67–1.38) | 416 (One observational study)23 | ⨁◯◯◯ Very low‡# | The evidence is very uncertain about the effect of MTaT on the prevalence of infection |
| 12 months: prevalence of infection (NRS) | 363 per 1,000 | 302 per 1,000 (277–327) | OR: 0.76 (0.67–0.85) | 8,907 (One observational study)23 | ⨁◯◯◯ Very low‡# | The evidence is very uncertain about the effect of MTaT on the prevalence of infection |
AE = adverse event; GRADE = Grading of Recommendations, Assessment, Development and Evaluation; MTaT = mass testing and treatment; NRS = nonrandomized study; OR = odds ratio; RCT = randomized controlled trial; RR = risk ratio; SAE = serious adverse event. To achieve transparency and implicity, the GRADE system classifies the certainty of evidence in one of four grades: High: Further research is very unlikely to change our confidence in the estimate of effect. ⨁⨁⨁⨁ Moderate: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. ⨁⨁⨁◯ Low: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. ⨁⨁◯◯ Very low: Any estimate of effect is very uncertain. ⨁◯◯◯
The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
One study had two intervention arms. Both intervention arms were pooled with another study and compared with the control. The control arm was inflated in value because it was the same comparison group for the two different intervention arms in one study.
Used as a proxy for prevalence of infection at the community level.
SAEs and AEs are not classified based on intervention and control arms.
Unable to calculate control measures in the absence of control measure.
Common AEs are reported for the whole study; however, no breakdown is provided for different arms.
Critical overall risk of bias due to inherent biases associated with study design.
Fever and symptoms screening before testing.
Study did not control for one confounding domain and missing register from health facility in intervention village; the analysis is unlikely to have removed the risk of bias arising from the missing data.
Study did not control for one confounding domain and missing register from health facility in intervention village; the analysis is unlikely to have removed the risk of bias arising from the missing data.