Archibald 1960 NGA.
| Methods | Dates of study: 1957‐1959 Location of study: Nigeria Malaria endemicity (prevalence): Intervention group 1 (Arugungu ‐ June 1958): 28% in children 1‐10 years; 29% in children 0‐15 years [Moderate]. Intervention group 1 (Gulmare and Koei ‐ October 1957): 64% in children 1‐10 years; 58.3% in children 0‐15 years [High]. Transmission season: June to October Malaria species: P. falciparum, P. malariae Vector species: A. gambiae, A. funestus Study design: Uncontrolled before‐and‐after study Evaluation design: Cross‐sectional surveys |
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| Participants | Age groups included: All ages Sample size Intervention group 1 (mean): 10,000 Intervention group 2 (mean): 1300 |
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| Interventions | Intervention group 1 (Arugungu): MDA to all persons with chloroquine 600 mg and pyrimethamine 25 mg given monthly from June to October 1958. Coverage not specified. Co‐intervention with IRS. Intervention group 2 (Gulmare and Koei): MDA to all persons with chloroquine 600 mg and pyrimethamine 25 mg given every six months (November 1957, May 1958, November 1958 and March 1959). Coverage not specified. Co‐intervention with IRS. |
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| Outcomes | Parasitaemia prevalence Gametocytaemia prevalence No adverse event surveillance conducted Adverse events reported: "There were substantial difficulties with toddlers taking chloroquine and a number of them vomited that drug." |
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| Notes | MDA added to IRS programme. The outcomes for intervention groups 1 and 2 were assessed in a sub‐sample of the treated population. A third intervention group received only pyrimethamine 25 mg but was not included in the meta‐analysis due to reports of rapid development of resistance. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | No comparison group |
| Allocation concealment (selection bias) | High risk | No comparison group |
| Baseline imbalance (selection bias) | High risk | No comparison group |
| Contamination protection | High risk | No comparison group |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No comparison group |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | No comparison group |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | The highest number of confirmed absentees reported by the investigators in September 1958 in Argungu was only 625 (6%). |
| Selective reporting (reporting bias) | High risk | The number of children examined varied greatly between surveys without any explanation and a very small number of children were examined in Arugungu. |
| Other bias | High risk | Anecdotes of ill effects began to circulate and there was evidence of 'palming' of tablets. |