Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned

Abstract

Northern Uganda hosts a large population of refugees from South Sudan, and malaria is one of the major health problems in the area. In 2015, intermittent preventive treatment for malaria (IPTc) was implemented in two refugee camps among children aged 6 months to 14 years. Three distributions of dihydroartemisinin–piperaquine (DP) were conducted at 8-week intervals. The first dose was directly administered at IPTc distribution sites and the second and third doses were given to caregivers to administer at home. A multi-faceted evaluation was implemented, including coverage surveys, malaria prevalence surveys, reinforced surveillance, and pharmacovigilance. Programme coverage exceeded 90% during all three distributions with a total of 40,611 participants. Compared to same period during the previous year (only available data), the incidence of malaria in the target populations was reduced (IRR 0.73, 95% CI 0.69–0.77 among children under 5 years old; IRR 0.70, 95% CI 0.67–0.72 among children aged 5–14 years). Among those not targeted for intervention, the incidence between the 2 years increased (IRR 1.49, 95% CI 1.42–1.56). Cross-sectional surveys showed a prevalence of parasitaemia (microscopy or PCR) of 12.9–16.4% (95% CI 12.6–19.3) during the intervention, with the highest prevalence among children aged 5–14 years, but with a large increase 8 weeks after the final distribution. A total of 57 adverse events were reported during the intervention period, including one severe adverse event (death from varicella). Adverse events were of mild to moderate severity, and were mainly dermatologic and gastrointestinal. This is the first documentation of an IPTc programme in a refugee camp. The positive impact of DP on the incidence of malaria, together with its favourable safety profile, should lead to further use of IPTc in similar settings. Expanding coverage groups and decreasing intervals between distributions might provide more benefit, but would need to be balanced with the operational implications of a broader, more frequent distribution schedule.

Interactions between climatic changes and intervention effects on malaria spatio-temporal dynamics in Uganda

“…The temporal trends in incidence observed in Uganda are in line in with global malaria trends ( World Health Organisation, 2017 ). The initial decline has been attributed to the effect of the scaled-up malaria interventions ( Bhatt et al, 2015 ), whereas the resurgence has been explained by insecticide resistance ( Talisuna et al, 2015 ), migration of non-immune populations such as refugees ( Coldiron et al, 2017 ), and by the increasing role of climate change on malaria transmission ( Ngarakana-Gwasira et al, 2016b ).…”

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

“…From the screening and assessment of the grey literature and of the reference lists of relevant systematic reviews, a further 24 eligible publications were identified. From the total of 194 eligible publications18–211 included in our review (table 1; online supplementary appendix B), we captured 392 reported instances of infectious disease intervention delivery. Publication frequency varied since the beginning of the review study period in 1990, with peaks in 1996 and again in 2013 (n=26), and remaining high since then (figure 2).…”

Risk of sudden unexplained death after use of dihydroartemisinin–piperaquine for malaria: a systematic review and Bayesian meta-analysis

“…Additionally, since our search was concluded, dihydroartemisinin–piperaquine has been reported to have been administered safely to 40 611 children as seasonal malaria chemoprevention in a refugee camp with reinforced surveillance in Uganda. 58 …”