Mass drug administration for malaria

Abstract

Background Mass drug administration (MDA), defined as the empiric administration of a therapeutic antimalarial regimen to an entire population at the same time, has been a historic component of many malaria control and elimination programmes, but is not currently recommended. With renewed interest in MDA and its role in malaria elimination, this review aims to summarize the findings from existing research studies and program experiences of MDA strategies for reducing malaria burden and transmission. Objectives To assess the impact of antimalarial MDA on population asexual parasitaemia prevalence, parasitaemia incidence, gametocytaemia prevalence, anaemia prevalence, mortality and MDA‐associated adverse events. Search methods We searched the Cochrane Infectious Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE+, EMBASE, to February 2013. We also searched CABS Abstracts, LILACS, reference lists, and recent conference proceedings. Selection criteria Cluster‐randomized trials and non‐randomized controlled studies comparing therapeutic MDA versus placebo or no MDA, and uncontrolled before‐and‐after studies comparing post‐MDA to baseline data were selected. Studies administering intermittent preventive treatment (IPT) to sub‐populations (for example, pregnant women, children or infants) were excluded. Data collection and analysis Two authors independently reviewed studies for inclusion, extracted data and assessed risk of bias. Studies were stratified by study design and then subgrouped by endemicity, by co‐administration of 8‐aminoquinoline plus schizonticide drugs and by plasmodium species. The quality of evidence was assessed using the GRADE approach. Main results Two cluster‐randomized trials, eight non‐randomized controlled studies and 22 uncontrolled before‐and‐after studies are included in this review. Twenty‐two studies (29 comparisons) compared MDA to placebo or no intervention of which two comparisons were conducted in areas of low endemicity (≤5%), 12 in areas of moderate endemicity (6‐39%) and 15 in areas of high endemicity (≥ 40%). Ten studies evaluated MDA plus other vector control measures. The studies used a wide variety of MDA regimens incorporating different drugs, dosages, timings and numbers of MDA rounds. Many of the studies are now more than 30 years old. Areas of low endemicity ( ≤5 %) Within the first month post‐MDA, a single uncontrolled before‐and‐after study conducted in 1955 on a small Taiwanese island reported a much lower prevalence of parasitaemia following a single course of chloroquine compared to baseline (1 study, very low quality evidence ). This lower parasite prevalence was still present after more than 12 months (one study, very low quality evidence ...

Seasonal Variation in the Epidemiology of Asymptomatic Plasmodium falciparum Infections across Two Catchment Areas in Bongo District, Ghana

“…The research suggests that multiple rounds of MDA, carried out over several consecutive seasons prior to the rise in EIR would be the most suitable strategy to eliminate the P. falciparum reservoir. 7,53,[64][65][66][67][68] Based on the study results, both the density and prevalence of asymptomatic P. falciparum infections in BD are at their lowest point at the end of the dry season, making this an ideal time frame to consider targeting an MDA intervention for malaria elimination in this area of West Africa.…”

From within host dynamics to the epidemiology of infectious disease: Scientific overview and challenges

“…Moreover, for malaria elimination strategies to succeed, both symptomatic individuals and asymptomatic carriers must be considered, which imposes diagnostic and treatment challenges [28; 29; 30]. Mass drug administration modelling and interdisciplinary debates have become necessary to address the utility and ethical benefits and constraints of drug treatment policies and protocols [31; 32; 33]. …”

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana

“…In order to change the present dynamics, there is a need to employ alternative intervention strategies such as mass testing, treatment and tracking (MTTT) [3,5]. Malaria mass drug administration (MDA) is an effective and well-known strategy that has been found to drastically reduce prevalence, reverse mortality trends and led to elimination in specific areas [6][7][8][9][10][11][12][13]. MDA was used in the malaria eradication efforts at different points in history between 1950s -1970s [6,8,14,15].…”

“…MDA integrated with other approaches such as distribution of LLINs and strengthening community based health services and health workers, can accelerate malaria elimination ( [16][17][18][19]. MDA as an approach has shown mixed results in the history of malaria elimination [8,10,20] and depends upon i) the targeted region's epidemiology of malaria or transmission intensity; ii) geographical characteristics of the malaria endemic regions (islands where mobility of population is minimal have cleared malaria, such as Aneityum, Taiwan); iii) coverage of such an approach with effective community engagement [21,22]; and the challenges could be resistance to antimalarials [19,[23][24][25] as well as lack of support from local authorities.…”