Review of Mass Drug Administration for Malaria and Its Operational Challenges

Newby, Gretchen; Hwang, Jimee; Koita, Kadiatou; Chen, Ingrid; Greenwood, Brian; Seidlein, Lorenz von; Shanks, G. Dennis; Slutsker, Laurence; Kachur, S. Patrick; Wegbreit, Jennifer; Ippolito, Matthew M.; Poirot, Eugenie; Gosling, Roly

doi:10.4269/ajtmh.14-0254

Cited by 188 publications

(238 citation statements)

References 22 publications

Supporting

Mentioning

232

Contrasting

Order By: Relevance

“…On regional scales, for example, DBLα diversity loss is expected following major interventions such as mass drug administration (MDA) (54,55). It is unknown, however, whether the intraspecific repertoire structuring of P. falciparum has a role in how this diversity is lost.…”

Section: Discussionmentioning

confidence: 99%

Evidence of strain structure in Plasmodium falciparum var gene repertoires in children from Gabon, West Africa

Day

Artzy‐Randrup

Tiedje

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

100

View full text Add to dashboard Cite

Existing theory on competition for hosts between pathogen strains has proposed that immune selection can lead to the maintenance of strain structure consisting of discrete, weakly overlapping antigenic repertoires. This prediction of strain theory has conceptual overlap with fundamental ideas in ecology on niche partitioning and limiting similarity between coexisting species in an ecosystem, which oppose the hypothesis of neutral coexistence. For Plasmodium falciparum, strain theory has been specifically proposed in relation to the major surface antigen of the blood stage, known as PfEMP1 and encoded by the multicopy multigene family known as the var genes. Deep sampling of the DBLα domain of var genes in the local population of Bakoumba, West Africa, was completed to define whether patterns of repertoire overlap support a role of immune selection under the opposing force of high outcrossing, a characteristic of areas of intense malaria transmission. Using a 454 high-throughput sequencing protocol, we report extremely high diversity of the DBLα domain and a large parasite population with DBLα repertoires structured into nonrandom patterns of overlap. Such population structure, significant for the high diversity of var genes that compose it at a local level, supports the existence of "strains" characterized by distinct var gene repertoires. Nonneutral, frequency-dependent competition would be at play and could underlie these patterns. With a computational experiment that simulates an intervention similar to mass drug administration, we argue that the observed repertoire structure matters for the antigenic var diversity of the parasite population remaining after intervention.Plasmodium falciparum | var genes | parasite diversity | strain structure | Gabon

show abstract

Section: Discussionmentioning

confidence: 99%

Evidence of strain structure in Plasmodium falciparum var gene repertoires in children from Gabon, West Africa

Day

Artzy‐Randrup

Tiedje

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

100

View full text Add to dashboard Cite

show abstract

“…Similar to other distributions where the importance of community engagement was highlighted as critical to ensuring high campaign coverage [9, 11], these relationships proved essential in reaching more than 80% of the population in each target community [11]. Community sensitization was key however challenging.…”

Section: Discussionmentioning

confidence: 84%

Impact and Lessons Learned from Mass Drug Administrations of Malaria Chemoprevention during the Ebola Outbreak in Monrovia, Liberia, 2014

Kuehne

Tiffany²,

Lasry

et al. 2016

PLoS ONE

View full text Add to dashboard Cite

BackgroundIn October 2014, during the Ebola outbreak in Liberia healthcare services were limited while malaria transmission continued. Médecins Sans Frontières (MSF) implemented a mass drug administration (MDA) of malaria chemoprevention (CP) in Monrovia to reduce malaria-associated morbidity. In order to inform future interventions, we described the scale of the MDA, evaluated its acceptance and estimated the effectiveness.MethodsMSF carried out two rounds of MDA with artesunate/amodiaquine (ASAQ) targeting four neighbourhoods of Monrovia (October to December 2014). We systematically selected households in the distribution area and administered standardized questionnaires. We calculated incidence ratios (IR) of side effects using poisson regression and compared self-reported fever risk differences (RD) pre- and post-MDA using a z-test.FindingsIn total, 1,259,699 courses of ASAQ-CP were distributed. All households surveyed (n = 222; 1233 household members) attended the MDA in round 1 (r1) and 96% in round 2 (r2) (212/222 households; 1,154 household members). 52% (643/1233) initiated ASAQ-CP in r1 and 22% (256/1154) in r2. Of those not initiating ASAQ-CP, 29% (172/590) saved it for later in r1, 47% (423/898) in r2. Experiencing side effects in r1 was not associated with ASAQ-CP initiation in r2 (IR 1.0, 95%CI 0.49–2.1). The incidence of self-reported fever decreased from 4.2% (52/1229) in the month prior to r1 to 1.5% (18/1229) after r1 (p<0.001) and decrease was larger among household members completing ASAQ-CP (RD = 4.9%) compared to those not initiating ASAQ-CP (RD = 0.6%) in r1 (p<0.001).ConclusionsThe reduction in self-reported fever cases following the intervention suggests that MDAs may be effective in reducing cases of fever during Ebola outbreaks. Despite high coverage, initiation of ASAQ-CP was low. Combining MDAs with longer term interventions to prevent malaria and to improve access to healthcare may reduce both the incidence of malaria and the proportion of respondents saving their treatment for future malaria episodes.

show abstract

“…The effectiveness of mass antimalarial administration is predicated on several factors, including high population coverage [6]. Achieving high coverage is a challenge for several reasons.…”

Section: Introductionmentioning

confidence: 99%

Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

Adhikari

Pell

Phommasone

et al. 2017

Global Health Action

107

186

View full text Add to dashboard Cite

Background: Mass drug (antimalarial) administration (MDA) is currently under study in Southeast Asia as part of a package of interventions referred to as targeted malaria elimination (TME). This intervention relies on effective community engagement that promotes uptake and adherence in target communities (above 80%). Objective: Based on the experienced of designing and implementing the community engagement for TME in Laos, in this article we aim to present the elements of effective community engagement for mass antimalarial administration. Methods: The design and implementation of community engagement, which took place from September 2015 to August 2016 was recorded as field notes, meeting minutes and photographs. These data underwent qualitative content analysis. Results: The community engagement strategy that accompanied TME in Laos was successful in terms of contributing to high levels of participation in mass anti-malarial administration (above 85%). Based on the experience of designing and implementing the community engagement, five key elements were identified: (1) stakeholder and authority engagement, which proceeded from national level, to regional/district and local level; (2) local human resources, particularly the recruitment of local volunteers who were integral to the design and implementation of activities in the study villages; (3) formative research, to rapidly gain insight into the local social and economic context; (4) responsiveness whereby the approach was adapted according to the needs of the community and their responses to the various study components; and (5) sharing control/leadership with the community in terms of decisions on the organization of TME activities. Conclusions: The community engagement that accompanied TME in Laos had to deal with challenges of implementing a complex study in remote and linguistically isolated villages. Despite these challenges, the study recorded high population coverage. Lessons learnt from this experience are useful for studies and intervention programs in diverse contexts.

show abstract

Review of Mass Drug Administration for Malaria and Its Operational Challenges

Cited by 188 publications

References 22 publications

Evidence of strain structure in Plasmodium falciparum var gene repertoires in children from Gabon, West Africa

Evidence of strain structure in Plasmodium falciparum var gene repertoires in children from Gabon, West Africa

Impact and Lessons Learned from Mass Drug Administrations of Malaria Chemoprevention during the Ebola Outbreak in Monrovia, Liberia, 2014

Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

Contact Info

Product

Resources

About