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ABSTRACT: Background
The increase in multidrug-resistant Plasmodium falciparum in Southeast Asia suggests a need for acceleration of malaria elimination. We evaluated the effectiveness and safety of mass drug administration (MDA) to interrupt malaria transmission.Methods
Four malaria-endemic villages in western Cambodia were randomized to 3 rounds of MDA (a 3-day course of dihydroartemisinin with piperaquine-phosphate), administered either early in or at the end of the study period. Comprehensive malaria treatment records were collected during 2014-2017. Subclinical parasite prevalence was estimated by ultrasensitive quantitative polymerase chain reaction quarterly over 12 months.Results
MDA coverage with at least 1 complete round was 88% (1999/2268), ≥2 rounds 73% (1645/2268), and all 3 rounds 58% (1310/2268). Plasmodium falciparum incidence in intervention and control villages was similar over the 12 months prior to the study: 39 per 1000 person-years (PY) vs 45 per 1000 PY (P = .50). The primary outcome, P. falciparum incidence in the 12 months after MDA, was lower in intervention villages (1.5/1000 PY vs 37.1/1000 PY; incidence rate ratio, 24.5 [95% confidence interval], 3.4-177; P = .002). Following MDA in 2016, there were no clinical falciparum malaria cases over 12 months (0/2044 PY) in all 4 villages. Plasmodium vivax prevalence decreased markedly in intervention villages following MDA but returned to approximately half the baseline prevalence by 12 months. No severe adverse events were attributed to treatment.Conclusions
Mass drug administrations achieved high coverage, were safe, and associated with the absence of clinical P. falciparum cases for at least 1 year.Clinical trials registration
NCT01872702.
SUBMITTER: Tripura R
PROVIDER: S-EPMC6117448 | biostudies-literature | 2018 Aug
REPOSITORIES: biostudies-literature
Tripura Rupam R Peto Thomas J TJ Chea Nguon N Chan Davoeung D Mukaka Mavuto M Sirithiranont Pasathorn P Dhorda Mehul M Promnarate Cholrawee C Imwong Mallika M von Seidlein Lorenz L Duanguppama Jureeporn J Patumrat Krittaya K Huy Rekol R Grobusch Martin P MP Day Nicholas P J NPJ White Nicholas J NJ Dondorp Arjen M AM
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20180801 6
<h4>Background</h4>The increase in multidrug-resistant Plasmodium falciparum in Southeast Asia suggests a need for acceleration of malaria elimination. We evaluated the effectiveness and safety of mass drug administration (MDA) to interrupt malaria transmission.<h4>Methods</h4>Four malaria-endemic villages in western Cambodia were randomized to 3 rounds of MDA (a 3-day course of dihydroartemisinin with piperaquine-phosphate), administered either early in or at the end of the study period. Compre ...[more]