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J Infect Dis. 2016 Dec 15;214(12):1831-1839.

Short-term Impact of Mass Drug Administration With Dihydroartemisinin Plus Piperaquine on Malaria in Southern Province Zambia: A Cluster-Randomized Controlled Trial.

Author information

1
Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
2
Malaria Elimination Initiative, Global Health Group, University of California San Francisco.
3
PATH-Malaria Control and Elimination Partnership in Africa (MACEPA), National Malaria Control Centre, Chainama Hospital College Grounds.
4
Institute for Medical Research and Training, University Teaching Hospital.
5
National Malaria Control Centre, Zambia Ministry of Health, Chainama Hospital, Lusaka.
6
Zambia Ministry of Health, Southern Provincial Health Office, Choma.
7
PATH-MACEPA, Seattle, Washington.

Abstract

BACKGROUND:

 Mass drug administration (MDA) using dihydroartemisinin plus piperaquine (DHAp) represents a potential strategy to clear Plasmodium falciparum infections and reduce the human parasite reservoir.

METHODS:

 A cluster-randomized controlled trial in Southern Province, Zambia, was used to assess the short-term impact of 2 rounds of community-wide MDA and household-level (focal) MDA with DHAp compared with no mass treatment. Study end points included parasite prevalence in children, infection incidence, and confirmed malaria case incidence.

RESULTS:

 All end points significantly decreased after intervention, irrespective of treatment group. Parasite prevalence from 7.71% at baseline to 0.54% after MDA in lower-transmission areas, resulting in an 87% reduction compared with control (adjusted odds ratio, 0.13; 95% confidence interval, .02-.92; P = .04). No difference between treatment groups was observed in areas of high transmission. The 5-month cumulative infection incidence was 70% lower (crude incidence rate ratio, 0.30; 95% confidence interval, .06-1.49; P = .14) and 58% lower (0.42; .18-.98; P = .046) after MDA compared with control in lower- and higher-transmission areas, respectively. No significant impact of focal MDA was observed for any end point.

CONCLUSIONS:

 Two rounds of MDA with DHAp rapidly reduced infection prevalence, infection incidence, and confirmed case incidence rates, especially in low-transmission areas.

CLINICAL TRIALS REGISTRATION:

NCT02329301.

KEYWORDS:

elimination; malaria; mass drug administration

PMID:
27923947
PMCID:
PMC5142084
DOI:
10.1093/infdis/jiw416
[Indexed for MEDLINE]
Free PMC Article

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