Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda

BMC Infectious Diseases

Research

Samuel Gonahasa¹  Joaniter Nankabirwa¹  Emanuele Giorgi²  Adoke Yeka³  Ronald Mulebeke³  Jimmy Opigo⁴  Suzanne E. Powell⁵  Dorothy C. Echodu⁵  Mellisa Roskosky⁶  Richard C. Elliott⁷  Thomas Eganyu⁸  Maxwell Kilama⁸  Humphrey Wanzira⁸  Fred Bukenya⁸  Wycliff Odude⁸  Osborn Omoding⁸  Benjamin Amoah⁹  Kathryn Colborn^1,10 

[1] Infectious Diseases Research Collaboration, Kampala, Uganda;Lancaster University Medical School, Centre for Health Informatics, Computing and Statistics, Lancaster, UK;Makerere University College of Health Sciences, School of Public Health, P.O. Box 7072, Kampala, Uganda;National Malaria Control Division, Ministry of Health Uganda, Kampala, Uganda;Pilgrim Africa, 8001 14th Avenue NE, Suite A, 98115, Seattle, WA, USA;Pilgrim Africa, 8001 14th Avenue NE, Suite A, 98115, Seattle, WA, USA;Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Pilgrim Africa, 8001 14th Avenue NE, Suite A, 98115, Seattle, WA, USA;Micron School of Materials Science and Engineering, Boise State University, Engineering Building, Suite 338, 83725, Boise, ID, USA;Pilgrim Africa, PO Box 577, Plot 8 Engwau Road, Soroti, Uganda;School of Public Health, Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, SW7 2AZ, London, UK;University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, 80045, Aurora, CO, USA;

关键词: MDA;    Malaria;    IRS;    High burden;    Uganda;    Controlled trial;    Pirimiphos;    Dihydroartemisinin;   

DOI  :  10.1186/s12879-023-07991-w

 received in 2022-05-23, accepted in 2023-01-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDeclines in malaria burden in Uganda have slowed. Modelling predicts that indoor residual spraying (IRS) and mass drug administration (MDA), when co-timed, have synergistic impact. This study investigated additional protective impact of population-based MDA on malaria prevalence, if any, when added to IRS, as compared with IRS alone and with standard of care (SOC).MethodsThe 32-month quasi-experimental controlled before-and-after trial enrolled an open cohort of residents (46,765 individuals, 1st enumeration and 52,133, 4th enumeration) of Katakwi District in northeastern Uganda. Consented participants were assigned to three arms based on residential subcounty at study start: MDA+IRS, IRS, SOC. IRS with pirimiphos methyl and MDA with dihydroartemisinin- piperaquine were delivered in 4 co-timed campaign-style rounds 8 months apart. The primary endpoint was population prevalence of malaria, estimated by 6 cross-sectional surveys, starting at baseline and preceding each subsequent round.ResultsComparing malaria prevalence in MDA+IRS and IRS only arms over all 6 surveys (intention-to-treat analysis), roughly every 6 months post-interventions, a geostatistical model found a significant additional 15.5% (95% confidence interval (CI): [13.7%, 17.5%], Z = 9.6, p = 5e−20) decrease in the adjusted odds ratio (aOR) due to MDA for all ages, a 13.3% reduction in under 5’s (95% CI: [10.5%, 16.8%], Z = 4.02, p = 5e−5), and a 10.1% reduction in children 5–15 (95% CI: [8.5%, 11.8%], Z = 4.7, p = 2e−5). All ages residents of the MDA + IRS arm enjoyed an overall 80.1% reduction (95% CI: [80.0%, 83.0%], p = 0.0001) in odds of qPCR confirmed malaria compared with SOC residents. Secondary difference-in-difference analyses comparing surveys at different timepoints to baseline showed aOR (MDA + IRS vs IRS) of qPCR positivity between 0.28 and 0.66 (p < 0.001). Of three serious adverse events, one (nonfatal) was considered related to study medications. Limitations include the initial non-random assignment of study arms, the single large cluster per arm, and the lack of an MDA-only arm, considered to violate equipoise.ConclusionsDespite being assessed at long time points 5–7 months post-round, MDA plus IRS provided significant additional protection from malaria infection over IRS alone. Randomized trials of MDA in large areas undergoing IRS recommended as well as cohort studies of impact on incidence.Trial registration: This trial was retrospectively registered 11/07/2018 with the Pan African Clinical Trials Registry (PACTR201807166695568).

【 授权许可】

CC BY   
© The Author(s) 2023

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