Journal article
A controlled trial of mass drug administration to interrupt transmission of multi drug resistant falciparum malaria in Cambodian villages
- Abstract:
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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 administrations (MDA) to interrupt malaria transmission.
Methods
Four malaria-endemic villages in western Cambodia were randomized to three rounds of MDA (a three-day course of dihydroartemisinin with piperaquine-phosphate), administered in either early or at the end of the study-period. Comprehensive malaria treatment records were collected during 2014-2017. Subclinical parasite prevalence was estimated by ultra-sensitive quantitative polymerase chain reaction (uPCR) quarterly over 12 months.
Results
MDA coverage with at least one complete round was 88% (1999/2268), ≥2-rounds 73% (1645/2268), and all 3-rounds 58% (1310/2268). P.falciparum incidence in intervention and control villages was similar over the 12 months prior to the study: 39/1000 person-years vs 45/1000 person-years (p=0.50). The primary outcome, P.falciparum incidence in the 12 months after MDA, was lower in intervention villages (1.5/1,000 person-years vs 37.1/1,000 person-years; incidence rate ratio 24.5, 95%CI 3.4-177; p=0.002). Following MDA in 2016, there were no clinical falciparum malaria cases over 12 months (0/2044 person-years) in all 4 villages. After an initial decrease of P.vivax prevalence in intervention villages, P.vivax prevalence had returned to approximately half of the baseline prevalence by 12 months, and was no longer significantly lower than in control villages. No severe adverse events were attributed to treatment.
Conclusion
MDAs with high coverage were safe, and associated with the absence of clinical P.falciparum cases for at least one year.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 11.7MB, Terms of use)
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- Publisher copy:
- 10.1093/cid/ciy196
Authors
- Publisher:
- Oxford University Press
- Journal:
- Clinical Infectious Diseases More from this journal
- Volume:
- 67
- Issue:
- 6
- Pages:
- 817–826
- Publication date:
- 2018-03-07
- Acceptance date:
- 2018-02-28
- DOI:
- EISSN:
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1537-6591
- ISSN:
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1058-4838
- Keywords:
- Pubs id:
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pubs:829875
- UUID:
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uuid:732c549d-4775-4cac-98f1-a0d698b66b01
- Local pid:
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pubs:829875
- Source identifiers:
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829875
- Deposit date:
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2018-03-16
Terms of use
- Copyright holder:
- Peto et al
- Copyright date:
- 2018
- Notes:
- © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
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