Impact of Population Based Indoor Residual Spraying in Combination with Mass Drug Administration on Malaria Incidence and Test Positivity in a High Transmission Setting in North Eastern Uganda

Overview

Journal Malar J

Publisher Biomed Central

Specialty Tropical Medicine

Date 2023 Dec 14

PMID 38093286

Authors

Mulebeke Ronald

Wanzira Humphrey

Yeka Adoke

Van Geertruyden Jean-Pierre

Affiliations

Soon will be listed here.

Abstract

Background: Mass drug administration (MDA) and indoor residual spraying (IRS) are potent malaria burden reduction tools. The impact of combining MDA and IRS is not well documented. We evaluated the impact of MDA + IRS compared to IRS alone at a high transmission site in Eastern Uganda.

Methods: A quasi-experimental study was implemented in Toroma and Kapujan subcounties in north eastern Uganda. Both subcounties received four rounds of IRS using primiphos-methyl (Acttellic SC300) 6-8 months apart from December 2016 to December 2018. Eligible residents of Kapujan simultaneously received MDA using dihydroartemesinin-piperaquine (DHA-PQ). Health facility data was used to monitor malaria case incidence rate and test positivity rates.

Results: In the MDA + IRS arm, malaria incidence dropped by 83% (IRR: 0·17 (0.16-0.18); p < 0.001) in children under 5 year and by 78% (IRR: 0·22 (0.22-0.23); p < 0.001) in persons aged ≥ 5 years from the pre-intervention to the intervention period. In the IRS arm malaria incidence dropped by 47% (IRR: 0.53 (0.51, 0.56); p < 0.001) in children under 5 years and by 71% 0.29 (0.28, 0.30); p < 0.001) in persons aged ≥ 5 years. A drastic drop occurred immediately after the intervention after which cases slowly increased in both arms. Malaria test positivity rate (TPR) dropped at a rate of 21 (p = 0.003) percentage points per 1000 persons in the MDA + IRS arm compared to the IRS arm. There was a mean decrease of 60 (p-value, 0.040) malaria cases among children under five years and a mean decrease in TPR of 16·16 (p-value, 0.001) in the MDA + IRS arm compared to IRS arm.

Interpretation: MDA significantly reduced malaria burden among children < 5 years however the duration of this impact needs to be further investigated.

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References

Brady O, Slater H, Pemberton-Ross P, Wenger E, Maude R, Ghani A . Role of mass drug administration in elimination of Plasmodium falciparum malaria: a consensus modelling study. Lancet Glob Health. 2017; 5(7):e680-e687. PMC: 5469936. DOI: 10.1016/S2214-109X(17)30220-6. View

Jensen T, Bukirwa H, Njama-Meya D, Francis D, Kamya M, Rosenthal P . Use of the slide positivity rate to estimate changes in malaria incidence in a cohort of Ugandan children. Malar J. 2009; 8:213. PMC: 2749863. DOI: 10.1186/1475-2875-8-213. View

Eisele T, Bennett A, Silumbe K, Finn T, Chalwe V, Kamuliwo M . Short-term Impact of Mass Drug Administration With Dihydroartemisinin Plus Piperaquine on Malaria in Southern Province Zambia: A Cluster-Randomized Controlled Trial. J Infect Dis. 2016; 214(12):1831-1839. PMC: 5142084. DOI: 10.1093/infdis/jiw416. View

Killeen G . A second chance to tackle African malaria vector mosquitoes that avoid houses and don't take drugs. Am J Trop Med Hyg. 2013; 88(5):809-816. PMC: 3752742. DOI: 10.4269/ajtmh.13-0065. View

Jagannathan P, Muhindo M, Kakuru A, Arinaitwe E, Greenhouse B, Tappero J . Increasing incidence of malaria in children despite insecticide-treated bed nets and prompt anti-malarial therapy in Tororo, Uganda. Malar J. 2013; 11:435. PMC: 3551700. DOI: 10.1186/1475-2875-11-435. View

Rassi C, Graham K, King R, Ssekitooleko J, Mufubenga P, Gudoi S . Assessing demand-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study in two regions of Uganda. Malar J. 2016; 15(1):530. PMC: 5096321. DOI: 10.1186/s12936-016-1589-7. View

Bousema T, Drakeley C . Epidemiology and infectivity of Plasmodium falciparum and Plasmodium vivax gametocytes in relation to malaria control and elimination. Clin Microbiol Rev. 2011; 24(2):377-410. PMC: 3122489. DOI: 10.1128/CMR.00051-10. View

Shekalaghe S, Drakeley C, van den Bosch S, ter Braak R, van den Bijllaardt W, Mwanziva C . A cluster-randomized trial of mass drug administration with a gametocytocidal drug combination to interrupt malaria transmission in a low endemic area in Tanzania. Malar J. 2011; 10:247. PMC: 3169516. DOI: 10.1186/1475-2875-10-247. View

von Seidlein L, Peto T, Landier J, Nguyen T, Tripura R, Phommasone K . The impact of targeted malaria elimination with mass drug administrations on falciparum malaria in Southeast Asia: A cluster randomised trial. PLoS Med. 2019; 16(2):e1002745. PMC: 6377128. DOI: 10.1371/journal.pmed.1002745. View

10.

Bi Y, Hu W, Liu H, Xiao Y, Guo Y, Chen S . Can slide positivity rates predict malaria transmission?. Malar J. 2012; 11:117. PMC: 3416572. DOI: 10.1186/1475-2875-11-117. View

11.

Francis D, Gasasira A, Kigozi R, Kigozi S, Nasr S, Kamya M . Health facility-based malaria surveillance: the effects of age, area of residence and diagnostics on test positivity rates. Malar J. 2012; 11:229. PMC: 3444404. DOI: 10.1186/1475-2875-11-229. View

12.

Aregawi M, Ali A, Al-Mafazy A, Molteni F, Katikiti S, Warsame M . Reductions in malaria and anaemia case and death burden at hospitals following scale-up of malaria control in Zanzibar, 1999-2008. Malar J. 2011; 10:46. PMC: 3050777. DOI: 10.1186/1475-2875-10-46. View

13.

Morris U, Msellem M, Mkali H, Islam A, Aydin-Schmidt B, Jovel I . A cluster randomised controlled trial of two rounds of mass drug administration in Zanzibar, a malaria pre-elimination setting-high coverage and safety, but no significant impact on transmission. BMC Med. 2018; 16(1):215. PMC: 6287359. DOI: 10.1186/s12916-018-1202-8. View

14.

Newby G, Hwang J, Koita K, Chen I, Greenwood B, von Seidlein L . Review of mass drug administration for malaria and its operational challenges. Am J Trop Med Hyg. 2015; 93(1):125-134. PMC: 4497884. DOI: 10.4269/ajtmh.14-0254. View

15.

Walker P, Griffin J, Ferguson N, Ghani A . Estimating the most efficient allocation of interventions to achieve reductions in Plasmodium falciparum malaria burden and transmission in Africa: a modelling study. Lancet Glob Health. 2016; 4(7):e474-84. DOI: 10.1016/S2214-109X(16)30073-0. View

16.

Wafula S, Mendoza H, Nalugya A, Musoke D, Waiswa P . Determinants of uptake of malaria preventive interventions among pregnant women in eastern Uganda. Malar J. 2021; 20(1):5. PMC: 7780677. DOI: 10.1186/s12936-020-03558-1. View

17.

Echodu D, Yeka A, Eganyu T, Odude W, Bukenya F, Amoah B . 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.... BMC Infect Dis. 2023; 23(1):72. PMC: 9901833. DOI: 10.1186/s12879-023-07991-w. View

18.

Elliott R, Smith D, Echodu D . Medical and entomological malarial interventions, a comparison and synergy of two control measures using a Ross/Macdonald model variant and openmalaria simulation. Math Biosci. 2018; 300:187-200. PMC: 6013649. DOI: 10.1016/j.mbs.2018.04.005. View

19.

Khamis D, Mouden C, Kura K, Bonsall M . Optimal control of malaria: combining vector interventions and drug therapies. Malar J. 2018; 17(1):174. PMC: 5937842. DOI: 10.1186/s12936-018-2321-6. View

20.

Sundell K, Jagannathan P, Huang L, Bigira V, Kapisi J, Kakuru M . Variable piperaquine exposure significantly impacts protective efficacy of monthly dihydroartemisinin-piperaquine for the prevention of malaria in Ugandan children. Malar J. 2015; 14:368. PMC: 4582734. DOI: 10.1186/s12936-015-0908-8. View