Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Dec 15;214(12):1831-1839.
doi: 10.1093/infdis/jiw416.

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

Thomas P Eisele  1 , Adam Bennett  2 , Kafula Silumbe  3 , Timothy P Finn  1 , Victor Chalwe  4 , Mulakwa Kamuliwo  5 , Busiku Hamainza  5 , Hawela Moonga  5 , Emmanuel Kooma  6 , Elizabeth Chizema Kawesha  5 , Joshua Yukich  1 , Joseph Keating  1 , Travis Porter  1 , Ruben O Conner  7 , Duncan Earle  3 , Richard W Steketee  7 , John M Miller  3
Affiliations
Randomized Controlled Trial

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

Thomas P Eisele et al. J Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] J Infect Dis. 2017 Nov 15;216(8):1048. doi: 10.1093/infdis/jix439. J Infect Dis. 2017. PMID: 29149341 Free PMC article. No abstract available.

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.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Map of the study area, divided into 60 health facility catchment areas that served as the unit of randomization. Abbreviations: fMDA, focal mass drug administration; MDA, mass drug administration; N, north.
Figure 2.
Figure 2.
Trial profile. Sixty health facility catchment areas (HFCAs) served as the unit of randomization. After matching for transmission stratum and HFCA population size, HFCAs were randomly assigned to either mass drug administration (MDA), focal MDA (fMDA), or control groups, using the random allocation rule. As a result, 10 HFCAs per transmission stratum were assigned to MDA, fMDA, and control groups. All eligible participants in MDA and fMDA HFCAs each received 2 rounds of these mass treatment interventions. The primary end point of infection prevalence was measured before and after the mass treatment rounds with a parasite survey. The secondary end point of cumulative infection incidence was measured with a prospective cohort, with 5 months of follow-up after round 1 of the mass treatment rounds. Individuals in control HFCAs did not receive any mass treatment but were eligible to participate in the parasite surveys and cohort. Abbreviation: DHAp, dihydroartemisinin plus piperaquine.
See this image and copyright information in PMC

Comment in

References

    1. Chizema-Kawesha E, Miller JM, Steketee RW, et al. . Scaling up malaria control in Zambia: progress and impact 2005–2008. Am J Trop Med Hyg 2010; 83:480–8. - PMC - PubMed
    1. Zambia Ministry of Health. National Malaria Control Programme strategic plan for FY 2011–2015: consolidating malaria gains for impact. Lusaka, Zambia: National Malaria Control Programme, 2011.
    1. Tiono AB, Ouedraogo A, Ogutu B, et al. . A controlled, parallel, cluster-randomized trial of community-wide screening and treatment of asymptomatic carriers of Plasmodium falciparum in Burkina Faso. Malar J 2013; 12:79. - PMC - PubMed
    1. Larsen DA, Bennett A, Silumbe K, et al. . Population-wide malaria testing and treatment with rapid diagnostic tests and artemether-lumefantrine in southern Zambia: a community randomized step-wedge control trial design. Am J Trop Med Hyg 2015; 92:913–21. - PMC - PubMed
    1. Cook J, Xu W, Msellem M, et al. . Mass screening and treatment on the basis of results of a Plasmodium falciparum-specific rapid diagnostic test did not reduce malaria incidence in Zanzibar. J Infect Dis 2015; 211:1476–83. - PMC - PubMed

Publication types

Associated data