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Meta-Analysis
. 2023 Dec 20;110(4_Suppl):17-29.
doi: 10.4269/ajtmh.22-0766. Print 2024 Apr 2.

Mass Drug Administration to Reduce Malaria Transmission: A Systematic Review and Meta-Analysis

Zachary D Schneider  1 , Monica P Shah  1 , Marisa C Boily  2 , Alexandra L Busbee  2 , Jimee Hwang  3 , Kim A Lindblade  1   4 , Julie R Gutman  1
Affiliations
Meta-Analysis

Mass Drug Administration to Reduce Malaria Transmission: A Systematic Review and Meta-Analysis

Zachary D Schneider et al. Am J Trop Med Hyg. .

Abstract

Malaria remains a significant cause of morbidity and mortality, even in low-transmission settings. With the advent of longer acting, more effective, and well-tolerated antimalarials, there is renewed interest in the efficacy of mass drug administration (MDA) to accelerate to elimination. We conducted a systematic review and meta-analysis to assess the efficacy of MDA to reduce the incidence and prevalence of Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) infection. From 1,044 articles screened, 14 articles, including 10 randomized controlled trials (RCTs), were identified. Five included data on Pf only; five included Pf and Pv. Two of the Pf studies were conducted in areas of high-moderate transmission, the remainder were in areas of low-very low transmission. In higher transmission areas, MDA reduced incidence of Pf parasitemia (rate ratio = 0.61, 95% CI: 0.40-0.92; moderate certainty) 1 to 3 months after drug administration; no significant effect of MDA on Pf parasitemia prevalence was detected 1 to 3 months post-MDA (risk ratio [RR] = 1.76, 95% CI: 0.58-5.36; low certainty). In lower transmission settings, both incidence and prevalence of Pf parasitemia were reduced 1 to 3 months post-MDA (rate ratio = 0.37, 95% CI: 0.21-0.66; RR = 0.25, 95% CI: 0.15-0.41, respectively). Pv prevalence was reduced 1 to 3 months post-MDA (RR = 0.15, 95% CI: 0.10-0.24); there were no RCTs providing data on incidence of Pv. There was no significant effect of MDA at later time points. MDA may have short-term benefits; however, there was no evidence for longer term impact, although none of the trials assessed prolonged interventions.

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Conflict of interest statement

Disclosure: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. Pf = P. falciparum, Pv = P. vivax, WHO = World Health Origination.
Figure 2.
Figure 2.
Classification of included studies.
Figure 3.
Figure 3.
Plasmodium falciparum parasitemia incidence, cluster-randomized controlled studies, moderate–high transmission.
Figure 4.
Figure 4.
Plasmodium falciparum: parasitemia prevalence, cluster-randomized controlled studies, moderate–high transmission.
Figure 5.
Figure 5.
Plasmodium falciparum: parasitemia Incidence, cluster-randomized controlled studies, low–very low transmission.
Figure 6.
Figure 6.
Plasmodium falciparum: parasitemia prevalence, randomized controlled trials, low–very low transmission.
Figure 7.
Figure 7.
Plasmodium vivax: parasitemia prevalence, randomized controlled trials.
See this image and copyright information in PMC

References

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    1. Malaria Policy Advisory Committee Meeting, World Health Organization , 2015. Consensus Modelling Evidence to Support the Design of Mass Drug Administration Programmes. Geneva, Switzerland: WHO.
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