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. 2024 Jun 11;52(1):42.
doi: 10.1186/s41182-024-00607-2.

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate-pyronaridine to control malaria outbreaks in Cambodia

Dysoley Lek  1   2 , Nguon Sokomar  3 , Top Samphornarann  3 , Jeanne Rideout  3 , Saad El-Din Hassan  3 , Tol Bunkea  4 , Saing Sam Ath  4 , Rothpisey Seng  4 , John Hustedt  3   5 , Thomas J Peto  6   7 , Jayme Hughes  8 , Ke Kimmen  9 , Khoy Dy  8 , Bipin Adhikari  10   11
Affiliations

Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate-pyronaridine to control malaria outbreaks in Cambodia

Dysoley Lek et al. Trop Med Health. .

Abstract

Introduction: The national malaria programme of Cambodia targets the rapid elimination of all human malaria by 2025. As clinical cases decline to near-elimination levels, a key strategy is the rapid identification of malaria outbreaks triggering effective action to interrupt local transmission. We report a comprehensive, multipronged management approach in response to a 2022 Plasmodium falciparum outbreak in Kravanh district, western Cambodia.

Methods: The provincial health department of Pursat in conjunction with the Center for Parasitology, Entomology and Malaria Control (CNM) identified villages where transmission was occurring using clinical records, and initiated various interventions, including the distribution of insecticide-treated bed nets, running awareness campaigns, and implementing fever screening with targeted drug administration. Health stations were set up at forest entry points, and later, targeted drug administrations with artesunate-pyronaridine (Pyramax) and intermittent preventive treatment for forest goers (IPTf) were implemented in specific village foci. Data related to adherence and adverse events from IPTf and TDA were collected. The coverage rates of interventions were calculated, and local malaria infections were monitored.

Results: A total of 942 individuals were screened through active fever surveillance in villages where IPTf and TDA were conducted. The study demonstrated high coverage and adherence rates in the targeted villages, with 92% (553/600) coverage in round one and 65% (387/600) in round two. Adherence rate was 99% (551/553) in round one and 98% (377/387) in round two. The study found that forest goers preferred taking Pyramax over repeated testing consistent with the coverage rates: 92% in round one compared to 65% in round two. All individuals reachable through health stations or mobile teams reported complete IPTf uptake. No severe adverse events were reported. Only six individuals reported mild adverse events, such as loss of energy, fever, abdominal pain, diarrhoea, and muscle aches. Two individuals attributed their symptoms to heavy alcohol intake following prophylaxis.

Conclusions: The targeted malaria outbreak response demonstrated high acceptability, safety, and feasibility of the selected interventions. Malaria transmission was rapidly controlled using the available community resources. This experience suggests the effectiveness of the programmatic response for future outbreaks.

Keywords: Artesunate–pyronaridine; Cambodia; Intermittent preventive treatment; Outbreak response, forest goers; Targeted drug administration.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Number of Plasmodium falciparum cases in Kravanh district between January and April 2021 and 2022
Fig. 2
Fig. 2
Timeline showing programmatic responses to outbreak. Main programmatic responses included Intermittent Preventive Treatment for Forest goers (IPTf) and Targeted Drug Administration (TDA)
Fig. 3
Fig. 3
Location of Intermittent Preventive Treatment for Forest goers (IPTf) and Targeted Drug Administration (TDA) villages, mobile teams, and health stations
Fig. 4
Fig. 4
Plasmodium falciparum cases in villages eligible for Targeted Drug Administration (TDA) and Intermittent Preventive Treatment for Forest goers (IPTf) in Phnom Kravanh, Jan–Nov 2022
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