Artemisinin combination therapy mass drug administration in a setting of low malaria endemicity: programmatic coverage and adherence during an observational study in Zanzibar

Abstract

BackgroundMass drug administration (MDA) appears to be effective in reducing the risk of malaria parasitaemia. This study reports on programmatic coverage and compliance of MDA using artemisinin-based combination therapy (ACT) in four shehias (smallest administration unit) that had been identified as hotspots through Zanzibar’s malaria case notification surveillance system.MethodsMass drug administration was done in four shehias selected on the basis of: being an established malaria hot spot; having had mass screening and treatment (MSaT) 2–6 weeks previously; and exceeding the epidemic alert threshold of 5 cases within a week even after MSaT. Communities were sensitized and MDA was conducted using a house-to-house approach. All household members, except pregnant women and children aged less than 2 months, were provided with ACT medicine. Two weeks after the MDA campaign, a survey was undertaken to investigate completion of ACT doses.ResultsA total of 8816 [97.1% of eligible; 95% confidence interval (CI) 96.8–97.5] people received ACT. During post MDA surveys, 2009 people were interviewed: 90.2% reported having completed MDA doses; 1.9% started treatment but did not complete dosage; 4.7% did not take treatment; 2.0% were absent during MDA and 1.2% were ineligible (i.e. infants <2 months and pregnant women). Main reasons for failure to complete treatment were experience of side-effects and forgetting to take subsequent doses. Failure to take treatment was mainly due to fear of side-effects, reluctance due to lack of malaria symptoms and caregivers forgetting to give medication to children.ConclusionMass drug administration for malaria was well accepted by communities at high risk of malaria in Zanzibar, with high participation and completion rates. Further work to investigate the potential of MDA in accelerating Zanzibar’s efforts towards malaria elimination should be pursued.

Simulating the council-specific impact of anti-malaria interventions: A tool to support malaria strategic planning in Tanzania

“…Deployment of MDA at 80% coverage would be expected to bring the prevalence in most councils beneath this threshold (Fig 4). Though very high coverage of MDA has been achieved in Zanzibar [114], this would be extremely difficult to achieve and sustain across so many councils. Historically MDA programs have rarely achieved the coverage needed to meet such targets [92,115], and we concur with the WHO Global Malaria Program Global Technical Strategy [2] and other modelling studies [29] concluding that additional innovative tools are needed to achieve elimination.…”

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

“…The high coverage and compliance achieved in this study may partly be due to the familiarity of MDA as an intervention through its previous use in control and elimination of schistosomiasis and lymphatic filariasis [ 28 , 29 ], as well as historic and more recent use in malaria control [ 23 , 30 ]. Community engagement to build awareness of MDA for asymptomatic malaria and partnerships between researchers, local volunteers, and authorities are also factors noted to contribute to high intervention uptake [ 23 , 30 – 34 ]. These factors were considered in the community sensitisation that was conducted prior to the study start.…”

“…Zanzibar therefore represents an ideal situation to test MDA in the WHO recommended context of malaria elimination. A pilot MDA was conducted in response to a malaria outbreak in Zanzibar in 2013 [ 23 ]. Approximately 8800 inhabitants received a single round of MDA with DP.…”

Estimating malaria chemoprevention and vector control coverage using program and campaign data: A scoping review of current practices and opportunities

“…The reviewed articles involved two to three rounds of two- or three-day courses of anti-malarials, and all but one study [ 24 ] involved direct observation of at least the first dose of treatment. Studies used program records [ 20 , 22 , 23 , 27 ], post-campaign surveys [ 26 ] or a combination of program records and post-campaign surveys [ 18 , 19 , 21 , 24 , 26 , 28 ] to estimate coverage. One study compared coverage estimates using capture-recapture methods to those from program and survey data [ 28 ].…”