Impact of the Mass Drug Administration for malaria in response to the Ebola outbreak in Sierra Leone

Abstract

BackgroundAs emergency response to the Ebola epidemic, the Government of Sierra Leone and its partners implemented a large-scale Mass Drug Administration (MDA) with artesunate–amodiaquine (ASAQ) covering >2.7 million people in the districts hardest hit by Ebola during December 2014–January 2015. The World Health Organization (WHO) and the National Malaria Control Programme (NMCP) evaluated the impact of the MDA on malaria morbidity at health facilities and the number of Ebola alerts received at District Ebola Command Centres.MethodsThe coverage of the two rounds of MDA with ASAQ was estimated by relating the number anti-malarial medicines distributed to the estimated resident population. Segmented time-series analysis was applied to weekly data collected from 49 primary health units (PHUs) and 11 hospitals performing malaria parasitological testing during the study period, to evaluate trends of malaria cases and Ebola alerts during the post-MDA weeks compared to the pre-MDA weeks in MDA- and non-MDA-cheifdoms.ResultsAfter two rounds of the MDA, the number of suspected cases tested with rapid diagnostic test (RDT) decreased significantly by 43 % (95 % CI 38–48 %) at week 1 and remained low at week 2 and 3 post-first MDA and at week 1 and 3 post-second MDA; RDT positive cases decreased significantly by 47 % (41–52 %) at week 1 post-first and remained lower throughout all post-MDA weeks; and the RDT test positivity rate (TPR) declined by 35 % (32–38 %) at week 2 and stayed low throughout all post-MDA weeks. The total malaria (clinical + confirmed) cases decreased significantly by 45 % (39–52 %) at week 1 and were lower at week 2 and 3 post-first MDA; and week 1 post-second MDA. The proportion of confirmed malaria cases (out of all-outpatients) fell by 33 % (29–38 %) at week 1 post-first MDA and were lower during all post-MDA weeks. On the contrary, the non-malaria outpatient cases (cases due to other health conditions) either remained unchanged or fluctuated insignificantly. The Ebola alerts decreased by 30 % (13–46 %) at week 1 post-first MDA and much lower during all the weeks post–second MDA.ConclusionsThe MDA achieved its goals of reducing malaria morbidity and febrile cases that would have been potentially diagnosed as suspected Ebola cases with increased risk of nosocomial infections. The intervention also helped reduce patient case-load to the severely strained health services at the peak of the Ebola outbreak and malaria transmission. As expected, the effect of the MDA waned in a matter of few weeks and malaria intensity returned to the pre-MDA levels. Nevertheless, the approach was an appropriate public health intervention in the context of the Ebola epidemic even in high malaria transmission areas of Sierra Leone.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1493-1) contains supplementary material, which is available to authorized users.

Elements of effective community engagement: lessons from a targeted malaria elimination study in Lao PDR (Laos)

“…This entailed sensitizing authorities, seeking consensus and collaborating with government at different levels and then selecting and training volunteers to conduct MDA. Similar processes have been reported in the community engagement that accompanied recent malaria MDAs, for example, in Vanuatu [21], Gambia [22], Nicaragua [23], Liberia [24], Cambodia [25], and Sierra Leone [26]. Although the exact nature of the individual steps and the order in which they are taken depends on the nature of the intervention and the local context, for TME in Laos, engagement with authority figures, who acted as gatekeepers was a crucial first step.…”

Factors associated with population coverage of targeted malaria elimination (TME) in southern Savannakhet Province, Lao PDR

“…In Kenya, meetings with authorities and trained volunteers were held at different community locations, such as schools and trading centres [ 25 ]. In Nicaragua [ 26 ], Liberia [ 27 ], Cambodia [ 28 ] and Sierra Leone [ 29 ] meetings were held as part of a stepwise process of community engagement for MDA.…”

What Do We Know About Controlling Ebola Virus Disease Outbreaks?

“…71 Where advance contingency planning had been implemented, services were able to be maintained at reasonable levels, 72 and countermeasures such as additional mass drug administration for malaria during the outbreak were effective. 73 A recent systematic review highlighted long-lasting indirect health system effects on all aspects of communicable and non-communicable disease prevention and management; it is likely these will become more apparent as further evidence emerges and longitudinal studies are performed. 9 A robust health system is the cornerstone of any response, and it is essential to invest in getting the basics right before any emergency arises.…”