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.
Highlights
Mass 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 that had been identified as hotspots through Zanzibar’s malaria case notification (MCN) surveillance system
Age and gender characteristics of study population A total of 9076 participants in 2001 households were enumerated in the four districts targeted for MDA; a total of 2009 participants were enumerated in 413 households during the post MDA survey
Summary
Mass 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. In response to the malaria burden, the Zanzibar Malaria Control Programme—in collaboration with bilateral, multilateral and non-governmental partners—scaled up prevention and control efforts, including: artemisininbased combination therapy (ACT); insecticide-treated nets (ITNs); indoor residual spraying of households with insecticide (IRS); and intermittent preventive treatment for pregnant women (IPTp) with sulfadoxine–pyrimethamine (SP) [2,3,4]. While malaria elimination relies upon a similar mix of interventions as during the malaria control phase (i.e. case management, vector control, and surveillance), it requires more intensified, rapid, and targeted responses, especially for targeting transmission hotspots and specific high-risk populations [7,8,9]. The Zanzibar Malaria Elimination Programme (ZAMEP) is able to identify hotspots through its malaria case notification (MCN) (“Coconut”) surveillance system, which tracks daily facility-based malaria cases for real-time decision-making and active case detection through household screening and treatment (HSaT)
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