Abstract
BackgroundMass drug administration (MDA) is a suggested mean to accelerate efforts towards elimination and attainment of malaria-free status. There is limited evidence of suitable methods of implementing MDA programme to achieve a high coverage and compliance in low-income countries. The objective of this paper is to assess the impact of this MDA delivery strategy while using coverage measured as effective population in the community and population available.MethodsPopulation-based MDA was implemented as a part of a larger program in a high transmission setting in Uganda. Four rounds of interventions were implemented over a period of 2 years at an interval of 6 to 8 months. A housing and population census was conducted to establish the eligible population. A team of 19 personnel conducted MDA at established village meeting points as distribution sites at every village. The first dose of dihydroartemisinin–piperaquine (DHA-PQ) was administered via a fixed site distribution strategy by directly observed treatment on site, the remaining doses were taken at home and a door-to-door follow up strategy was implemented by community health workers to monitor adherence to the second and third doses.ResultsBased on number of individuals who turned up at the distribution site, for each round of MDA, effective coverage was 80.1%, 81.2%, 80.0% and 80% for the 1st, 2nd, 3rd and 4th rounds respectively. However, coverage based on available population at the time of implementing MDA was 80.1%, 83.2%, 82.4% and 82.9% for rounds 1, 2, 3 and 4, respectively. Intense community mobilization using community structures and mass media facilitated community participation and adherence to MDA.ConclusionA hybrid of fixed site distribution and door-to-door follow up strategy of MDA delivery achieved a high coverage and compliance and seemed feasible. This model can be considered in resource-limited settings.
Highlights
Mass drug administration (MDA) is a suggested mean to accelerate efforts towards elimination and attainment of malaria-free status
Background the malaria burden is declining in several countries [1, 2], malaria-related morbidity and mortality remains high in sub-Saharan African countries, such as Uganda [1,2,3,4,5,6]
MDA for malaria was administered in the framework of a clinical trial assessing the additional population impact of adding MDA to an indoor residual spraying (IRS) intervention in a high malaria transmission setting in Uganda (PACTR 201807166695568)
Summary
Mass drug administration (MDA) is a suggested mean to accelerate efforts towards elimination and attainment of malaria-free status. As a stably endemic, high burden country with pockets of extremely high malaria transmission faces the challenge of charting a rapid and safe route from a high malaria transmission zone towards pre-elimination phase via an intermediate low transmission state. In this regard there is a renewed interest in using malaria mass drug administration (MDA) to rapidly reduce the malaria burden and hasten the path to pre-elimination [9,10,11]. The impact of MDA on malaria burden will be reported elsewhere
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