Abstract
BackgroundRecent progress in malaria control has caused renewed interest in mass drug administration (MDA) as a potential elimination strategy but the evidence base is limited. China has extensive experience with MDA, but it is not well documented.MethodsAn ecological study was conducted to describe the use of MDA for the control and elimination of Plasmodium vivax in Jiangsu Province and explore the association between MDA and malaria incidence. Two periods were focused on: 1973 to 1983 when malaria burden was high and MDA administered to highly endemic counties province-wide, and 2000 to 2009, when malaria burden was low and a focal approach was used in two counties. All available data about the strategies implemented, MDA coverage, co-interventions, incidence, and adverse events were collected and described. Joinpoint analysis was used to describe trends in incidence and the relationship between MDA coverage and incidence was explored in negative binomial regression models.ResultsFrom 1973 to 1983, MDA with pyrimethamine and primaquine was used on a large scale, with up to 30 million people in target counties covered in a peak year (50% of the total population). Joinpoint analyses identified declines in annual incidence, -56.7% (95% CI -75.5 to -23.7%) from 1973–1976 and -12.4% (95% CI -24.7 to 2.0%) from 1976–1983. Population average negative binomial models identified a relationship between higher total population MDA coverage and lower monthly incidence from 1973–1976, IRR 0.98 (95% CI 0.97 to 1.00), while co-interventions, rainfall and GDP were not associated. From 2000–2009, incidence in two counties declined (annual change -43.7 to -14.0%) during a time when focal MDA using chloroquine and primaquine was targeted to villages and/or individuals residing near passively detected index cases (median 0.04% of total population). Although safety data were not collected systematically, there were rare reports of serious but non-fatal events.ConclusionsIn Jiangsu Province, China, large-scale MDA was implemented and associated with declines in high P. vivax malaria transmission; a more recent focal approach may have contributed to interruption of transmission. MDA should be considered a potential key strategy for malaria control and elimination.
Highlights
Recent progress in malaria control has caused renewed interest in mass drug administration (MDA) as a potential elimination strategy but the evidence base is limited
For malaria eradication in the 1950s and 60s, MDA was advocated by the World Health Organization (WHO) as a strategy in situations where more conventional control measures such as indoor residual spraying (IRS) with dichlorodiphenyltrichloroethane (DDT) had failed to end residual transmission
Study design An ecological study was performed to describe the use of mass drug administration for control and elimination of P. vivax malaria in Jiangsu Province, China (Figure 1A), and to explore the impact on malaria incidence
Summary
Recent progress in malaria control has caused renewed interest in mass drug administration (MDA) as a potential elimination strategy but the evidence base is limited. For malaria eradication in the 1950s and 60s, MDA was advocated by the World Health Organization (WHO) as a strategy in situations where more conventional control measures such as indoor residual spraying (IRS) with dichlorodiphenyltrichloroethane (DDT) had failed to end residual transmission. Recent progress in malaria control has caused renewed enthusiasm and interest in MDA as a potential strategy for elimination and eradication [6,7]. There has been less attention on MDA for Plasmodium vivax, the species which becomes the ultimate challenge for most eliminating countries because it is more resilient than Plasmodium falciparum to standard interventions outside Africa [15]. Anopheline mosquito species that transmit P. vivax tend to be outdoor biting and resting making standard vector control measures such as bed nets and IRS less effective [18]
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