Abstract
Background: Mass drug administration with artemisinin-piperaquine (AP-MDA) is being considered for elimination of residual foci of malaria in Democratic Republic of São Tomé and Principe.Methods: Three monthly rounds of AP-MDA were implemented from July to October 2019. Four zones were selected. A and B were selected as a study site and a control site, respectively. C and D were located within 1.5 and 1.5 km away from the study site, respectively. Parasite prevalence, malaria incidence, and the proportion of the Plasmodium falciparum malaria cases were evaluated.Results: After 3 monthly rounds of AP-MDA, the parasite prevalence and the gametocyte carriage rate of P. falciparum in zone A decreased from 28.29(‰) to 0 and 4.99(‰) to 0, respectively. Compared to zone B, the relative risk for the population with Plasmodium falciparum malaria in zone A was lower (RR = 0.458, 95% CI: 0.146–1.437). Malaria incidence fell from 290.49(‰) (the same period of the previous year) to 15.27(‰) (from the 29th week in 2019 to the 14th week in 2020), a decrease of 94.74% in zone A, and from 31.74 to 5.46(‰), a decline of 82.80% in zone B. Compared to the data of the same period the previous year, the cumulative number of P. falciparum malaria cases were lower, decreasing from 165 to 10 in zone A and from 17 to 4 in zone B. The proportion of the P. falciparum malaria cases on the total malaria cases of the country decreased of 90.16% in zone A and 71.34% in zone C.Conclusion: AP-MDA greatly curbed malaria transmission by reducing malaria incidence in the study site and simultaneously creating a knock-on effect of malaria control within 1.5 km of the study site and within the limited time interval of 38 weeks.
Highlights
Malaria is one of the world’s three major infectious diseases
The national malaria incidences of São Tomé and Principe during 2014–2018 were 9.97–14.56‰; all malaria cases were infected with P. falciparum malaria [2]
According to World Health Organization (WHO) epidemiological classification of malaria [7] and based on the level of malaria incidence, São Tomé and Principe is a country of low malaria incidence and is listed as a country with subnational/territorial elimination program [2], with the aim for malaria elimination by 2025
Summary
In 2015, there were 214 million malaria cases globally, the lowest in the last decade. In 2016–2018, the global number of malaria cases rose from 217 million to 228 million [1, 2], an increase of more than 5%, with 90% of the cases occurring in Africa. Situated in the Gulf of Guinea, the Democratic Republic of São Tomé and Principe (hereinafter referred to as “São Tomé and Principe”) was once a malaria endemic island country (Figure 1). Mass drug administration with artemisinin-piperaquine (AP-MDA) is being considered for elimination of residual foci of malaria in Democratic Republic of São Tomé and Principe
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