Use Of Mass Drug Administration Research Articles

Assessment of participants’ perception on the use of mass drug administration in communities endemic to <i>Wuchereria bancrofti</i> Cobbold, 1877 in Northern Nigeria

Lymphatic filariasis (LF) is one of the neglected tropical diseases that cause permanent long term disability inform of hydrocoele, lymphoedema and elephantiasis that develop as a result of inflammation of the lymphatic system. This study aimed to assess the prevalence of lymphatic filariasis and perception of participants towards Mass Drug Administration (MDA) programme. The study was a community-based cross-sectional study for screening microfilariae of Wuchereria bancrofti in consenting participants. A total of 1010 participants’ from selected communities on the MDA programme in 5 Local Government Areas (LGAs) of Bauchi, Plateau and Kaduna states were enlisted into to the study. The communities were chosen based on the presence of the people living with LF according to the signs and symptoms. A well-structured adapted questionnaire was administered to collect participants’ information and their perception of the MDA programme. Microflaria of Wuchereria bancrofti were identified based on the sheathed nuclear, caudal nuclei and bent tail in Parasitology and Entomology Research Laboratory, Ahmadu Bello University, Zaria. Data was analysed using descriptive statistics, chi-squared and odds ratio. Participants with knowledge (294/1010; 29.11%) of the MDA programme were less than those without knowledge (716/1010; 70.89%) of the MDA. Similar, the prevalence of LF was higher in participants with knowledge (26.87%) of the MDA than in those without knowledge (25.14%). The status of participation showed that, those that participated (380/1010; 37.62%) in the MDA were lower than those did not participants (630/1010; 62.38%); the infection in participants that did not partook in the MDA programme had higher prevalence (29.68%) of LF than those that participated. Participants gave various reasons for not being part of the MDA programme ranging from absent (177/1010; 17.53%) at the time of the campaign to side effect (2/1010; 0.20%) of the drugs after taking it. However, those that gave reasons for not participating because Community Drug Distributors (CDD) did not come, had highest prevalence (40.74%) of LF compared to those that gave reasons as side effect (0.00%) for not taking the drugs. Overall LF prevalence of 25.64% was found in this study. There is poor knowledge of MDA programme among the participants in the communities examined. Similarly, microfilaria was present in some participants despite the MDA campaign in the selected states. Intensive awareness campaign and drug distribution need to be carried out in most of the remote communities in the affected states. Furthermore, members of the communities must be part of the CDDs for acceptability and effectiveness of the campaign.

Albendazole metabolites excretion in human saliva as a biomarker to assess treatment compliance in mass drug administration (MDA) anthelmintic programs.

Soil-transmitted-helminth (STH) infections continue to be a persistent global public health problem. Control strategies for STH have been based on the use of mass drug administration (MDA). Coverage and compliance assessment is critical to understanding the trueeffectiveness of albendazole(ABZ) in those MDA programs.The aims of this work wereto characterize the pattern ofalbendazole and metabolites excretion in human saliva, and to develop a saliva-based biomarker (HPLC drug/metabolite detection)useful to accurately estimate the coverage/compliance in MDA campaigns.The study subjects were 12 healthy volunteers treated with a single oral dose of ABZ (400 mg). Saliva and blood (dried blood spot, DBS) samples were taken previously and between 2 and 72 h post-treatment. The samples were analyzed by HPLC with UV detection, C18 reversed-phase column. ABZ sulphoxide was the main analyte recovered up to 72 h p.t. in blood and saliva. The concentration profiles measured in the blood (DBS samples) were higher (P < 0.05) than those in saliva, however,this ABZ-metabolite was recovered longer in saliva.Thein vivomeasurement of drugs/metabolites in saliva samples from ABZ-treated volunteers offers strong scientific evidence to support the use of saliva as a valid biological sample for assessing compliance in MDA programs.

Adverse drug effects among students following mass de-worming exercise involving administration of Praziquantel and Albendazole in KEEA Municipality, Ghana.

To manage the deleterious effects of parasitic infections such as lymphatic filariasis (LF) and schistosomiasis among school children, most countries including Ghana make use of mass drug administration (MDA). Although MDA has proven effective in reducing worm burden, unfortunately adverse drug effects (ADEs) post-MDA are derailing the gains and also remain poorly monitored. The study assessed incidence and factors associated with ADEs among students following a school-based mass de-worming exercise involving administration of Praziquantel (PZQT) and Albendazole (ADZ) against LF and SCH at Komenda-Edina-Eguafo-Abirem (KEEA) Municipal. After fulfilling all ethical obligations, a total of 598 students aged 5-20 years who received PZQT or ADZ monotherapy or a combination of the two (PZQT + ADZ) as part of the mass de-worming exercise were recruited through quota and random sampling. Bodyweight and height of students were measured and body mass index (BMI) calculated. Students were orally interviewed to obtain information such as age, sex, intake of diet before taking drugs. Subsequently, students were monitored over 24 hours post-MDA for cases of ADEs. Descriptive statistics and logistic regression analysis using SPSS version 26 was used to describe data collected and to determine associations between incidence of ADEs and predictor variables. Out of the 598 students, 243 (40.64%) represented by 124 males (51.03%) and 119 females (48.97%) with mean (SD) age of 13.43 (2.74) years experienced one or more forms of ADE. In decreasing order, the detected ADEs included headache (64.6%), Abdominal pain (48.6%), fever (30.0%), diarrhea (21.4%) and itching (12.8%). Multivariable statistical analysis showed that age 5-9 years (OR: 2.01, p = 0.041) and underweight (OR: 2.02, p = 0.038) were associated with incidence of ADEs. Compared with students who received combination therapy, students who received ADZ only (OR: 0.05, p < 0.001) and PZQT only (OR: 0.26, p < 0.001) had low cases of ADEs. Gender and diet intake before MDA were not associated with ADE incidence. ADE incidence was common among students in the KEEA municipality. Age, underweight, and double dosing were associated with increase in ADE incidence, while gender and food intake were not associated with increase in ADE incidence. The Disease Control Unit of the Ghana Health Service should incorporate stringent ADE monitoring in post-MDA surveillance in the National MDA program in order to be able to detect, manage and report ADEs to inform planning for future MDA programs. Such initiatives will help not only in improving effectiveness of MDA programs but also identify high risk groups and exact strategies to reduce negative influence of ADE on MDA coverage and anthelminthic drug compliance.

Mass drug administration of ivermectin, diethylcarbamazine, plus albendazole compared with diethylcarbamazine plus albendazole for reduction of lymphatic filariasis endemicity in Papua New Guinea: a cluster-randomised trial

SummaryBackgroundA single co-administered dose of a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole) has been shown to be safe and more efficacious for clearing Wuchereria bancrofti microfilariae than the standard two-drug regimen of diethylcarbamazine plus albendazole in clinical trials. However, the effectiveness of mass drug administration with the triple-drug regimen compared with the two-drug regimen is unknown. We compared the effectiveness of mass drug administration with the triple-drug and two-drug regimens for reducing microfilariae prevalence to less than 1% and circulating filarial antigen prevalence to less than 2%, levels that are unlikely to sustain transmission of lymphatic filariasis, in Papua New Guinea.MethodsThis open-label, cluster-randomised study was done in 24 villages in a district endemic for lymphatic filariasis in Papua New Guinea. Villages paired by population size were randomly assigned to receive mass drug administration with a single dose of the triple-drug oral regimen of ivermectin (200 μg per kg of bodyweight) plus diethylcarbamazine (6 mg per kg of bodyweight) plus albendazole (400 mg) or a single dose of the two-drug oral regimen of diethylcarbamazine (6 mg per kg of bodyweight) plus albendazole (400 mg). This is a follow-on study of a previously reported safety study (ClinicalTrials.govNCT02899936). All residents aged 5 years or older and non-pregnant women were asked to participate. After cross-sectional night blood microfilariae and circulating filarial antigen surveys, mass drug administration was provided at baseline and repeated 12 months later. The primary outcomes were mean prevalence of microfilariae and circulating filarial antigen at 12 months and 24 months, assessed in all residents willing to participate at each timepoint. This study is registered with ClinicalTrials.gov, NCT03352206.FindingsBetween Nov 18, 2016, and May 26, 2017, 4563 individuals were enrolled in 24 clusters; 12 clusters (2382 participants) were assigned to the triple-drug regimen and 12 clusters (2181 participants) to the two-drug regimen. Mean drug ingestion rates (of residents aged ≥5 years) were 66·1% at baseline and 63·2% at 12 months in communities assigned to the triple-drug regimen and 65·9% at baseline and 54·9% at 12 months in communities assigned to the two-drug regimen. Microfilariae prevalence in the triple-drug regimen group decreased from 105 (4·4%) of 2382 participants (95% CI 3·6–5·3) at baseline to nine (0·4%) of 2319 (0·1–0·7) at 12 months and four (0·2%) of 2086 (0·1–0·5) at 24 months. In the two-drug regimen group, microfilariae prevalence decreased from 93 (4·3%) of 2181 participants (95% CI 3·5–5·2) at baseline to 29 (1·5%) of 1963 (1·0–2·1) at 12 months and eight (0·4%) of 1844 (0·2–0·9) at 24 months (adjusted estimated risk ratio 4·5, 95% CI 1·4–13·8, p=0·0087, at 12 months; 2·9, 95% CI 1·0–8·8, p=0·058, at 24 months). The prevalence of circulating filarial antigen decreased from 523 (22·0%) of 2382 participants (95% CI 20·3–23·6) at baseline to 378 (16·3%) of 2319 (14·9–17·9) at 12 months and 156 (7·5%) of 2086 (6·4–8·7) at 24 months in the triple-drug regimen group and from 489 (22·6%) of 2168 participants (20·7–24·2) at baseline to 358 (18·2%) of 1963 (16·7–20·1) at 12 months and 184 (10·0%) of 1840 (8·7–11·5) at 24 months in the two-drug regimen group; after adjustment, differences between groups were not significant.InterpretationMass administration of the triple-drug regimen was more effective than the two-drug regimen in reducing microfilariae prevalence in communities to less than the target level of 1%, but did not reduce circulating filarial antigen prevalence to less than 2%. These results support the use of mass drug administration with the triple-drug regimen to accelerate elimination of lymphatic filariasis.FundingBill & Melinda Gates Foundation.

Malacological and Parasitological Surveys on Ethiopian Rift Valley Lakes: Implications for Control and Elimination of Snail-Borne Diseases.

Schistosomiasis is one of the snail-borne diseases responsible for the second-highest burden of diseases among neglected tropical diseases. The use of mass drug administration to the populations most at risk is a backbone of the strategy to prevent and control schistosomiasis transmission. However, it offers no protection against re-infection, and humans are often re-exposed when they return to water bodies where snails release cercariae. Surveys on cercarial infection in snails could provide better insights on human disease risk. Hence, in this study, we investigated cercarial infection in snails and also determined the epidemiology of Schistosoma mansoni among fishermen at Ethiopian Rift Valley lakes. Freshwater snails were collected from the shorelines of Ethiopian Rift Valley lakes for examination of cercarial infection during 2020. Environmental data on water quality variables and physical characteristics of snail habitats were collected. Stool samples were collected from fishermen and the Kato-Katz technique was applied for the quantification of Schistosoma mansoni eggs. A malacological survey indicated that six morphologically distinguishable types of cercariae were found in snails. Infected snails with cercaria were more likely present in habitats with high five-day biological oxygen demand and low dissolved oxygen. The overall prevalence of Schistosoma mansoni infection among the fishermen at Ethiopian Rift Valley lakes was found to be 21.5%. This indicates that fishermen at Ethiopian Rift Valley lakes are one of the groups of people harboring schistosome cercariae which are potentially responsible for the transmission of schistosomiasis to lakeshore communities who have contact with lake water. Therefore, complementary medical treatment, public health interventions, environmental management and snail reduction are needed to control the transmission of schistosomiasis.

Assessment of Diet-Related Changes on Albendazole Absorption, Systemic Exposure, and Pattern of Urinary Excretion in Treated Human Volunteers.

Soil-transmitted-helminth (STH) infections are a persistent global public health problem. Control strategies for STH have been based on the use of mass drug administration (MDA) mainly targeting preschool- and school-aged-children, although there is increasing interest in expanding treatment to include adults and others through community-wide MDA. Coverage assessment is critical to understanding the real effectiveness of albendazole (ALB) treatment in those MDA programs. The work described here aims to (i) evaluate the effect of type of diet (a heavy or light meal) and fasting before ALB treatment on the systemic disposition of ALB and its metabolites in treated human volunteers and (ii) evaluate the potential feasibility of detecting albendazole metabolites in urine. The data reported here demonstrate that the systemic availability of the active ALB-sulfoxide (ALBSO) metabolite was enhanced more than 2-fold after food ingestion (a heavy or light meal). ALB dissolution improvement related to the ingestion of food may modify the amount of drug/metabolites reaching the parasite, affecting drug efficacy and the overall success of MDA strategies. The measurement in urine samples of the amino-ALB-sulfone (NHALBSO2) derivative and ALBSO for up to 96 h suggests that it may be feasible to develop a noninvasive tool to evaluate compliance/adherence to ALB treatment.

Survey of Schistosomiasis in Saint Lucia: Evidence for Interruption of Transmission

.Saint Lucia at one time had levels of schistosomiasis prevalence and morbidity as high as many countries in Africa. However, as a result of control efforts and economic development, including more widespread access to sanitation and safe water, schistosomiasis on the island has practically disappeared. To evaluate the current status of schistosomiasis in Saint Lucia, we conducted a nationally representative school-based survey of 8–11-year-old children for prevalence of Schistosoma mansoni infections using circulating antigen and specific antibody detection methods. We also conducted a questionnaire about available water sources, sanitation, and contact with fresh water. The total population of 8–11-year-old children on Saint Lucia was 8,985; of these, 1,487 (16.5%) provided urine for antigen testing, 1,455 (16.2%) provided fingerstick blood for antibody testing, and 1,536 (17.1%) answered the questionnaire. Although a few children were initially low positives by antigen or antibody detection methods, none could be confirmed positive by follow-up testing. Most children reported access to clean water and sanitary facilities in or near their homes and 48% of the children reported contact with fresh water. Together, these data suggest that schistosomiasis transmission has been interrupted on Saint Lucia. Additional surveys of adults, snails, and a repeat survey among school-age children will be necessary to verify these findings. However, in the same way that research on Saint Lucia generated the data leading to use of mass drug administration for schistosomiasis control, the island may also provide the information needed for guidelines to verify interruption of schistosomiasis transmission.

Insights from mathematical modelling on the proposed WHO 2030 goals for scabies.

Scabies was adopted by the World Health Organization (WHO) as a Neglected Tropical Disease in 2017. There is currently no formal global scabies control programmes or existing WHO guidelines on scabies control although at least two countries, Fiji and Ethiopia, have adopted national approaches to scabies control. In February 2019 WHO held a first Informal Consultation on a Framework for Scabies Control, in part as a response to multiple national requests for guidance on public health management in high disease burden areas. Below we outline control strategies proposed at this meeting and summarise the role that modelling can play in supporting the development of evidence to translate these proposals into formal WHO recommendations and national and global control programmes. Provisional proposals discussed at the WHO Informal Consultation for a scabies control programme include the use of mass drug administration when the community prevalence of scabies is ≥ 10% (generally considered to reflect a childhood prevalence of at least 20%) and the use of intensified case management when the prevalence is below 10%.

An outbreak of schistosomiasis in a primary school in Omusati region, Namibia, March, 2016.

Schistosomiasis is endemic in some parts of northern Namibia and there is a control program in the country with the use of mass drug administration to control and prevent the disease. On the 1st March, 2016, there was a report of bloody urine among primary school pupils in a school in Omusati region, Namibia. A team of health professionals was dispatched to investigate. This case study describes steps in conducting a schistosomiasis outbreak investigation and how to determine the risk factors. This describes how to calculate both the basic and analytical measures of association with 95% confidence intervals. This case study provides a step-by-step approach and can be used as a tool to teach the fundamental principles of outbreak investigation and response and how to measure the appropriate measures of association. This case study is targeted at intermediate- and advanced-level residents of the Field Epidemiology and Laboratory Training Program and other epidemiology trainees.

The Global Fund and global goals: the role of implementation and operational research.

The Global Fund to Fight AIDS, Tuberculosis and Malaria has transformed the financing and delivery of health interventions in countries to meet Millennium Development Goal (MDG) 6, to combat human immunodeficiency virus/acquired immunedeficiency syndrome (HIV/AIDS), malaria and other diseases (mainly tuberculosis [TB]). At the United Nations General Assembly in New York, 25–27 September 2015, governments are due to adopt the new Sustainable Development Goals (SDGs) for 2016–2030. One of the proposed 17 goals is on health (Goal 3). This goal comprises 13 targets, including HIV/AIDS, malaria and tuberculosis, among a broader array of health problems. Leaving aside the important question as to whether the mission of the Global Fund may embrace a broader health agenda in the future, it is useful at this turning point to review the role of implementation and operational research in reducing the burden of HIV/AIDS, malaria and tuberculosis, looking back at the MDG era and looking forward towards the SDG era. Science and technology have generated tools to address HIV/AIDS, malaria and tuberculosis, and implementation and operational research have taken these tools out of the research and development laboratories and into communities. The development of HIV tests and drugs counts as one of the greatest modern achievements in health science and technology. Implementation and operational research have contributed to the global scale-up of access to antiretroviral drugs. By June 2014, 13.6 million people living with HIV infection were receiving antiretroviral therapy (ART) globally, an increase from just 800 000 in 2003. Successful scale-up of ART has had a dramatic impact on the estimated number of people dying of HIV-related illnesses: the number of HIV deaths declined by 35% from a peak of 2.4 million in 2005 to 1.5 million people in 2013.1 Despite a lack of progress for many years in developing new TB diagnostics, drugs and vaccines, implementation and operational research have maximised the impact of the available tools. The data systematically collected by national TB programmes on people diagnosed with TB and the outcomes of their treatment have not only enabled evaluation of programme performance, they have also fuelled operational research, which has been the hallmark of effective TB control in a wide variety of settings. Globally, the TB mortality rate fell by 45% between 1990 and 2013.1 The prospects for large-scale access to new diagnostic tests, such as nucleic acid amplification tests, and new drugs, such as delamanid and bedaquiline, depend on implementation research to realise their potential to contribute to a further decrease in the TB burden. Implementation research has taken the technologies for malaria control, including indoor residual spraying, long-lasting insecticidal nets, point-of-care diagnostic tests and artemisinin-based combination therapies, into communities and contributed to a significantly decreased burden of malaria: between 2000 and 2015, the global malaria mortality rate has decreased by 58%.1 The SDGs are to build on the lessons learned from progress towards the MDGs and setbacks. Progress towards the SDG years depends on maximising the gains from the health interventions that are currently available and from those that will become available (undoubtedly including new drugs and potentially new vaccines against HIV, TB and malaria). For HIV, extending access to ‘test and treat’ using currently available HIV diagnostic tests and treatment, and in the future making an effective HIV vaccine widely available, both depend on implementation research to bring these interventions to scale. For TB, the dramatic increase in the rate of decline of TB incidence that is needed to realise the ultimate goal of TB elimination will depend not only on science and technology for the development of new drugs and vaccines but also on implementation research to make these widely available. Finally, for malaria, the use of mass drug administration in the contribution to malaria elimination raises the question of how effective and feasible methods of delivery through community engagement can be developed. In the SDGs era, we need to maximise the potential of implementation and operational research to make the benefits of science and technology available to at-risk individuals and communities and to help achieve the ambition of ending the epidemics of TB, HIV and malaria. Implementation and operational research involve modest costs, but they have the potential for a huge magnifier effect in extending the impact of health interventions delivered by programmes supported by the Global Fund. The challenge arises for the Public Health Action community: how can we engage with the wide range of stakeholders involved in Global Fund grant activities to promote the inclusion of implementation and operational research as a key activity for funding under a Global Fund grant?

Sampling strategies to detect anthelmintic resistance: the perspective of human onchocerciasis

The large-scale use of mass drug administration in human helminthiases control has raised awareness that anthelmintic resistance could develop. This has motivated an increasing number of studies to investigate changes in genetic structure of parasite populations undergoing treatment. For these studies to reflect accurately the current situation, parasitologists need to consider the sampling schemes they employ. In this article, we use mathematical models to discuss issues such as which hosts to examine, on which parasite life stage(s) to focus, and when after treatment to sample to quantify the presence and frequency of genetic markers of treatment-induced selection or drug resistance.

Neglected tropical diseases: Need for sensitization of medical students

The neglected tropical diseases are a set of thirteen disabling conditions that are among the most common chronic infections in the developing countries like India. About 350 million people are already disabled or severely impaired due to them. Over 3 billion children, women and men are at risk worldwide. These neglected tropical diseases lead to long term disability and the resultant poverty. Seven most prevalent and neglected tropical diseases are ascariasis, trichuriasis, hookworm infection, schistosomiasis, lymphatic filariasis, trachoma and onchocerciasis. Together, these diseases are responsible for billions of infections in the developing world and more than six million deaths per year.[1] Population mostly affected from these diseases are the poorest people in the tropical and subtropical areas of the world. Increased awareness of public as well as the political will are needed to reduce the negative impact of neglected tropical diseases on the health and the social and economic wellbeing of affected communities.[2] These neglected tropical diseases, have been recently, identified as ‘targets of opportunity’ by WHO and US Centers for Disease Control and Prevention, in an effort to improve global health, while creating more vigorous economies and a better quality of life in some of the world's poorest countries. These diseases are targets of opportunity because through the expanded use of mass drug administration as well as targeted treatments, we now have the opportunity to control or even eliminate some of the most important neglected tropical diseases in terms of prevalence and disease burden.[3] Strategies to control these diseases are based on surveillance, early diagnosis and treatment, vector control in most of these infections, mass drug administration and patient education. The use of mass drug administration for the control of neglected tropical diseases or preventive chemotherapy was first started in China. Prolonged and targeted use of diethylcarbamazine resulted in the elimination of lymphatic filariasis and widespread use of praziquantel, in control of schistosomiasis in that country. This has promoted the concept of international partnership to control or eliminate these infections. Such partnerships are being formed by pharmaceutical companies mainly through donation of drugs for mass administration. Such comprehensive programmes can be executed in India also. Lymphatic filariasis (LF) is the second most common vector borne parasitic disease after malaria, found in over 80 tropical and subtropical countries. According to WHO, it is the second most common cause of long term disability after mental illness. One third of people infected with LF live in India.[4] So, a global programme to eliminate LF was launched in 2000. This programme largely depends on mass administration of diethylcarbamazine with or without ivermectin or albendazole. Studies show that integration of vector control with the mass drug administration sustains this programme in a better way and decreases the time required to eliminate LF.[5] Though it is a region-based disease but with the advancement in the connectivity through railways or road the specific boundaries cannot be drawn. Hence, teaching of diseases like LF should not be region based but exhaustive knowledge about these diseases should be given an utmost priority. In India, where a large number of people are poor, uneducated and underprivileged it should be considered a moral obligation of medical fraternity to address the problems of the poor. The problem needs to be addressed during the formative years in MBBS curriculum. The domain does not belong to Community Medicine alone but an equal importance should be given in Pharmacology training also in a more comprehensive manner. Several steps can be taken to sensitize the medical students in this regard as follows: An appropriate stress must be given to the National Health Programmes right at the beginning of the Pharmacology teaching. Students must be educated about the seven neglected tropical diseases and their management in details. They should be apprised of the fact that if these diseases are tackled at an early stage, some major complications can be avoided. The students should know the importance of keeping in mind the cost of the drugs while prescribing for these diseases. These topics must be given as much importance as the diseases of CNS, CVS, GIT and Respiratory System and should be taken up by the senior faculty.