Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned
Abstract Northern Uganda hosts a large population of refugees from South Sudan, and malaria is one of the major health problems in the area. In 2015, intermittent preventive treatment for malaria (IPTc) was implemented in two refugee camps among children aged 6 months to 14 years. Three distribution...
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | Malaria Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12936-017-1869-x |
| _version_ | 1828416016312434688 |
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| author | Matthew E. Coldiron Estrella Lasry Malika Bouhenia Debashish Das Peter Okui Dan Nyehangane Juliet Mwanga Celine Langendorf Greg Elder Léon Salumu Rebecca F. Grais |
| author_facet | Matthew E. Coldiron Estrella Lasry Malika Bouhenia Debashish Das Peter Okui Dan Nyehangane Juliet Mwanga Celine Langendorf Greg Elder Léon Salumu Rebecca F. Grais |
| author_sort | Matthew E. Coldiron |
| collection | DOAJ |
| description | Abstract Northern Uganda hosts a large population of refugees from South Sudan, and malaria is one of the major health problems in the area. In 2015, intermittent preventive treatment for malaria (IPTc) was implemented in two refugee camps among children aged 6 months to 14 years. Three distributions of dihydroartemisinin–piperaquine (DP) were conducted at 8-week intervals. The first dose was directly administered at IPTc distribution sites and the second and third doses were given to caregivers to administer at home. A multi-faceted evaluation was implemented, including coverage surveys, malaria prevalence surveys, reinforced surveillance, and pharmacovigilance. Programme coverage exceeded 90% during all three distributions with a total of 40,611 participants. Compared to same period during the previous year (only available data), the incidence of malaria in the target populations was reduced (IRR 0.73, 95% CI 0.69–0.77 among children under 5 years old; IRR 0.70, 95% CI 0.67–0.72 among children aged 5–14 years). Among those not targeted for intervention, the incidence between the 2 years increased (IRR 1.49, 95% CI 1.42–1.56). Cross-sectional surveys showed a prevalence of parasitaemia (microscopy or PCR) of 12.9–16.4% (95% CI 12.6–19.3) during the intervention, with the highest prevalence among children aged 5–14 years, but with a large increase 8 weeks after the final distribution. A total of 57 adverse events were reported during the intervention period, including one severe adverse event (death from varicella). Adverse events were of mild to moderate severity, and were mainly dermatologic and gastrointestinal. This is the first documentation of an IPTc programme in a refugee camp. The positive impact of DP on the incidence of malaria, together with its favourable safety profile, should lead to further use of IPTc in similar settings. Expanding coverage groups and decreasing intervals between distributions might provide more benefit, but would need to be balanced with the operational implications of a broader, more frequent distribution schedule. |
| first_indexed | 2024-12-10T13:56:29Z |
| format | Article |
| id | doaj.art-b3be3589e5894693bc633f569fca21da |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-10T13:56:29Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-b3be3589e5894693bc633f569fca21da2022-12-22T01:45:58ZengBMCMalaria Journal1475-28752017-05-011611810.1186/s12936-017-1869-xIntermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learnedMatthew E. Coldiron0Estrella Lasry1Malika Bouhenia2Debashish Das3Peter Okui4Dan Nyehangane5Juliet Mwanga6Celine Langendorf7Greg Elder8Léon Salumu9Rebecca F. Grais10EpicentreMédecins Sans FrontièresEpicentreEpicentreNational Malaria Control Programme, Ministry of HealthEpicentreEpicentreEpicentreEpicentreEpicentreEpicentreAbstract Northern Uganda hosts a large population of refugees from South Sudan, and malaria is one of the major health problems in the area. In 2015, intermittent preventive treatment for malaria (IPTc) was implemented in two refugee camps among children aged 6 months to 14 years. Three distributions of dihydroartemisinin–piperaquine (DP) were conducted at 8-week intervals. The first dose was directly administered at IPTc distribution sites and the second and third doses were given to caregivers to administer at home. A multi-faceted evaluation was implemented, including coverage surveys, malaria prevalence surveys, reinforced surveillance, and pharmacovigilance. Programme coverage exceeded 90% during all three distributions with a total of 40,611 participants. Compared to same period during the previous year (only available data), the incidence of malaria in the target populations was reduced (IRR 0.73, 95% CI 0.69–0.77 among children under 5 years old; IRR 0.70, 95% CI 0.67–0.72 among children aged 5–14 years). Among those not targeted for intervention, the incidence between the 2 years increased (IRR 1.49, 95% CI 1.42–1.56). Cross-sectional surveys showed a prevalence of parasitaemia (microscopy or PCR) of 12.9–16.4% (95% CI 12.6–19.3) during the intervention, with the highest prevalence among children aged 5–14 years, but with a large increase 8 weeks after the final distribution. A total of 57 adverse events were reported during the intervention period, including one severe adverse event (death from varicella). Adverse events were of mild to moderate severity, and were mainly dermatologic and gastrointestinal. This is the first documentation of an IPTc programme in a refugee camp. The positive impact of DP on the incidence of malaria, together with its favourable safety profile, should lead to further use of IPTc in similar settings. Expanding coverage groups and decreasing intervals between distributions might provide more benefit, but would need to be balanced with the operational implications of a broader, more frequent distribution schedule.http://link.springer.com/article/10.1186/s12936-017-1869-xMalariaAnti-malarialsArtemisininQuinolinesRefugeeSouth Sudan |
| spellingShingle | Matthew E. Coldiron Estrella Lasry Malika Bouhenia Debashish Das Peter Okui Dan Nyehangane Juliet Mwanga Celine Langendorf Greg Elder Léon Salumu Rebecca F. Grais Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned Malaria Journal Malaria Anti-malarials Artemisinin Quinolines Refugee South Sudan |
| title | Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned |
| title_full | Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned |
| title_fullStr | Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned |
| title_full_unstemmed | Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned |
| title_short | Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned |
| title_sort | intermittent preventive treatment for malaria among children in a refugee camp in northern uganda lessons learned |
| topic | Malaria Anti-malarials Artemisinin Quinolines Refugee South Sudan |
| url | http://link.springer.com/article/10.1186/s12936-017-1869-x |
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