Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda
Abstract Background Declines in malaria burden in Uganda have slowed. Modelling predicts that indoor residual spraying (IRS) and mass drug administration (MDA), when co-timed, have synergistic impact. This study investigated additional protective impact of population-based MDA on malaria prevalence,...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-023-07991-w |
| _version_ | 1811166094577106944 |
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| author | Dorothy C. Echodu Adoke Yeka Thomas Eganyu Wycliff Odude Fred Bukenya Benjamin Amoah Humphrey Wanzira Kathryn Colborn Richard C. Elliott Suzanne E. Powell Maxwell Kilama Ronald Mulebeke Joaniter Nankabirwa Emanuele Giorgi Mellisa Roskosky Osborn Omoding Samuel Gonahasa Jimmy Opigo |
| author_facet | Dorothy C. Echodu Adoke Yeka Thomas Eganyu Wycliff Odude Fred Bukenya Benjamin Amoah Humphrey Wanzira Kathryn Colborn Richard C. Elliott Suzanne E. Powell Maxwell Kilama Ronald Mulebeke Joaniter Nankabirwa Emanuele Giorgi Mellisa Roskosky Osborn Omoding Samuel Gonahasa Jimmy Opigo |
| author_sort | Dorothy C. Echodu |
| collection | DOAJ |
| description | Abstract Background Declines in malaria burden in Uganda have slowed. Modelling predicts that indoor residual spraying (IRS) and mass drug administration (MDA), when co-timed, have synergistic impact. This study investigated additional protective impact of population-based MDA on malaria prevalence, if any, when added to IRS, as compared with IRS alone and with standard of care (SOC). Methods The 32-month quasi-experimental controlled before-and-after trial enrolled an open cohort of residents (46,765 individuals, 1st enumeration and 52,133, 4th enumeration) of Katakwi District in northeastern Uganda. Consented participants were assigned to three arms based on residential subcounty at study start: MDA+IRS, IRS, SOC. IRS with pirimiphos methyl and MDA with dihydroartemisinin- piperaquine were delivered in 4 co-timed campaign-style rounds 8 months apart. The primary endpoint was population prevalence of malaria, estimated by 6 cross-sectional surveys, starting at baseline and preceding each subsequent round. Results Comparing malaria prevalence in MDA+IRS and IRS only arms over all 6 surveys (intention-to-treat analysis), roughly every 6 months post-interventions, a geostatistical model found a significant additional 15.5% (95% confidence interval (CI): [13.7%, 17.5%], Z = 9.6, p = 5e−20) decrease in the adjusted odds ratio (aOR) due to MDA for all ages, a 13.3% reduction in under 5’s (95% CI: [10.5%, 16.8%], Z = 4.02, p = 5e−5), and a 10.1% reduction in children 5–15 (95% CI: [8.5%, 11.8%], Z = 4.7, p = 2e−5). All ages residents of the MDA + IRS arm enjoyed an overall 80.1% reduction (95% CI: [80.0%, 83.0%], p = 0.0001) in odds of qPCR confirmed malaria compared with SOC residents. Secondary difference-in-difference analyses comparing surveys at different timepoints to baseline showed aOR (MDA + IRS vs IRS) of qPCR positivity between 0.28 and 0.66 (p < 0.001). Of three serious adverse events, one (nonfatal) was considered related to study medications. Limitations include the initial non-random assignment of study arms, the single large cluster per arm, and the lack of an MDA-only arm, considered to violate equipoise. Conclusions Despite being assessed at long time points 5–7 months post-round, MDA plus IRS provided significant additional protection from malaria infection over IRS alone. Randomized trials of MDA in large areas undergoing IRS recommended as well as cohort studies of impact on incidence. Trial registration: This trial was retrospectively registered 11/07/2018 with the Pan African Clinical Trials Registry (PACTR201807166695568). |
| first_indexed | 2024-04-10T15:46:57Z |
| format | Article |
| id | doaj.art-f5d75891bf5d4a42b878d1608278892b |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-10T15:46:57Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-f5d75891bf5d4a42b878d1608278892b2023-02-12T12:05:32ZengBMCBMC Infectious Diseases1471-23342023-02-0123111810.1186/s12879-023-07991-wImpact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern UgandaDorothy C. Echodu0Adoke Yeka1Thomas Eganyu2Wycliff Odude3Fred Bukenya4Benjamin Amoah5Humphrey Wanzira6Kathryn Colborn7Richard C. Elliott8Suzanne E. Powell9Maxwell Kilama10Ronald Mulebeke11Joaniter Nankabirwa12Emanuele Giorgi13Mellisa Roskosky14Osborn Omoding15Samuel Gonahasa16Jimmy Opigo17Pilgrim AfricaMakerere University College of Health Sciences, School of Public HealthPilgrim AfricaPilgrim AfricaPilgrim AfricaSchool of Public Health, Imperial College LondonPilgrim AfricaUniversity of Colorado Anschutz Medical CampusPilgrim AfricaPilgrim AfricaPilgrim AfricaMakerere University College of Health Sciences, School of Public HealthInfectious Diseases Research CollaborationLancaster University Medical School, Centre for Health Informatics, Computing and StatisticsPilgrim AfricaPilgrim AfricaInfectious Diseases Research CollaborationNational Malaria Control Division, Ministry of Health UgandaAbstract Background Declines in malaria burden in Uganda have slowed. Modelling predicts that indoor residual spraying (IRS) and mass drug administration (MDA), when co-timed, have synergistic impact. This study investigated additional protective impact of population-based MDA on malaria prevalence, if any, when added to IRS, as compared with IRS alone and with standard of care (SOC). Methods The 32-month quasi-experimental controlled before-and-after trial enrolled an open cohort of residents (46,765 individuals, 1st enumeration and 52,133, 4th enumeration) of Katakwi District in northeastern Uganda. Consented participants were assigned to three arms based on residential subcounty at study start: MDA+IRS, IRS, SOC. IRS with pirimiphos methyl and MDA with dihydroartemisinin- piperaquine were delivered in 4 co-timed campaign-style rounds 8 months apart. The primary endpoint was population prevalence of malaria, estimated by 6 cross-sectional surveys, starting at baseline and preceding each subsequent round. Results Comparing malaria prevalence in MDA+IRS and IRS only arms over all 6 surveys (intention-to-treat analysis), roughly every 6 months post-interventions, a geostatistical model found a significant additional 15.5% (95% confidence interval (CI): [13.7%, 17.5%], Z = 9.6, p = 5e−20) decrease in the adjusted odds ratio (aOR) due to MDA for all ages, a 13.3% reduction in under 5’s (95% CI: [10.5%, 16.8%], Z = 4.02, p = 5e−5), and a 10.1% reduction in children 5–15 (95% CI: [8.5%, 11.8%], Z = 4.7, p = 2e−5). All ages residents of the MDA + IRS arm enjoyed an overall 80.1% reduction (95% CI: [80.0%, 83.0%], p = 0.0001) in odds of qPCR confirmed malaria compared with SOC residents. Secondary difference-in-difference analyses comparing surveys at different timepoints to baseline showed aOR (MDA + IRS vs IRS) of qPCR positivity between 0.28 and 0.66 (p < 0.001). Of three serious adverse events, one (nonfatal) was considered related to study medications. Limitations include the initial non-random assignment of study arms, the single large cluster per arm, and the lack of an MDA-only arm, considered to violate equipoise. Conclusions Despite being assessed at long time points 5–7 months post-round, MDA plus IRS provided significant additional protection from malaria infection over IRS alone. Randomized trials of MDA in large areas undergoing IRS recommended as well as cohort studies of impact on incidence. Trial registration: This trial was retrospectively registered 11/07/2018 with the Pan African Clinical Trials Registry (PACTR201807166695568).https://doi.org/10.1186/s12879-023-07991-wMDAMalariaIRSHigh burdenUgandaControlled trial |
| spellingShingle | Dorothy C. Echodu Adoke Yeka Thomas Eganyu Wycliff Odude Fred Bukenya Benjamin Amoah Humphrey Wanzira Kathryn Colborn Richard C. Elliott Suzanne E. Powell Maxwell Kilama Ronald Mulebeke Joaniter Nankabirwa Emanuele Giorgi Mellisa Roskosky Osborn Omoding Samuel Gonahasa Jimmy Opigo Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda BMC Infectious Diseases MDA Malaria IRS High burden Uganda Controlled trial |
| title | Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda |
| title_full | Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda |
| title_fullStr | Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda |
| title_full_unstemmed | Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda |
| title_short | Impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin-piperaquine on malaria prevalence in a high transmission setting: a quasi-experimental controlled before-and-after trial in northeastern Uganda |
| title_sort | impact of population based indoor residual spraying with and without mass drug administration with dihydroartemisinin piperaquine on malaria prevalence in a high transmission setting a quasi experimental controlled before and after trial in northeastern uganda |
| topic | MDA Malaria IRS High burden Uganda Controlled trial |
| url | https://doi.org/10.1186/s12879-023-07991-w |
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