Impact of the Mass Drug Administration for malaria in response to the Ebola outbreak in Sierra Leone
| Autor: | John J. Aponte, Pedro L. Alonso, Anitta R. Y. Kamara, Musa Sillah-Kanu, John Seppeh, Maru Aregawi, Samuel Juana Smith, Ryan Williams, Andrea Bosman |
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| Přispěvatelé: | Alonso, Pedro |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Veterinary medicine Disease Outbreaks 0302 clinical medicine 030212 general & internal medicine Child skin and connective tissue diseases Administration of drugs Aged 80 and over education.field_of_study Rapid diagnostic test Middle Aged Artemisinins Drug Combinations Infectious Diseases Child Preschool Female Health Services Research Administració de medicaments Adult medicine.medical_specialty Adolescent 030231 tropical medicine Population Malària Ebola virus disease Context (language use) Sierra Leone Sierra leone Antimalarials Young Adult 03 medical and health sciences Internal medicine medicine Humans education Mass drug administration Malaltia de l'Ebola Aged business.industry Research Public health Amodiaquine Infant Hemorrhagic Fever Ebola medicine.disease Malaria Tropical medicine Parasitology business |
| Zdroj: | Dipòsit Digital de la UB Universidad de Barcelona Malaria Journal Recercat. Dipósit de la Recerca de Catalunya instname |
| Popis: | Background As emergency response to the Ebola epidemic, the Government of Sierra Leone and its partners implemented a large-scale Mass Drug Administration (MDA) with artesunate–amodiaquine (ASAQ) covering >2.7 million people in the districts hardest hit by Ebola during December 2014–January 2015. The World Health Organization (WHO) and the National Malaria Control Programme (NMCP) evaluated the impact of the MDA on malaria morbidity at health facilities and the number of Ebola alerts received at District Ebola Command Centres. Methods The coverage of the two rounds of MDA with ASAQ was estimated by relating the number anti-malarial medicines distributed to the estimated resident population. Segmented time-series analysis was applied to weekly data collected from 49 primary health units (PHUs) and 11 hospitals performing malaria parasitological testing during the study period, to evaluate trends of malaria cases and Ebola alerts during the post-MDA weeks compared to the pre-MDA weeks in MDA- and non-MDA-cheifdoms. Results After two rounds of the MDA, the number of suspected cases tested with rapid diagnostic test (RDT) decreased significantly by 43 % (95 % CI 38–48 %) at week 1 and remained low at week 2 and 3 post-first MDA and at week 1 and 3 post-second MDA; RDT positive cases decreased significantly by 47 % (41–52 %) at week 1 post-first and remained lower throughout all post-MDA weeks; and the RDT test positivity rate (TPR) declined by 35 % (32–38 %) at week 2 and stayed low throughout all post-MDA weeks. The total malaria (clinical + confirmed) cases decreased significantly by 45 % (39–52 %) at week 1 and were lower at week 2 and 3 post-first MDA; and week 1 post-second MDA. The proportion of confirmed malaria cases (out of all-outpatients) fell by 33 % (29–38 %) at week 1 post-first MDA and were lower during all post-MDA weeks. On the contrary, the non-malaria outpatient cases (cases due to other health conditions) either remained unchanged or fluctuated insignificantly. The Ebola alerts decreased by 30 % (13–46 %) at week 1 post-first MDA and much lower during all the weeks post–second MDA. Conclusions The MDA achieved its goals of reducing malaria morbidity and febrile cases that would have been potentially diagnosed as suspected Ebola cases with increased risk of nosocomial infections. The intervention also helped reduce patient case-load to the severely strained health services at the peak of the Ebola outbreak and malaria transmission. As expected, the effect of the MDA waned in a matter of few weeks and malaria intensity returned to the pre-MDA levels. Nevertheless, the approach was an appropriate public health intervention in the context of the Ebola epidemic even in high malaria transmission areas of Sierra Leone. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1493-1) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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