Effect of generalised access to early diagnosis and treatment and targeted mass drug administration on Plasmodium falciparum malaria in Eastern Myanmar: an observational study of a regional elimination programme

Potentially untreatable Plasmodium falciparum malaria threatens the Greater Mekong subregion. A previous series of pilot projects in Myanmar, Laos, Cambodia, and Vietnam suggested that mass drug administration was safe, and when added to provision of early diagnosis and treatment, could reduce the r...

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Veröffentlicht in:The Lancet (British edition) 2018-05, Vol.391 (10133), p.1916-1926
Hauptverfasser: Landier, Jordi, Parker, Daniel M, Thu, Aung Myint, Lwin, Khin Maung, Delmas, Gilles, Nosten, François H, Andolina, Chiara, Aguas, Ricardo, Ang, Saw Moe, Aung, Ei Phyo, Baw, Naw Baw, Be, Saw Aye, B'Let, Saw, Bluh, Hay, Bonnington, Craig A., Chaumeau, Victor, Chirakiratinant, Miasa, Cho, Win Cho, Christensen, Peter, Corbel, Vincent, Day, Nicholas PJ, Dah, Saw Hsa, Dhorda, Mehul, Dondorp, Arjen M, Gaudart, Jean, Gornsawun, Gornpan, Haohankhunnatham, Warat, Hla, Saw Kyaw, Hsel, Saw Nay, Htoo, Gay Nay, Htoo, Saw Nay, Imwong, Mallika, John, Saw, Kajeechiwa, Ladda, Kereecharoen, Lily, Kittiphanakun, Praphan, Kittitawee, Keerati, Konghahong, Kamonchanok, Khin, Saw Diamond, Kyaw, Saw Win, Ling, Clare, Lwin, Khine Shwe War, Ma, Naw K' Yin, Marie, Alexandra, Maung, Cynthia, Marta, Ed, Minh, Myo Chit, Miotto, Olivo, Moo, Paw Khu, Moo, Ku Ler, Moo, Merry, Na, Naw Na, Nay, Mar, Nosten, François H., Nosten, Suphak, Nyo, Slight Naw, Oh, Eh Kalu Shwe, Oo, Phu Thit, Oo, Tun Pyit, Parker, Daniel M., Paw, Eh Shee, Phumiya, Choochai, Phyo, Aung Pyae, Pilaseng, Kasiha, Proux, Stéphane, Rakthinthong, Santisuk, Ritwongsakul, Wannee, Salathibuphha, Kloloi, Santirad, Armon, Sawasdichai, Sunisa, von Seidlein, Lorenz, Shee, Paw Wah, Shee, Paw Bway, Tangseefa, Decha, Thwin, May Myo, Tun, Saw Win, Wanachaloemlep, Chode, White, Lisa J, White, Nicholas J, Wiladphaingern, Jacher, Win, Saw Nyunt, Yee, Nan Lin, Yuwapan, Daraporn
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Zusammenfassung:Potentially untreatable Plasmodium falciparum malaria threatens the Greater Mekong subregion. A previous series of pilot projects in Myanmar, Laos, Cambodia, and Vietnam suggested that mass drug administration was safe, and when added to provision of early diagnosis and treatment, could reduce the reservoir of P falciparum and interrupts transmission. We examined the effects of a scaled-up programme of this strategy in four townships of eastern Myanmar on the incidence of P falciparum malaria. The programme was implemented in the four townships of Myawaddy, Kawkareik, Hlaingbwe, and Hpapun in Kayin state, Myanmar. Increased access to early diagnosis and treatment of malaria was provided to all villages through community-based malaria posts equipped with rapid diagnostic tests, and treatment with artemether–lumefantrine plus single low-dose primaquine. Villages were identified as malarial hotspots (operationally defined as >40% malaria, of which 20% was P falciparum) with surveys using ultrasensitive quantitative PCR either randomly or targeted at villages where the incidence of clinical cases of P falciparum malaria remained high (ie, >100 cases per 1000 individuals per year) despite a functioning malaria post. During each survey, a 2 mL sample of venous blood was obtained from randomly selected adults. Hotspots received targeted mass drug administration with dihydroartemisinin–piperaquine plus single-dose primaquine once per month for 3 consecutive months in addition to the malaria posts. The main outcome was the change in village incidence of clinical P falciparum malaria, quantified using a multivariate, generalised, additive multilevel model. Malaria prevalence was measured in the hotspots 12 months after mass drug administration. Between May 1, 2014, and April 30, 2017, 1222 malarial posts were opened, providing early diagnosis and treatment to an estimated 365 000 individuals. Incidence of P falciparum malaria decreased by 60 to 98% in the four townships. 272 prevalence surveys were undertaken and 69 hotspot villages were identified. By April 2017, 50 hotspots were treated with mass drug administration. Hotspot villages had a three times higher incidence of P falciparum at malarial posts than neighbouring villages (adjusted incidence rate ratio [IRR] 2·7, 95% CI 1·8–4·4). Early diagnosis and treatment was associated with a significant decrease in P falciparum incidence in hotspots (IRR 0·82, 95% CI 0·76–0·88 per quarter) and in other villages (0·75,
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(18)30792-X