Dihydroartemisinin-Piperaquine Chemoprevention and Malaria Incidence After Severe Flooding: Evaluation of a Pragmatic Intervention in Rural Uganda. (9th September 2021)

• Record Type: Journal Article
• Authors: Boyce, Ross M; Hollingsworth, Brandon D; Baguma, Emma; Xu, Erin; Goel, Varun; Brown-Marusiak, Amanda; Muhindo, Rabbison; Reyes, Raquel; Ntaro, Moses; Siedner, Mark J; Staedke, Sarah G; Juliano, Jonathan J; Mulogo, Edgar M
• Is Part Of: Clinical infectious diseases. Volume 74:Number 12(2022)
• Page Start: 2191
• Page End: 2199
• Publication Date: 2021-09-09
• Subjects: chemoprevention -- flooding -- malaria -- mass drug administration -- Plasmodium; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab781
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Malaria epidemics are a well-described phenomenon after extreme precipitation and flooding. Yet, few studies have examined mitigation measures to prevent post-flood malaria epidemics. Methods: We evaluated a malaria chemoprevention program implemented in response to severe flooding in western Uganda. Children aged ≤12 years from 1 village were eligible to receive 3 monthly rounds of dihydroartemisinin-piperaquine (DP). Two neighboring villages served as controls. Malaria cases were defined as individuals with a positive rapid diagnostic test result as recorded in health center registers. We performed a difference-in-differences analysis to estimate changes in the incidence and test positivity of malaria between intervention and control villages. Results: A total of 554 children received at least 1 round of chemoprevention, with 75% participating in at least 2 rounds. Compared with control villages, we estimated a 53.4% reduction (adjusted rate ratio [aRR], 0.47; 95% confidence interval [CI]: .34–.62; P < .01) in malaria incidence and a 30% decrease in the test positivity rate (aRR, 0.70; 95% CI: .50–.97; P = .03) in the intervention village in the 6 months post-intervention. The impact was greatest among children who received the intervention, but decreased incidence was also observed in older children and adults (aRR, 0.57; 95% CI: .38–.84; P < .01). Conclusions: Three rounds of chemoprevention with DP delivered under pragmatic conditions reduced the incidence of malaria after severe flooding in western Uganda. These findings provide a proof-of-concept for the use of malaria chemoprevention to reduce excess disease burden associated with severe flooding. Abstract : Three rounds of chemoprevention with dihydroartemisinin-piperaquine delivered under pragmatic conditions reduced the incidence of malaria after severe flooding in western Uganda. These findings provide a proof-of-concept for the use of chemoprevention to reduce excess disease burden associated with severe flooding.