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Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo

BACKGROUND: Angumu health zone in Ituri, Democratic Republic of Congo, is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. There...

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Autores principales: Grout, Lise, Katuala Givo, Yves, Newport, Trish, Mahamat, Tom Adoum, Gitahi, Priscillah, Mandagot, Jean Jacques, Quere, Michel, Wodon, Sophie, Ciglenecki, Iza, Bastard, Mathieu, Baelongandi, Francis, Tshulo, Louis, Uluba, Herman Jakisa, Sterk, Esther, Gignoux, Etienne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901819/
https://www.ncbi.nlm.nih.gov/pubmed/36747229
http://dx.doi.org/10.1186/s12936-023-04469-7
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author Grout, Lise
Katuala Givo, Yves
Newport, Trish
Mahamat, Tom Adoum
Gitahi, Priscillah
Mandagot, Jean Jacques
Quere, Michel
Wodon, Sophie
Ciglenecki, Iza
Bastard, Mathieu
Baelongandi, Francis
Tshulo, Louis
Uluba, Herman Jakisa
Sterk, Esther
Gignoux, Etienne
author_facet Grout, Lise
Katuala Givo, Yves
Newport, Trish
Mahamat, Tom Adoum
Gitahi, Priscillah
Mandagot, Jean Jacques
Quere, Michel
Wodon, Sophie
Ciglenecki, Iza
Bastard, Mathieu
Baelongandi, Francis
Tshulo, Louis
Uluba, Herman Jakisa
Sterk, Esther
Gignoux, Etienne
author_sort Grout, Lise
collection PubMed
description BACKGROUND: Angumu health zone in Ituri, Democratic Republic of Congo, is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. Therefore, three MDA rounds were implemented by Ministry of Public Health and Médecins sans Frontières from September 2020 to January 2021 in four health areas selected for epidemiological (high malaria incidence) and logistic reasons. Reported mortality and morbidity were compared in locations where MDA has been performed and locations where it has not. METHODS: A non-randomized controlled population-based retrospective mortality survey was conducted in March 2021. Two-stage cluster sampling was used in villages; all IDP sites were surveyed with systematic random sampling. The main (mortality rates) and secondary (morbidity) outcomes were estimated and compared between locations where MDA had been conducted and where it had not, using mixed Poisson and binomial regression models respectively. RESULTS: Data was collected for 2554 households and 15470 individuals, of whom 721 died in the 18-month recall period. The under-five mortality rate (U5MR) decreased in the locations where MDA had been implemented from 2.32 [1.48–3.16] “before” the MDA to 1.10 [0.5–1.71] deaths/10,000 children under 5 years/day “after”, whereas it remained stable from 2.74 [2.08–3.40] to 2.67 [1.84–3.50] deaths/10,000 children/day in the same time periods in locations where MDA had not been implemented. The U5MR and malaria-specific mortality was significantly higher in non-MDA locations after MDA was implemented (aRR = 2.17 [1.36–3.49] and 2.60 [1.56–4.33], respectively, for all-cause and malaria-specific mortality among children  < 5 years). Morbidity (all age and  < 5 years, all cause or malaria-specific) appeared lower in MDA locations 2.5 months after last round: reported malaria-specific morbidity was 14.7% [11–18] and 25.0% [19–31] in villages and IDP sites where MDA had been implemented, while it was 30.4% [27–33] and 49.3% [45–54] in villages and IDP sites with no MDA. CONCLUSIONS: Despite traditional limitations associated with non-randomized controlled retrospective surveys, the documented sharp decrease of under-5 mortality and morbidity shows that MDA has the potential to become an important malaria-control tool in emergency settings. Based on these results, new MDA rounds, along with indoor residual spraying campaigns, have been planned in the health zone in 2022. A set of surveys will be conducted before, during and after these rounds to confirm the effect observed in 2021 and assess its duration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12936-023-04469-7.
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spelling pubmed-99018192023-02-07 Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo Grout, Lise Katuala Givo, Yves Newport, Trish Mahamat, Tom Adoum Gitahi, Priscillah Mandagot, Jean Jacques Quere, Michel Wodon, Sophie Ciglenecki, Iza Bastard, Mathieu Baelongandi, Francis Tshulo, Louis Uluba, Herman Jakisa Sterk, Esther Gignoux, Etienne Malar J Research BACKGROUND: Angumu health zone in Ituri, Democratic Republic of Congo, is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. Therefore, three MDA rounds were implemented by Ministry of Public Health and Médecins sans Frontières from September 2020 to January 2021 in four health areas selected for epidemiological (high malaria incidence) and logistic reasons. Reported mortality and morbidity were compared in locations where MDA has been performed and locations where it has not. METHODS: A non-randomized controlled population-based retrospective mortality survey was conducted in March 2021. Two-stage cluster sampling was used in villages; all IDP sites were surveyed with systematic random sampling. The main (mortality rates) and secondary (morbidity) outcomes were estimated and compared between locations where MDA had been conducted and where it had not, using mixed Poisson and binomial regression models respectively. RESULTS: Data was collected for 2554 households and 15470 individuals, of whom 721 died in the 18-month recall period. The under-five mortality rate (U5MR) decreased in the locations where MDA had been implemented from 2.32 [1.48–3.16] “before” the MDA to 1.10 [0.5–1.71] deaths/10,000 children under 5 years/day “after”, whereas it remained stable from 2.74 [2.08–3.40] to 2.67 [1.84–3.50] deaths/10,000 children/day in the same time periods in locations where MDA had not been implemented. The U5MR and malaria-specific mortality was significantly higher in non-MDA locations after MDA was implemented (aRR = 2.17 [1.36–3.49] and 2.60 [1.56–4.33], respectively, for all-cause and malaria-specific mortality among children  < 5 years). Morbidity (all age and  < 5 years, all cause or malaria-specific) appeared lower in MDA locations 2.5 months after last round: reported malaria-specific morbidity was 14.7% [11–18] and 25.0% [19–31] in villages and IDP sites where MDA had been implemented, while it was 30.4% [27–33] and 49.3% [45–54] in villages and IDP sites with no MDA. CONCLUSIONS: Despite traditional limitations associated with non-randomized controlled retrospective surveys, the documented sharp decrease of under-5 mortality and morbidity shows that MDA has the potential to become an important malaria-control tool in emergency settings. Based on these results, new MDA rounds, along with indoor residual spraying campaigns, have been planned in the health zone in 2022. A set of surveys will be conducted before, during and after these rounds to confirm the effect observed in 2021 and assess its duration. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12936-023-04469-7. BioMed Central 2023-02-06 /pmc/articles/PMC9901819/ /pubmed/36747229 http://dx.doi.org/10.1186/s12936-023-04469-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Grout, Lise
Katuala Givo, Yves
Newport, Trish
Mahamat, Tom Adoum
Gitahi, Priscillah
Mandagot, Jean Jacques
Quere, Michel
Wodon, Sophie
Ciglenecki, Iza
Bastard, Mathieu
Baelongandi, Francis
Tshulo, Louis
Uluba, Herman Jakisa
Sterk, Esther
Gignoux, Etienne
Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo
title Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo
title_full Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo
title_fullStr Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo
title_full_unstemmed Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo
title_short Effect of large-scale mass drug administration for malaria on mortality and morbidity in Angumu health zone, Ituri, Democratic Republic of Congo
title_sort effect of large-scale mass drug administration for malaria on mortality and morbidity in angumu health zone, ituri, democratic republic of congo
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901819/
https://www.ncbi.nlm.nih.gov/pubmed/36747229
http://dx.doi.org/10.1186/s12936-023-04469-7
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