Elimination of Plasmodium falciparum in an area of multi-drug resistance

Resistance to the artemisinin derivatives in Plasmodium falciparum has emerged in Cambodia and is now spreading throughout South-East Asia. The rapid elimination of P. falciparum seems to be the only viable option to avoid a public health disaster but this is difficult because even in low transmission settings many residents have asymptomatic parasitaemias. In response to a large number of malaria cases reported in three remote villages on the Thai-Myanmar border where malaria is endemic and the disease is seasonal, surveys were conducted using an ultra-sensitive qPCR assay (LOD 22 parasites per mL).

In one of the villages where it was feasible, mass anti-malarial drug administration (MDA) was proposed to the population as a potential solution, and this was adopted. Monthly intervals of dihydroartemisinin-piperaquine were administered during the months of June, July and August. Out of the 3 villages initially targeted, two were inaccessible during the rainy season and so chemoprevention could not be deployed without the necessary supervision. Children under 14 years old and malaria clinical episodes were excluded, and the outcome measures were the proportion of malaria infections by microscopy and PCR and the malaria clinical episodes. 

Type: Interventional
Allocation: Non- Randomized
Intervention model: Single-group
Masking: None (open label)
Primary purpose: Prevention

Drug-based Strategies

Jan 2012 — Dec 2013

Myanmar
Thailand

Mass Drug Administration (MDA)