Feasibility of large-scale mass drug administration for malaria in Angumu health zone, Ituri, Democratic Republic of Congo
The Democratic Republic of Congo (DRC) Ministry of Health, together with MSF, implemented mass drug administration campaing in a complex emergency setting of the country, with the goal of rapidly reducing malaria morbidity and mortality. The intervention’s feasibility, data on pharmacovigilance, and associations with reported malaria morbidity were assessed.
Angumu is a highly malaria endemic area in North-Eastern DRC, with displaced people having relocated from an area with lower exposure to malaria. In Angumu, there are high levels of mortality linked with malaria, and crude and under-5 mortality rates have been shown to be above the emergency threshold in 2020 population survey data. In addition, healthcare systems are over-burdened due to population displacement, together with deterioration in access to healthcare caused by the COVID-19 pandemic.
MDA was implemented in the region by 227 teams, involving two community health workers each. The first MDA round, carried out between September and October 2020, reached 74,847 people (133%), and the second was executed during November 2020, reaching 75,487 people (134%). The third MDA round ran between December 2020 and January 2021, reaching 78,227 people (139%). There were 679 mild and three severe (0.9%, of all those receiving MDA) adverse events (AE's) reported during the first round, and 425 mild and three severe (0.57%) AE’s during the second round. None of the severe AE’s reported were causally linked with MDA, after investigation. The average weekly number of malaria cases decreased by 81% (151 vs. 29) in MDA-targetted areas, as compared with a drop of 33% (139 vs. 93) in non-targetted areas.
The intervention was based on three MDA rounds, spaced at least 28 days apart, for adults and children aged over 2 months, covering a total population of 56,353. For the first two rounds the antimalarial drug was amodiaquine-artesunate (AQAS), and for the third round artesunate-pyronaridine (Pyramax) was administered.
Door-to-door distribution was chosen to reduce risk of COVID-19 transmission. First doses were directly observed and notification of adverse events was implemented.
Study type: Cross-sectional population-based retrospective study.
Outcome measures: administrative coverage, reduction in weekly confirmed malaria cases reported from MSF-supported health facilities before and after MDA delivery, and differences between targetted (6 facilities) and non-targetted health areas (14 facilities).