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Steinhardt LC, KC A, Tiffany A, Quincer EM, Loerinc L, Laramee N, Large A, Lindblade KA. Reactive Case Detection and Treatment and Reactive Drug Administration for Reducing Malaria Transmission: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2024; 110:82-93. [PMID: 38118166 PMCID: PMC10993791 DOI: 10.4269/ajtmh.22-0720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/09/2023] [Indexed: 12/22/2023] Open
Abstract
Many countries pursuing malaria elimination implement "reactive" strategies targeting household members and neighbors of index cases to reduce transmission. These strategies include reactive case detection and treatment (RACDT; testing and treating those positive) and reactive drug administration (RDA; providing antimalarials without testing). We conducted systematic reviews of RACDT and RDA to assess their effect on reducing malaria transmission and gathered evidence about key contextual factors important to their implementation. Two reviewers screened titles/abstracts and full-text records using defined criteria (Patient = those in malaria-endemic/receptive areas; Intervention = RACDT or RDA; Comparison = standard of care; Outcome = malaria incidence/prevalence) and abstracted data for meta-analyses. The Grading of Recommendations, Assessment, Development, and Evaluations approach was used to rate certainty of evidence (CoE) for each outcome. Of 1,460 records screened, reviewers identified five RACDT studies (three cluster-randomized controlled trials [cRCTs] and two nonrandomized studies [NRS]) and seven RDA studies (six cRCTs and one NRS); three cRCTs comparing RDA to RACDT were included in both reviews. Compared with RDA, RACDT was associated with nonsignificantly higher parasite prevalence (odds ratio [OR] = 1.85; 95% CI: 0.96-3.57; one study) and malaria incidence (rate ratio [RR] = 1.30; 95% CI: 0.94-1.79; three studies), both very low CoE. Compared with control or RACDT, RDA was associated with non-significantly lower parasite incidence (RR = 0.73; 95% CI: 0.36-1.47; 2 studies, moderate CoE), prevalence (OR = 0.78; 95% CI: 0.52-1.17; 4 studies, low CoE), and malaria incidence (RR = 0.93; 95% CI: 0.82-1.05; six studies, moderate CoE). Evidence for reactive strategies' impact on malaria transmission is limited, especially for RACDT, but suggests RDA might be more effective.
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Affiliation(s)
- Laura C. Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Achyut KC
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Tiffany
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Nicolas Laramee
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amy Large
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kim A. Lindblade
- Malaria Branch, Division of Parasitic Diseases and Malaria, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
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Orish VN, Kyeremateng C, Appiah BP, Addei IB, Ayaba MA, Kwadzokpui PK, Marinkovic A, Prakash S, Okorie C, Izurieta R, Sanyaolu A. Knowledge and perception of asymptomatic malaria in the Volta region of Ghana. Trans R Soc Trop Med Hyg 2024; 118:33-43. [PMID: 37534813 DOI: 10.1093/trstmh/trad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The control of asymptomatic malaria is considered a key aspect of malaria control. This study aimed to assess the knowledge and perception of asymptomatic malaria among people in Ho municipality of the Volta region. METHODS A descriptive cross-sectional study involving questionnaire administration was conducted among randomly sampled residents of the Ho municipality of the Volta region of Ghana. Using SPSS version 25 statistical software, frequency distributions and proportions were computed for sociodemographic variables while knowledge and perception about asymptomatic malaria were computed into percentages and categorized into three levels based on Bloom's cut-off for further analysis. Findings with p-values <0.05 were considered statistically significant. RESULTS Among the 200 participants, 197 (98.5%) were aware of malaria. The majority (116 [58.0%]) of the study participants agreed to the possibility of asymptomatic infection, but most (133 [66.5%]) of the community members did not know that asymptomatic individuals can still transmit infections. The majority of the participants (184 [92.0%]) showed interest in getting further education on asymptomatic malaria and a significant majority (180 [90.0%]) expressed a willingness to take treatment after testing positive without showing any symptoms. CONCLUSIONS Asymptomatic malaria control can be achieved through a mass testing and treatment strategy, therefore improving the knowledge and perception about asymptomatic malaria might improve malaria control.
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Affiliation(s)
- Verner N Orish
- Department of Microbiology and Immunology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Caleb Kyeremateng
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Baffoe P Appiah
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Isaac B Addei
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Moses A Ayaba
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | | | | | - Chuku Okorie
- Department of Allied Health Sciences, Union College of Union County, Plainfield Campus, NJ, USA
| | - Ricardo Izurieta
- Department of Global Communicable Diseases, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Adekunle Sanyaolu
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
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Rahmalia A, Poespoprodjo JR, Landuwulang CUR, Ronse M, Kenangalem E, Burdam FH, Thriemer K, Devine A, Price RN, Peeters Grietens K, Ley B, Gryseels C. Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study. Malar J 2023; 22:162. [PMID: 37210520 PMCID: PMC10199529 DOI: 10.1186/s12936-023-04578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete course of treatment. METHODS This is a mixed-methods study to assess socio-cultural factors influencing adherence to a 14-day PQ regimen in a 3-arm, treatment effectiveness trial in Papua, Indonesia. The qualitative strand, consisting of interviews and participant observation was triangulated with a quantitative strand in which trial participants were surveyed using a questionnaire. RESULTS Trial participants differentiated between two types of malaria: tersiana and tropika, equivalent to P. vivax and Plasmodium falciparum infection, respectively. The perceived severity of both types was similar with 44.0% (267/607) perceiving tersiana vs. 45.1% (274/607) perceiving tropika as more severe. There was no perceived differentiation whether malaria episodes were due to a new infection or relapse; and 71.3% (433/607) acknowledged the possibility of recurrence. Participants were familiar with malaria symptoms and delaying health facility visit by 1-2 days was perceived to increase the likelihood of a positive test. Prior to health facility visits, symptoms were treated with leftover drugs kept at home (40.4%; 245/607) or bought over the counter (17.0%; 103/607). Malaria was considered to be cured with 'blue drugs' (referring to dihydroartemisinin-piperaquine). Conversely, 'brown drugs,' referring to PQ, were not considered malaria medication and instead were perceived as supplements. Adherence to malaria treatment was 71.2% (131/184), in the supervised arm, 56.9% (91/160) in the unsupervised arm and 62.4% (164/263) in the control arm; p = 0.019. Adherence was 47.5% (47/99) among highland Papuans, 51.7% (76/147) among lowland Papuans, and 72.9% (263/361) among non-Papuans; p < 0.001. CONCLUSION Adherence to malaria treatment was a socio-culturally embedded process during which patients (re-)evaluated the characteristics of the medicines in relation to the course of the illness, their past experiences with illness, and the perceived benefits of the treatment. Structural barriers that hinder the process of patient adherence are crucial to consider in the development and rollout of effective malaria treatment policies.
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Affiliation(s)
- Annisa Rahmalia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia.
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
- Institute of Tropical Medicine, Antwerp, Belgium.
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika District Hospital, Timika, Indonesia
- Paediatric Research Office, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Chandra U R Landuwulang
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
| | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Faustina H Burdam
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Cuinhane CE, Galatas B, Lopez JM, Djive H, Nhantumbo H, Murato I, Saúte F, Aide P, Munguambe K, Torres N. Acceptability and perceived barriers to reactive focal mass drug administration in the context of a malaria elimination program in Magude district, Southern Mozambique: A qualitative study. PLoS One 2023; 18:e0283160. [PMID: 37000890 PMCID: PMC10065238 DOI: 10.1371/journal.pone.0283160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
This study analysed acceptability and perceived barriers to reactive focal mass drug administration (rfMDA) among community members exposed to community engagement campaigns and malaria elimination interventions in Magude district, following mass drug administration (MDA) in the same district. The study used a formative qualitative study design, consisting of 56 semi-structured interviews with community members, including community leaders, household heads, women of reproductive age, members of the community and adolescents, 4 semi-structured interviews with community health workers, 9 semi-structured interviews with healthcare professionals; and 16 focus group discussions with the general adult population. Data were collected between June and September 2017. A content thematic analysis approach was used to analyse the data. The results of this study showed that rfMDA was accepted due to awareness about the intervention, experience of a previous similar programme, the MDA campaign, and due to favourable perceptions built on the believe that rfMDA would help to prevent, treat and eliminate malaria in the community. Perceived barriers to rfMDA include lack of access to accurate information, reluctance to take a pregnancy test, concern on drug adverse reactions, and reluctance to take antimalarial drugs without any symptom. In conclusion, the community found rfMDA acceptable for malaria intervention. But more community engagement is needed to foster community involvement and self-appropriation of the malaria programme elimination.
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Affiliation(s)
- Carlos Eduardo Cuinhane
- Department of Sociology, Faculty of Arts and Social Sciences, Eduardo Mondlane University, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- * E-mail:
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
| | | | - Helder Djive
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Ilda Murato
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Khátia Munguambe
- ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Neusa Torres
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
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Masunaga Y, Muela Ribera J, Jaiteh F, de Vries DH, Peeters Grietens K. Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia. BMC Health Serv Res 2022; 22:54. [PMID: 35016656 PMCID: PMC8753917 DOI: 10.1186/s12913-021-07431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation.
Method
The study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys.
Results and discussion
We explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as ‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role.
Conclusion
It is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.
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Masunaga Y, Jaiteh F, Manneh E, Balen J, Okebe J, D'Alessandro U, Nieto-Sanchez C, de Vries DH, Gerrets R, Peeters Grietens K, Muela Ribera J. The Community Lab of Ideas for Health: Community-Based Transdisciplinary Solutions in a Malaria Elimination Trial in The Gambia. Front Public Health 2021; 9:637714. [PMID: 34354972 PMCID: PMC8329351 DOI: 10.3389/fpubh.2021.637714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Community participation in global health interventions may improve outcomes and solve complex health issues. Although numerous community participatory approaches have been developed and introduced, there has been little focus on "how" and "who" to involve in the implementation of community-based clinical trials where unequal distribution of power between implementers and communities pre-exists. Addressing how to achieve community-based solutions in a malaria elimination trial in The Gambia, we developed the Community Lab of Ideas for Health (CLIH): a participatory approach that enabled communities to shape trial implementation. Methods: As part of transdisciplinary research, we conducted qualitative research with in-depth interviews, discussions, and observations in 17 villages in the North Bank Region of The Gambia between March 2016 and December 2017. We designed an iterative research process involving ethnography, stakeholder-analysis, participatory-discussions, and qualitative monitoring and evaluation, whereby each step guided the next. We drew upon ethnographic results and stakeholder-analysis to identify key-informants who became participants in study design and implementation. The participatory-discussions provided a co-creative space for sharing community-centric ideas to tackle trial implementation challenges. The proposed strategies for trial implementation were continuously refined and improved through our monitoring and evaluation. Results: The CLIH incorporated communities' insights, to co-create tailored trial implementation strategies including: village health workers prescribing and distributing antimalarial treatments; "compounds" as community-accepted treatment units; medicine distribution following compound micro-politics; and appropriate modes of health message delivery. Throughout the iterative research process, the researchers and communities set the common goal, namely to curtail the medical poverty trap by reducing malaria transmission and the burden thereof. This innovative collaborative process built trust among stakeholders and fully engaged researchers and communities in co-creation and co-implementation of the trial. Discussion: The CLIH approach succeeded in touching the local realities by incorporating a spectrum of perspectives from community-members and discerning project-derived knowledge from local-knowledge. This process allowed us to co-develop locally-oriented solutions and ultimately to co-establish an intervention structure that community-members were ready and willing to use, which resulted in high uptake of the intervention (92% adherence to treatment). Successfully, the CLIH contributed in bridging research and implementation.
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Affiliation(s)
- Yoriko Masunaga
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
| | - Fatou Jaiteh
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Ebrima Manneh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Joseph Okebe
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Claudia Nieto-Sanchez
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
| | - Daniel H. de Vries
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
| | - René Gerrets
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
| | - Koen Peeters Grietens
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Joan Muela Ribera
- PASS Suisse, Neuchâtel, Switzerland
- Medical Anthropology Research Centre (MARC) at Departament d'Antropologia, Filosofia i Treball Social, Universitat Rovira i Virgili, Tarragona, Spain
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A Comprehensive Survey of Asymptomatic Malaria Cases in an Endemic Focus in Iran: A Successful Experience on the Road to Eliminate Malaria. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.103728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Malaria is one of the important infectious blood diseases caused by the protozoan parasite of the genus Plasmodium and transmitted by female Anopheles mosquito bites. A malaria elimination plan is currently being followed in Hormozgan Province. The robust malaria surveillance system with appropriate active case findings, especially asymptomatic cases, plays an important role in the malaria elimination program. Objectives: The main objectives of this research were to determine the presence and prevalence of asymptomatic malaria cases and monitor asymptomatic parasitic reservoirs in Jask District, Hormozgan Province. Methods: This cross-sectional study aimed to evaluate and monitor asymptomatic cases in the Jask District. The purpose and stages of the study were explained to all participants/parents, and written informed consent was obtained. A total of 230 asymptomatic residents (124 females and 86 males) were randomly selected, and their blood samples (3 mL) were taken to assess Plasmodium infection using microscopic, RDT, and molecular (18ssrRNA) methods. Results: Of the 230 studied cases, 54.8% were females, and 454.2% were males. The age range was four to 65 years old, and the mean age was 24.5. None of the diagnostic methods, including the microscopic, serological, and molecular techniques, could find asymptomatic malaria cases in the study area. Conclusions: It can be concluded that Malaria Elimination Program is feasible in the Jask Region irrespective of asymptomatic parasitic reservoirs. The results also emphasize a robust and efficient malaria surveillance system to diagnose and treat positive cases and monitor treated cases successfully. Ongoing and continuous studies are recommended in the high-risk malarious area of Hormozgan Province to monitor asymptomatic cases of malaria.
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Fehr A, Nieto-Sanchez C, Muela J, Jaiteh F, Ceesay O, Maneh E, Baldeh D, Achan J, Dabira E, Conteh B, Bunders-Aelen J, Smekens T, Broekhuizen H, D'Alessandro U, Peeters Grietens K. From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia. Malar J 2021; 20:198. [PMID: 33902611 PMCID: PMC8073909 DOI: 10.1186/s12936-021-03732-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement—coverage, adherence, and compliance—that cast doubts about the actual and potential epidemiological impact of MDA on disease control and elimination. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. Methods This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA. Results 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. Conclusions This study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03732-z.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgill, Tarragona, Spain
| | - Fatou Jaiteh
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ebrima Maneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jane Achan
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Edgard Dabira
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bakary Conteh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Tom Smekens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D'Alessandro
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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