Mass drug administration for the control and elimination of Plasmodium vivax malaria: An ecological study from Jiangsu province, China

Hsiang M.S., Hwang J., Tao A.R., Liu Y., Bennett A., Shanks G.D., Cao J., Kachur S.P., Feachem R.G.A., Gosling R.D. and Gao Q. (2013) Mass drug administration for the control and elimination of Plasmodium vivax malaria: An ecological study from Jiangsu province, China. Malaria Journal, 12 1: 383.1-383.14. doi:10.1186/1475-2875-12-383


Author Hsiang M.S.
Hwang J.
Tao A.R.
Liu Y.
Bennett A.
Shanks G.D.
Cao J.
Kachur S.P.
Feachem R.G.A.
Gosling R.D.
Gao Q.
Title Mass drug administration for the control and elimination of Plasmodium vivax malaria: An ecological study from Jiangsu province, China
Formatted title
Mass drug administration for the control and elimination of Plasmodium vivax malaria: An ecological study from Jiangsu province, China
Journal name Malaria Journal   Check publisher's open access policy
ISSN 1475-2875
Publication date 2013-11-01
Year available 2013
Sub-type Article (original research)
DOI 10.1186/1475-2875-12-383
Open Access Status DOI
Volume 12
Issue 1
Start page 383.1
End page 383.14
Total pages 14
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: Recent progress in malaria control has caused renewed interest in mass drug administration (MDA) as a potential elimination strategy but the evidence base is limited. China has extensive experience with MDA, but it is not well documented.

Methods: An ecological study was conducted to describe the use of MDA for the control and elimination of Plasmodium vivax in Jiangsu Province and explore the association between MDA and malaria incidence. Two periods were focused on: 1973 to 1983 when malaria burden was high and MDA administered to highly endemic counties province-wide, and 2000 to 2009, when malaria burden was low and a focal approach was used in two counties. All available data about the strategies implemented, MDA coverage, co-interventions, incidence, and adverse events were collected and described. Joinpoint analysis was used to describe trends in incidence and the relationship between MDA coverage and incidence was explored in negative binomial regression models.

Results: From 1973 to 1983, MDA with pyrimethamine and primaquine was used on a large scale, with up to 30 million people in target counties covered in a peak year (50% of the total population). Joinpoint analyses identified declines in annual incidence,-56.7% (95% CI-75.5 to-23.7%) from 1973-1976 and-12.4% (95% CI-24.7 to 2.0%) from 1976-1983. Population average negative binomial models identified a relationship between higher total population MDA coverage and lower monthly incidence from 1973-1976, IRR 0.98 (95% CI 0.97 to 1.00), while co-interventions, rainfall and GDP were not associated. From 2000-2009, incidence in two counties declined (annual change-43.7 to-14.0%) during a time when focal MDA using chloroquine and primaquine was targeted to villages and/or individuals residing near passively detected index cases (median 0.04% of total population). Although safety data were not collected systematically, there were rare reports of serious but non-fatal events.

Conclusions: In Jiangsu Province, China, large-scale MDA was implemented and associated with declines in high P. vivax malaria transmission; a more recent focal approach may have contributed to interruption of transmission. MDA should be considered a potential key strategy for malaria control and elimination.
Keyword China
Malaria elimination
Mass drug administration
Plasmodium vivax
Primaquine
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Public Health Publications
 
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Created: Mon, 05 May 2014, 20:04:27 EST by Ms Kate Rowe on behalf of School of Public Health