The role of social cohesion in the implementation and coverage of a mass drug administration trial for malaria control in the Gambia: An in-depth comparison of two intervention villages

Latar belakang: Penyakit Filariasis merupakan penyakit yang disebabkan oleh cacing filaria. Kota Pekalonganmerupakan kota dengan endemis filariasis dan telah dilakukan Program Pemberian Obat secara Massal (POPM) sejak tahun 2011 hingga 2015, Namun, hasil Survei Darah Jari (SDJ) menunjukkan nilai Mikrofilaria Rate di Kota Pekalongan masih > 1%. Penelitian ini bertujuan untuk menggambarkan peran Tenaga Pelaksana Eliminasi (TPE) filariasis dan hambatan yang ditemui pada pelaksanaan POPM di Kota Pekalongan.Metode: Penelitian ini merupakan penelitian cross sectiona. Jumlah sampel 95 orang petugas TPE dengan menggunakan simple ramdom sampling. Pengumpulan data dengan wawancara menggunakan kuesioner. Hasil: Hasil penelitian menunjukkan bahwa EP dalam memilih anggota keluarga target yang akan dirawat adalah optimal (63,2%). EP dalam membantu puskesmas menentukan dosis dan pemberian obat-obatan untuk masing-masing keluarga yang dibantu (52,6%). EP dalam merekam keluarga yang dibantu yang minum obat pada kartu sudah optimal (55,8%). EP dalam memantau dan mencatat reaksi perawatan yang mungkin timbul dan melaporkan kepada petugas kesehatan adalah optimal (61,1%).Simpulan: Peran tenaga pelaksana eliminasi TPE di Kota Pekalongan dalam menyeleksi anggota keluarga binaan yang akan diobati, dalam membantu puskesmas menentukan dosis dan pemberian obat pada setiap keluarga binaan, dalam pencatatan keluarga binaan yang meminum obat pada kartu, dan dalam pengawasan dan pencatatan reaksi pengobatan yang mungkin timbul serta pelaporan kepada petugas kesehatan sudah optimalKata kunci: Filariasis, Tenaga Pelaksana EliminasiABSTRACT Title: The role of Elimination Personnel (EP) implementing filariasis MDA in Pekalongan City Background: Filariasis is a disease caused by filarial worms, Pekalongan City has carried out filariasis MDA (Mass Drug Administration) since 2011-2015. However, the results of the Finger Blood Survey (SDJ) showed that the microfilaria rate was > 1%. This study aims to describe the role of Elimination Personnel (EP) and the obstacles faced in implementing filariasis MDA in Pekalongan City.Method: This study used a cross sectional research method. Sampling in this study used simple random side, total 95 respondents. Data obtained by structure interviews using questionnaires.Result: The results showed that EP in selecting the target family members to be treated is optimal (63.2%). EP in helping puskesmas determine the dosage and administration of medicines for each of the assisted families (52.6%). EP in recording the assisted families who drank the medicine on the card was optimal (55.8%). EP in monitoring and recording treatment reactions that may arise and reporting to health workers was optimal (61.1%).Conclusion: The roles of TPE elimination workers of Pekalongan City were optimum, such as selecting family member who will be treated, helping Puskesmas in deciding the dosage and giving the medicine to every treated family, record of treated family who take the medicine in the given card, and in the supervision and record of medical reaction that might happen and reporting it to health workers.Keywords: Filariasis, Elimination Personnel

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Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia

PLoS ONE ◽

10.1371/journal.pone.0148627 ◽

2016 ◽

Vol 11 (2) ◽

pp. e0148627 ◽

Cited By ~ 14

Author(s):

Susan Dierickx ◽

Charlotte Gryseels ◽

Julia Mwesigwa ◽

Sarah O’Neill ◽

Melanie Bannister-Tyrell ◽

...

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

The Gambia ◽

Factors Associated

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Impact of a single round of mass drug administration with azithromycin on active trachoma and ocular Chlamydia trachomatis prevalence and circulating strains in The Gambia and Senegal

Parasites & Vectors ◽

10.1186/s13071-019-3743-x ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Emma M. Harding-Esch ◽

Martin J. Holland ◽

Jean-François Schémann ◽

Ansumana Sillah ◽

Boubacar Sarr ◽

...

Keyword(s):

Drug Administration ◽

Mass Drug Administration ◽

Clinical Signs ◽

The Gambia ◽

Whole Genome Sequence ◽

Poor Correlation ◽

Infection Prevalence ◽

Active Trachoma ◽

One Year

Abstract Background Mass drug administration (MDA) with azithromycin is a cornerstone of the trachoma elimination strategy. Although the global prevalence of active trachoma has declined considerably, prevalence persists or even increases in some communities and districts. To increase understanding of MDA impact, we investigated the prevalence of active trachoma and ocular C. trachomatis prevalence, organism load, and circulating strains at baseline and one-year post-MDA in The Gambia and Senegal. Methods Pre- and one-year post-MDA, children aged 0–9 years were examined for clinical signs of trachoma in six Gambian and 12 Senegalese villages. Ocular swabs from each child’s right conjunctiva were tested for evidence of ocular C. trachomatis infection and organism load (ompA copy number), and ompA and multi-locus sequence typing (MLST) was performed. Results A total of 1171 children were examined at baseline and follow-up in The Gambia. Active trachoma prevalence decreased from 23.9% to 17.7%, whereas ocular C. trachomatis prevalence increased from 3.0% to 3.8%. In Senegal, 1613 and 1771 children were examined at baseline and follow-up, respectively. Active trachoma prevalence decreased from 14.9% to 8.0%, whereas ocular C. trachomatis prevalence increased from 1.8% to 3.6%. Higher organism load was associated with having active trachoma and severe inflammation. Sequence typing demonstrated that all Senegalese samples were genovar A, whereas Gambian samples were a mix of genovars A and B. MLST provided evidence of clustering at village and household levels and demonstrated differences of strain variant frequencies in Senegal, indicative of an “outbreak”. MLST, including partial ompA typing, provided greater discriminatory power than complete ompA typing. Conclusions We found that one round of MDA led to an overall decline in active trachoma prevalence but no impact on ocular C. trachomatis infection, with heterogeneity observed between villages studied. This could not be explained by MDA coverage or number of different circulating strains pre- and post-MDA. The poor correlation between active trachoma and infection prevalence supports the need for further work on alternative indicators to clinical signs for diagnosing ocular C. trachomatis infection. MLST typing has potential molecular epidemiology utility, including better understanding of transmission dynamics, although relationship to whole-genome sequence variability requires further exploration.

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Mass Drug Administration With High-Dose Ivermectin and Dihydroartemisinin-Piperaquine for Malaria Elimination in an Area of Low Transmission With High Coverage of Malaria Control Interventions: Protocol for the MASSIV Cluster Randomized Clinical Trial

JMIR Research Protocols ◽

10.2196/20904 ◽

2020 ◽

Vol 9 (11) ◽

pp. e20904

Author(s):

Edgard Diniba Dabira ◽

Harouna M Soumare ◽

Steven W Lindsay ◽

Bakary Conteh ◽

Fatima Ceesay ◽

...

Keyword(s):

Clinical Trial ◽

Malaria Transmission ◽

Randomized Clinical Trial ◽

Drug Administration ◽

Malaria Control ◽

Mass Drug Administration ◽

High Coverage ◽

River Region ◽

Cluster Randomized ◽

The Impact

Background With a decline in malaria burden, innovative interventions and tools are required to reduce malaria transmission further. Mass drug administration (MDA) of artemisinin-based combination therapy (ACT) has been identified as a potential tool to further reduce malaria transmission, where coverage of vector control interventions is already high. However, the impact is limited in time. Combining an ACT with an endectocide treatment that is able to reduce vector survival, such as ivermectin (IVM), could increase the impact of MDA and offer a new tool to reduce malaria transmission. Objective The study objective is to evaluate the impact of MDA with IVM plus dihydroartemisinin-piperaquine (DP) on malaria transmission in an area with high coverage of malaria control interventions. Methods The study is a cluster randomized trial in the Upper River Region of The Gambia and included 32 villages (16 control and 16 intervention). A buffer zone of ~2 km was created around all intervention clusters. MDA with IVM plus DP was implemented in all intervention villages and the buffer zones; control villages received standard malaria interventions according to the Gambian National Malaria Control Program plans. Results The MDA campaigns were carried out from August to October 2018 for the first year and from July to September 2019 for the second year. Statistical analysis will commence once the database is completed, cleaned, and locked. Conclusions This is the first cluster randomized clinical trial of MDA with IVM plus DP. The results will provide evidence on the impact of MDA with IVM plus DP on malaria transmission. Trial Registration ClinicalTrials.gov NCT03576313; https://clinicaltrials.gov/ct2/show/NCT03576313 International Registered Report Identifier (IRRID) DERR1-10.2196/20904

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From Informed Consent to Adherence: Factors Influencing Involvement in Mass Drug Administration With Ivermectin for Malaria Elimination in The Gambia

10.21203/rs.3.rs-100622/v1 ◽

2020 ◽

Author(s):

Alexandra E. Fehr ◽

Claudia Nieto-Sanchez ◽

Joan Muela ◽

Fatou Jaiteh ◽

Omar Ceesay ◽

...

Keyword(s):

Decision Making ◽

Drug Administration ◽

Mass Drug Administration ◽

Social Dynamics ◽

The Gambia ◽

World Health ◽

Cross Sectional Survey ◽

Enabling Factors ◽

Cross Sectional ◽

Medication Costs

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. 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: Our 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.

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Mass Drug Administration With High-Dose Ivermectin and Dihydroartemisinin-Piperaquine for Malaria Elimination in an Area of Low Transmission With High Coverage of Malaria Control Interventions: Protocol for the MASSIV Cluster Randomized Clinical Trial (Preprint)

10.2196/preprints.20904 ◽

2020 ◽

Author(s):

Edgard Diniba Dabira ◽

Harouna M Soumare ◽

Steven W Lindsay ◽

Bakary Conteh ◽

Fatima Ceesay ◽

...

Keyword(s):

Clinical Trial ◽

Malaria Transmission ◽

Randomized Clinical Trial ◽

Drug Administration ◽

Malaria Control ◽

Mass Drug Administration ◽

High Coverage ◽

River Region ◽

Cluster Randomized ◽

The Impact

BACKGROUND With a decline in malaria burden, innovative interventions and tools are required to reduce malaria transmission further. Mass drug administration (MDA) of artemisinin-based combination therapy (ACT) has been identified as a potential tool to further reduce malaria transmission, where coverage of vector control interventions is already high. However, the impact is limited in time. Combining an ACT with an endectocide treatment that is able to reduce vector survival, such as ivermectin (IVM), could increase the impact of MDA and offer a new tool to reduce malaria transmission. OBJECTIVE The study objective is to evaluate the impact of MDA with IVM plus dihydroartemisinin-piperaquine (DP) on malaria transmission in an area with high coverage of malaria control interventions. METHODS The study is a cluster randomized trial in the Upper River Region of The Gambia and included 32 villages (16 control and 16 intervention). A buffer zone of ~2 km was created around all intervention clusters. MDA with IVM plus DP was implemented in all intervention villages and the buffer zones; control villages received standard malaria interventions according to the Gambian National Malaria Control Program plans. RESULTS The MDA campaigns were carried out from August to October 2018 for the first year and from July to September 2019 for the second year. Statistical analysis will commence once the database is completed, cleaned, and locked. CONCLUSIONS This is the first cluster randomized clinical trial of MDA with IVM plus DP. The results will provide evidence on the impact of MDA with IVM plus DP on malaria transmission. CLINICALTRIAL ClinicalTrials.gov NCT03576313; https://clinicaltrials.gov/ct2/show/NCT03576313 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/20904

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Sero-epidemiological evaluation of malaria transmission in The Gambia before and after mass drug administration

BMC Medicine ◽

10.1186/s12916-020-01785-6 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Lindsey Wu ◽

Julia Mwesigwa ◽

Muna Affara ◽

Mamadou Bah ◽

Simon Correa ◽

...

Keyword(s):

Malaria Transmission ◽

Drug Administration ◽

Mass Drug Administration ◽

West Coast ◽

Malaria Infection ◽

The Gambia ◽

Antibody Responses ◽

The West ◽

Conversion Rates ◽

Antibody Levels

Abstract Background As The Gambia aims to achieve malaria elimination by 2030, serological assays are a useful surveillance tool to monitor trends in malaria incidence and evaluate community-based interventions. Methods Within a mass drug administration (MDA) study in The Gambia, where reduced malaria infection and clinical disease were observed after the intervention, a serological sub-study was conducted in four study villages. Spatio-temporal variation in transmission was measured with a panel of recombinant Pf antigens on a multiplexed bead-based assay. Village-level antibody levels were quantified as under-15 sero-prevalence, sero-conversion rates, and age-adjusted antibody acquisition rates. Antibody levels prior to MDA were assessed for association with persistent malaria infection after community chemoprophylaxis. Results Seasonal changes in antibodies to Etramp5.Ag1 were observed in children under 15 years in two transmission settings—the West Coast and Upper River Regions (4.32% and 31.30% Pf prevalence, respectively). At the end of the malaria season, short-lived antibody responses to Etramp5.Ag1, GEXP18, HSP40.Ag1, EBA175 RIII-V, and Rh2.2030 were lower amongst 1–15 year olds in the West Coast compared to the Upper River, reflecting known differences in transmission. Prior to MDA, individuals in the top 50th percentile of antibody levels had two-fold higher odds of clinical malaria during the transmission season, consistent with previous findings from the Malaria Transmission Dynamics Study, where individuals infected before the implementation of MDA had two-fold higher odds of re-infection post-MDA. Conclusions Serological markers can serve dual functions as indicators of malaria exposure and incidence. By monitoring age-specific sero-prevalence, the magnitude of age-stratified antibody levels, or identifying groups of individuals with above-average antibody responses, these antigens have the potential to complement conventional malaria surveillance tools. Further studies, particularly cluster randomised trials, can help establish standardised serological protocols to reliably measure transmission across endemic settings.

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