Impact and Lessons Learned from Mass Drug Administrations of Malaria Chemoprevention during the Ebola Outbreak in Monrovia, Liberia, 2014Reportar como inadecuado




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Background

In October 2014, during the Ebola outbreak in Liberia healthcare services were limited while malaria transmission continued. Médecins Sans Frontières MSF implemented a mass drug administration MDA of malaria chemoprevention CP in Monrovia to reduce malaria-associated morbidity. In order to inform future interventions, we described the scale of the MDA, evaluated its acceptance and estimated the effectiveness.

Methods

MSF carried out two rounds of MDA with artesunate-amodiaquine ASAQ targeting four neighbourhoods of Monrovia October to December 2014. We systematically selected households in the distribution area and administered standardized questionnaires. We calculated incidence ratios IR of side effects using poisson regression and compared self-reported fever risk differences RD pre- and post-MDA using a z-test.

Findings

In total, 1,259,699 courses of ASAQ-CP were distributed. All households surveyed n = 222; 1233 household members attended the MDA in round 1 r1 and 96% in round 2 r2 212-222 households; 1,154 household members. 52% 643-1233 initiated ASAQ-CP in r1 and 22% 256-1154 in r2. Of those not initiating ASAQ-CP, 29% 172-590 saved it for later in r1, 47% 423-898 in r2. Experiencing side effects in r1 was not associated with ASAQ-CP initiation in r2 IR 1.0, 95%CI 0.49–2.1. The incidence of self-reported fever decreased from 4.2% 52-1229 in the month prior to r1 to 1.5% 18-1229 after r1 p<0.001 and decrease was larger among household members completing ASAQ-CP RD = 4.9% compared to those not initiating ASAQ-CP RD = 0.6% in r1 p<0.001.

Conclusions

The reduction in self-reported fever cases following the intervention suggests that MDAs may be effective in reducing cases of fever during Ebola outbreaks. Despite high coverage, initiation of ASAQ-CP was low. Combining MDAs with longer term interventions to prevent malaria and to improve access to healthcare may reduce both the incidence of malaria and the proportion of respondents saving their treatment for future malaria episodes.



Autor: Anna Kuehne , Amanda Tiffany , Estrella Lasry, Michel Janssens, Clement Besse, Chibuzo Okonta, Kwabena Larbi, Alfred C. Pah, Kost

Fuente: http://plos.srce.hr/



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