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dc.contributor.authorJordi Landieren_US
dc.contributor.authorDaniel M. Parkeren_US
dc.contributor.authorAung Myint Thuen_US
dc.contributor.authorKhin Maung Lwinen_US
dc.contributor.authorGilles Delmasen_US
dc.contributor.authorFrançois H. Nostenen_US
dc.contributor.authorChiara Andolinaen_US
dc.contributor.authorRicardo Aguasen_US
dc.contributor.authorSaw Moe Angen_US
dc.contributor.authorEi Phyo Aungen_US
dc.contributor.authorNaw Baw Bawen_US
dc.contributor.authorSaw Aye Been_US
dc.contributor.authorSaw B'Leten_US
dc.contributor.authorHay Bluhen_US
dc.contributor.authorCraig A. Bonningtonen_US
dc.contributor.authorVictor Chaumeauen_US
dc.contributor.authorMiasa Chirakiratinanten_US
dc.contributor.authorWin Cho Choen_US
dc.contributor.authorPeter Christensenen_US
dc.contributor.authorVincent Corbelen_US
dc.contributor.authorNicholas PJ Dayen_US
dc.contributor.authorSaw Hsa Dahen_US
dc.contributor.authorMehul Dhordaen_US
dc.contributor.authorArjen M. Dondorpen_US
dc.contributor.authorJean Gaudarten_US
dc.contributor.authorGornpan Gornsawunen_US
dc.contributor.authorWarat Haohankhunnathamen_US
dc.contributor.authorSaw Kyaw Hlaen_US
dc.contributor.authorSaw Nay Hselen_US
dc.contributor.authorGay Nay Htooen_US
dc.contributor.authorSaw Nay Htooen_US
dc.contributor.authorMallika Imwongen_US
dc.contributor.authorSaw Johnen_US
dc.contributor.authorLadda Kajeechiwaen_US
dc.contributor.authorLily Kereecharoenen_US
dc.contributor.authorPraphan Kittiphanakunen_US
dc.contributor.authorKeerati Kittitaweeen_US
dc.contributor.authorKamonchanok Konghahongen_US
dc.contributor.authorSaw Diamond Khinen_US
dc.contributor.authorSaw Win Kyawen_US
dc.contributor.authorClare Lingen_US
dc.contributor.authorKhine Shwe War Lwinen_US
dc.contributor.authorNaw K’ Yin Maen_US
dc.contributor.authorAlexandra Marieen_US
dc.contributor.authorCynthia Maungen_US
dc.contributor.authorEd Martaen_US
dc.contributor.authorMyo Chit Minhen_US
dc.contributor.authorOlivo Miottoen_US
dc.contributor.authorPaw Khu Mooen_US
dc.contributor.authorKu Ler Mooen_US
dc.contributor.authorMerry Mooen_US
dc.contributor.authorNaw Na Naen_US
dc.contributor.authorMar Nayen_US
dc.contributor.authorSuphak Nostenen_US
dc.contributor.authorSlight Naw Nyoen_US
dc.contributor.authorEh Kalu Shwe Ohen_US
dc.contributor.authorPhu Thit Ooen_US
dc.contributor.authorTun Pyit Ooen_US
dc.contributor.authorDaniel M. Parkeren_US
dc.contributor.authorEh Shee Pawen_US
dc.contributor.authorChoochai Phumiyaen_US
dc.contributor.authorAung Pyae Phyoen_US
dc.contributor.authorKasiha Pilasengen_US
dc.contributor.authorStéphane Prouxen_US
dc.contributor.authorSantisuk Rakthinthongen_US
dc.contributor.authorWannee Ritwongsakulen_US
dc.contributor.authorKloloi Salathibuphhaen_US
dc.contributor.authorArmon Santiraden_US
dc.contributor.authorSunisa Sawasdichaien_US
dc.contributor.authorLorenz von Seidleinen_US
dc.contributor.authorPaw Wah Sheeen_US
dc.contributor.authorPaw Bway Sheeen_US
dc.contributor.authorDecha Tangseefaen_US
dc.contributor.authorMay Myo Thwinen_US
dc.contributor.authorSaw Win Tunen_US
dc.contributor.authorChode Wanachaloemlepen_US
dc.contributor.authorLisa J. Whiteen_US
dc.contributor.authorNicholas J. Whiteen_US
dc.contributor.authorJacher Wiladphaingernen_US
dc.contributor.authorSaw Nyunt Winen_US
dc.contributor.authorNan Lin Yeeen_US
dc.contributor.authorDaraporn Yuwapanen_US
dc.contributor.otherSciences Economiques et Sociales de la Santé et Traitement de l'Information Médicaleen_US
dc.contributor.otherMahidol Universityen_US
dc.contributor.otherNuffield Department of Clinical Medicineen_US
dc.contributor.otherUniversity of California, Irvineen_US
dc.identifier.citationThe Lancet. Vol.391, No.10133 (2018), 1916-1926en_US
dc.description.abstract© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Potentially untreatable Plasmodium falciparum malaria threatens the Greater Mekong subregion. A previous series of pilot projects in Myanmar, Laos, Cambodia, and Vietnam suggested that mass drug administration was safe, and when added to provision of early diagnosis and treatment, could reduce the reservoir of P falciparum and interrupts transmission. We examined the effects of a scaled-up programme of this strategy in four townships of eastern Myanmar on the incidence of P falciparum malaria. Methods: The programme was implemented in the four townships of Myawaddy, Kawkareik, Hlaingbwe, and Hpapun in Kayin state, Myanmar. Increased access to early diagnosis and treatment of malaria was provided to all villages through community-based malaria posts equipped with rapid diagnostic tests, and treatment with artemether–lumefantrine plus single low-dose primaquine. Villages were identified as malarial hotspots (operationally defined as >40% malaria, of which 20% was P falciparum) with surveys using ultrasensitive quantitative PCR either randomly or targeted at villages where the incidence of clinical cases of P falciparum malaria remained high (ie, >100 cases per 1000 individuals per year) despite a functioning malaria post. During each survey, a 2 mL sample of venous blood was obtained from randomly selected adults. Hotspots received targeted mass drug administration with dihydroartemisinin–piperaquine plus single-dose primaquine once per month for 3 consecutive months in addition to the malaria posts. The main outcome was the change in village incidence of clinical P falciparum malaria, quantified using a multivariate, generalised, additive multilevel model. Malaria prevalence was measured in the hotspots 12 months after mass drug administration. Findings: Between May 1, 2014, and April 30, 2017, 1222 malarial posts were opened, providing early diagnosis and treatment to an estimated 365 000 individuals. Incidence of P falciparum malaria decreased by 60 to 98% in the four townships. 272 prevalence surveys were undertaken and 69 hotspot villages were identified. By April 2017, 50 hotspots were treated with mass drug administration. Hotspot villages had a three times higher incidence of P falciparum at malarial posts than neighbouring villages (adjusted incidence rate ratio [IRR] 2·7, 95% CI 1·8–4·4). Early diagnosis and treatment was associated with a significant decrease in P falciparum incidence in hotspots (IRR 0·82, 95% CI 0·76–0·88 per quarter) and in other villages (0·75, 0·73–0·78 per quarter). Mass drug administration was associated with a five-times decrease in P falciparum incidence within hotspot villages (IRR 0·19, 95% CI 0·13–0·26). By April, 2017, 965 villages (79%) of 1222 corresponding to 104 village tracts were free from P falciparum malaria for at least 6 months. The prevalence of wild-type genotype for K13 molecular markers of artemisinin resistance was stable over the three years (39%; 249/631). Interpretation: Providing early diagnosis and effective treatment substantially decreased village-level incidence of artemisinin-resistant P falciparum malaria in hard-to-reach, politically sensitive regions of eastern Myanmar. Targeted mass drug administration significantly reduced malaria incidence in hotspots. If these activities could proceed in all contiguous endemic areas in addition to standard control programmes already implemented, there is a possibility of subnational elimination of P falciparum. Funding: The Bill & Melinda Gates Foundation, the Regional Artemisinin Initiative (Global Fund against AIDS, Tuberculosis and Malaria), and the Wellcome Trust.en_US
dc.rightsMahidol Universityen_US
dc.titleEffect of generalised access to early diagnosis and treatment and targeted mass drug administration on Plasmodium falciparum malaria in Eastern Myanmar: an observational study of a regional elimination programmeen_US
Appears in Collections:Scopus 2018

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