Publication:
Effect 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 programme

Issued Date

2018-05-12

Resource Type

Article

ISSN

1474547X
01406736

DOI

10.1016/S0140-6736(18)30792-X

Other identifier(s)

2-s2.0-85046171115

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet. Vol.391, No.10133 (2018), 1916-1926

Suggested Citation

Jordi Landier, Daniel M. Parker, Aung Myint Thu, Khin Maung Lwin, Gilles Delmas, François H. Nosten, Chiara Andolina, Ricardo Aguas, Saw Moe Ang, Ei Phyo Aung, Naw Baw Baw, Saw Aye Be, Saw B'Let, Hay Bluh, Craig A. Bonnington, Victor Chaumeau, Miasa Chirakiratinant, Win Cho Cho, Peter Christensen, Vincent Corbel, Nicholas PJ Day, Saw Hsa Dah, Mehul Dhorda, Arjen M. Dondorp, Jean Gaudart, Gornpan Gornsawun, Warat Haohankhunnatham, Saw Kyaw Hla, Saw Nay Hsel, Gay Nay Htoo, Saw Nay Htoo, Mallika Imwong, Saw John, Ladda Kajeechiwa, Lily Kereecharoen, Praphan Kittiphanakun, Keerati Kittitawee, Kamonchanok Konghahong, Saw Diamond Khin, Saw Win Kyaw, Clare Ling, Khine Shwe War Lwin, Naw K’ Yin Ma, Alexandra Marie, Cynthia Maung, Ed Marta, Myo Chit Minh, Olivo Miotto, Paw Khu Moo, Ku Ler Moo, Merry Moo, Naw Na Na, Mar Nay, Suphak Nosten, Slight Naw Nyo, Eh Kalu Shwe Oh, Phu Thit Oo, Tun Pyit Oo, Daniel M. Parker, Eh Shee Paw, Choochai Phumiya, Aung Pyae Phyo, Kasiha Pilaseng, Stéphane Proux, Santisuk Rakthinthong, Wannee Ritwongsakul, Kloloi Salathibuphha, Armon Santirad, Sunisa Sawasdichai, Lorenz von Seidlein, Paw Wah Shee, Paw Bway Shee, Decha Tangseefa, May Myo Thwin, Saw Win Tun, Chode Wanachaloemlep, Lisa J. White, Nicholas J. White, Jacher Wiladphaingern, Saw Nyunt Win, Nan Lin Yee, Daraporn Yuwapan Effect 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 programme. The Lancet. Vol.391, No.10133 (2018), 1916-1926. doi:10.1016/S0140-6736(18)30792-X Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46665

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Title

Effect 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 programme

Author(s)

Jordi Landier
 Daniel M. Parker
 Aung Myint Thu
 Khin Maung Lwin
 Gilles Delmas
 François H. Nosten
 Chiara Andolina
 Ricardo Aguas
 Saw Moe Ang
 Ei Phyo Aung
 Naw Baw Baw
 Saw Aye Be
 Saw B'Let
 Hay Bluh
 Craig A. Bonnington
 Victor Chaumeau
 Miasa Chirakiratinant
 Win Cho Cho
 Peter Christensen
 Vincent Corbel
 Nicholas PJ Day
 Saw Hsa Dah
 Mehul Dhorda
 Arjen M. Dondorp
 Jean Gaudart
 Gornpan Gornsawun
 Warat Haohankhunnatham
 Saw Kyaw Hla
 Saw Nay Hsel
 Gay Nay Htoo
 Saw Nay Htoo
 Mallika Imwong
 Saw John
 Ladda Kajeechiwa
 Lily Kereecharoen
 Praphan Kittiphanakun
 Keerati Kittitawee
 Kamonchanok Konghahong
 Saw Diamond Khin
 Saw Win Kyaw
 Clare Ling
 Khine Shwe War Lwin
 Naw K’ Yin Ma
 Alexandra Marie
 Cynthia Maung
 Ed Marta
 Myo Chit Minh
 Olivo Miotto
 Paw Khu Moo
 Ku Ler Moo
 Merry Moo
 Naw Na Na
 Mar Nay
 Suphak Nosten
 Slight Naw Nyo
 Eh Kalu Shwe Oh
 Phu Thit Oo
 Tun Pyit Oo
 Daniel M. Parker
 Eh Shee Paw
 Choochai Phumiya
 Aung Pyae Phyo
 Kasiha Pilaseng
 Stéphane Proux
 Santisuk Rakthinthong
 Wannee Ritwongsakul
 Kloloi Salathibuphha
 Armon Santirad
 Sunisa Sawasdichai
 Lorenz von Seidlein
 Paw Wah Shee
 Paw Bway Shee
 Decha Tangseefa
 May Myo Thwin
 Saw Win Tun
 Chode Wanachaloemlep
 Lisa J. White
 Nicholas J. White
 Jacher Wiladphaingern
 Saw Nyunt Win
 Nan Lin Yee
 Daraporn Yuwapan

Other Contributor(s)

Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale
 Mahidol University
 Nuffield Department of Clinical Medicine
 University of California, Irvine

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.

Keyword(s)

Medicine

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URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/46665

Collections

Scopus 2018