Dynamic of asymptomatic Plasmodium Falciparum parasitaemia during mass drug administration with dihydroartemisinin-piperaquine plus single low dose of primaquine in Savannakhet province, Laos
2
Issued Date
2024
Copyright Date
2018
Language
eng
File Type
application/pdf
No. of Pages/File Size
xi, 126 leaves : ill.
Access Rights
open access
Rights Holder(s)
Mahidol University
Bibliographic Citation
Thesis (Ph.D. (Clinical Tropical Medicine))--Mahidol University, 2018
Suggested Citation
Tiengkham Pongvongsa, 1962- Dynamic of asymptomatic Plasmodium Falciparum parasitaemia during mass drug administration with dihydroartemisinin-piperaquine plus single low dose of primaquine in Savannakhet province, Laos. Thesis (Ph.D. (Clinical Tropical Medicine))--Mahidol University, 2018. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/91643
Title
Dynamic of asymptomatic Plasmodium Falciparum parasitaemia during mass drug administration with dihydroartemisinin-piperaquine plus single low dose of primaquine in Savannakhet province, Laos
Author(s)
Abstract
The increase in multidrug resistant Plasmodium falciparum infections threatens the malaria elimination goals in countries within the Greater Mekong Subregion. A multi-pronged approach assuring access to basic malaria control measures including insecticide treated bed nets and early dignosis and treatment was followed by mass drug administrations (MDA) in southern Savannakhet Province, Laos. The main objective of this study was to evaluate the effectiveness and safety of mass drug administrations as well as their effects on the dynamic of asymptomatic P. falciparum infections in 4 malaria endemic villages. Two villages were randomized to early MDA consisting of 3 rounds of a 3 day course of dihydroartemisinin - piperaquine with a single low dose of primaquine. In the other 2 villages MDA was deferred by one year. A total of 1,036 residents were enrolled in early MDA villages and 883 in control villages (deferred-MDA). Tri-monthly parasitaemia surveys using uPCR were conducted for a year in the 4 villages. Eighty-four percent (872/1,036) of the residents participated in the MDAs, of whom 90% (781/872) completed 3 rounds of MDA (9doses). In intervention villages, the prevalence of asymptomatic P. falciparum infections decreased by 85% after MDA from 4.8% (95%CI: 3.4-6.4) at baseline (Month 0 or M0) to 0.7% (95%CI: 0.3-1.6) at Month 12. In control villages there was a decrease of 33% in P. falciparum prevalence between M0: 17.5% (95%CI: 15.9-20.3) and M12: 11.6% (95%CI: 9.3-14.2). In bi-variate and multivariate analyses P. falciparum infections were significantly reduced with early MDA (adjusted incidence rate ratios (AIRR): 0.08, CI: 0.01 to 0.091) and completion of 3 MDA rounds (AIRR: 0.06; CI: 0.01 to 0.66). A quarter of participants (226 /872) reported adverse events of which 99% were mild. The study found a significant reduction in P. falciparum prevalence and incidence following MDA. MDA was safe, well tolerated, feasible, achieved high population coverage and adherence. MDAs must be integrated in multipronged approaches such as vector control and preventive measures with a focus on specific risk groups such as mobile, migrant population and forest goers for a sustained period to eliminate the remaining parasite reservoirs.
Description
Clinical Tropical Medicine (Mahidol University 2018)
Degree Name
Doctor of Philosophy
Degree Level
Doctoral Degree
Degree Department
Mahidol University. Faculty of Tropical Medicine
Degree Discipline
Clinical Tropical Medicine
Degree Grantor(s)
Mahidol University