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Kositz C, Vasileva H, Mohammed N, Achan J, Dabira ED, D'Alessandro U, Bradley J, Marks M. Risk factors for non-participation in ivermectin and dihydroartemisinin-piperaquine mass drug administration for malaria control in the MASSIV trial. Malar J 2024; 23:54. [PMID: 38383367 PMCID: PMC10882911 DOI: 10.1186/s12936-024-04878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Mass Drug Administration (MDA) has become a mainstay for the control of several diseases over the last two decades. Successful implementation of MDA programmes requires community participation and can be threatened by systematic non-participation. Such concerns are particularly pertinent for MDA programmes against malaria, as they require multi-day treatment over several consecutive months. Factors associated with non-participation to the MDA campaign with ivermectin (IVM) and dihydroartemisinin-piperaquine (DHP) implemented within the MASSIV cluster randomized trial were determined. METHODS Coverage data was extracted from the MASSIV trial study database, with every datapoint being a directly observed therapy (DOT). A complete month of MDA was classified as receiving all three daily doses of treatment. For both ivermectin and DHP, ordinal logistic regression was used to identify individual and household level variables associated with non-participation. RESULTS For ivermectin, 51.5% of eligible participants received all 3 months of treatment while 30.7% received either one or two complete months. For DHP, 56.7% of eligible participants received all 3 months of treatment and 30.5% received either one or two complete months. Children aged 5-15 years and adults aged more than 50 years were more likely to receive at least one complete month of MDA than working age adults, both for ivermectin (aOR 4.3, 95% CI 3.51-5.28 and aOR of 2.26, 95% CI 1.75-2.95) and DHP (aOR 2.47, 95%CI 2.02-3.02 and aOR 1.33, 95%CI 1.01-1.35), respectively. Members of households where the head received a complete month of MDA were more likely to themselves have received a complete month of MDA, both for ivermectin (aOR 1.71, 95%CI 1.35-2.14) and for DHP (aOR 1.64, 95%CI 1.33-2.04). CONCLUSION Personal and household-level variables were associated with participation in the MDA programme for malaria control. Specific strategies to (increase participation amongst some groups may be important to ensure maximum impact of MDA strategies in achieving malaria elimination. TRIAL REGISTRATION The MASSIV trial is registered under NCT03576313.
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Affiliation(s)
- Christian Kositz
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
| | - Hristina Vasileva
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Nuredin Mohammed
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Jane Achan
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Edgard Diniba Dabira
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Umberto D'Alessandro
- Disease Control and Elimination, Medical Research Council Unit Gambia at the London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - John Bradley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
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Rahmalia A, Poespoprodjo JR, Landuwulang CUR, Ronse M, Kenangalem E, Burdam FH, Thriemer K, Devine A, Price RN, Peeters Grietens K, Ley B, Gryseels C. Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study. Malar J 2023; 22:162. [PMID: 37210520 PMCID: PMC10199529 DOI: 10.1186/s12936-023-04578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 04/25/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete course of treatment. METHODS This is a mixed-methods study to assess socio-cultural factors influencing adherence to a 14-day PQ regimen in a 3-arm, treatment effectiveness trial in Papua, Indonesia. The qualitative strand, consisting of interviews and participant observation was triangulated with a quantitative strand in which trial participants were surveyed using a questionnaire. RESULTS Trial participants differentiated between two types of malaria: tersiana and tropika, equivalent to P. vivax and Plasmodium falciparum infection, respectively. The perceived severity of both types was similar with 44.0% (267/607) perceiving tersiana vs. 45.1% (274/607) perceiving tropika as more severe. There was no perceived differentiation whether malaria episodes were due to a new infection or relapse; and 71.3% (433/607) acknowledged the possibility of recurrence. Participants were familiar with malaria symptoms and delaying health facility visit by 1-2 days was perceived to increase the likelihood of a positive test. Prior to health facility visits, symptoms were treated with leftover drugs kept at home (40.4%; 245/607) or bought over the counter (17.0%; 103/607). Malaria was considered to be cured with 'blue drugs' (referring to dihydroartemisinin-piperaquine). Conversely, 'brown drugs,' referring to PQ, were not considered malaria medication and instead were perceived as supplements. Adherence to malaria treatment was 71.2% (131/184), in the supervised arm, 56.9% (91/160) in the unsupervised arm and 62.4% (164/263) in the control arm; p = 0.019. Adherence was 47.5% (47/99) among highland Papuans, 51.7% (76/147) among lowland Papuans, and 72.9% (263/361) among non-Papuans; p < 0.001. CONCLUSION Adherence to malaria treatment was a socio-culturally embedded process during which patients (re-)evaluated the characteristics of the medicines in relation to the course of the illness, their past experiences with illness, and the perceived benefits of the treatment. Structural barriers that hinder the process of patient adherence are crucial to consider in the development and rollout of effective malaria treatment policies.
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Affiliation(s)
- Annisa Rahmalia
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia.
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
- Institute of Tropical Medicine, Antwerp, Belgium.
| | - Jeanne Rini Poespoprodjo
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika District Hospital, Timika, Indonesia
- Paediatric Research Office, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Chandra U R Landuwulang
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
| | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Enny Kenangalem
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Faustina H Burdam
- Timika Malaria Research Programme, Papuan Health and Community Development Foundation, Timika, Indonesia
- Mimika Regency Health Authority, Timika, Papua, Indonesia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Koen Peeters Grietens
- Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Benedikt Ley
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Cuinhane CE, Galatas B, Lopez JM, Djive H, Nhantumbo H, Murato I, Saúte F, Aide P, Munguambe K, Torres N. Acceptability and perceived barriers to reactive focal mass drug administration in the context of a malaria elimination program in Magude district, Southern Mozambique: A qualitative study. PLoS One 2023; 18:e0283160. [PMID: 37000890 PMCID: PMC10065238 DOI: 10.1371/journal.pone.0283160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
This study analysed acceptability and perceived barriers to reactive focal mass drug administration (rfMDA) among community members exposed to community engagement campaigns and malaria elimination interventions in Magude district, following mass drug administration (MDA) in the same district. The study used a formative qualitative study design, consisting of 56 semi-structured interviews with community members, including community leaders, household heads, women of reproductive age, members of the community and adolescents, 4 semi-structured interviews with community health workers, 9 semi-structured interviews with healthcare professionals; and 16 focus group discussions with the general adult population. Data were collected between June and September 2017. A content thematic analysis approach was used to analyse the data. The results of this study showed that rfMDA was accepted due to awareness about the intervention, experience of a previous similar programme, the MDA campaign, and due to favourable perceptions built on the believe that rfMDA would help to prevent, treat and eliminate malaria in the community. Perceived barriers to rfMDA include lack of access to accurate information, reluctance to take a pregnancy test, concern on drug adverse reactions, and reluctance to take antimalarial drugs without any symptom. In conclusion, the community found rfMDA acceptable for malaria intervention. But more community engagement is needed to foster community involvement and self-appropriation of the malaria programme elimination.
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Affiliation(s)
- Carlos Eduardo Cuinhane
- Department of Sociology, Faculty of Arts and Social Sciences, Eduardo Mondlane University, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- * E-mail:
| | - Beatriz Galatas
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
| | | | - Helder Djive
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Ilda Murato
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Khátia Munguambe
- ISGlobal, Hospital Clinic–Universitat de Barcelona, Barcelona, Spain
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Neusa Torres
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
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Fehr A, Nieto-Sanchez C, Muela J, Manneh E, Baldeh D, Ceesay O, D’Alessandro U, Dabira E, Kingori P, Grietens KP, Bardají A, Bunders-Aelen J, Zuiderent-Jerak T. Doing 'reciprocity work': The role of fieldworkers in a mass drug administration trial in the Gambia. Glob Public Health 2022; 17:4116-4128. [PMID: 36183416 PMCID: PMC7614349 DOI: 10.1080/17441692.2022.2125998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In their roles as nurses, data collectors, or other, fieldworkers undertake myriad tasks working intimately with and on the bodies of others - a type of work called 'body work'. This work further includes the micro-political relations shaping these interactions, and studies have shown the importance of these relationships in the success of clinical trials, particularly in the Gambia. This study seeks to expand the concept of body work to understand the roles and interactions of fieldworkers within the trial community, and the effect on a mass drug administration (MDA) clinical trial. We conducted a mixed-methods social science study alongside the MDA in 2018-2019, including in-depth interviews, focus group discussions, and semi-structured observations with the population involved (and not) in the MDA, as well as the MRC fieldworkers. We found that fieldworkers participated in what we call 'reciprocity work'. Through their regular tasks and interactions, they necessarily showed respect and established trust in a way that formed and contributed to reciprocal relationships, the results of which impacted the trial and individuals' autonomy in the decision-making process. Understanding the role of fieldworkers and their reciprocity work is a vital component in comprehending how research ethics are made and conducted in global health research.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Centre, Universitat Rovira I Virgili, Tarragona, Spain
| | - Ebrima Manneh
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - Dullo Baldeh
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - Omar Ceesay
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | | | - Edgard Dabira
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | | | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Azucena Bardají
- IS Global, Barcelona Institute for Global Health, Barcelona, Spain
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Xu X, Wang JJ, Jiang JJ, Zhang T, Lv XF, Wang SQ, Liu ZJ, Li WD, Lu XC. Mass drug administration in response to vivax malaria resurgence in Anhui Province of Huanghuai Plain, China. ADVANCES IN PARASITOLOGY 2022; 116:115-152. [PMID: 35752446 DOI: 10.1016/bs.apar.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article summarizes the background, specific conditions, main measures, steps and effects of the implementation of Mass Drug Administration (MDA) to control the local P. vivax malaria epidemic in Anhui Province in central China. Distributing medicines to the designated population quickly controlled the local epidemic of P. vivax. Implementing MDA to control P. vivax ensured the correct selection of medicines, clarification of the targeted population for receipt of medicines, and assurance of a high rate of compliance through government support and health education. These results provide a reference for countries and regions experiencing similar events and planning to implement MDA in malaria control.
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Affiliation(s)
- Xian Xu
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
| | - Jian-Jun Wang
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
| | - Jing-Jing Jiang
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
| | - Tao Zhang
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
| | - Xiao-Feng Lv
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
| | - Shu-Qi Wang
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
| | - Zi-Jian Liu
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
| | - Wei-Dong Li
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China.
| | - Xue-Chun Lu
- Anhui Provincial Center for Disease Control and Prevention, Anhui, PR China
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Erber AC, Colebunders R. Ivermectin for malaria control in mass drug administration programmes. THE LANCET. INFECTIOUS DISEASES 2022; 22:449-450. [PMID: 35338868 DOI: 10.1016/s1473-3099(22)00152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Astrid Christine Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Fehr A, Muela J, Nieto-Sanchez C, Manneh E, Baldeh D, Ceesay O, Bardají A, Zuiderent-Jerak T, Bunders-Aelen J. 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. Soc Sci Med 2021; 291:114487. [PMID: 34715624 DOI: 10.1016/j.socscimed.2021.114487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves administering medication to an entire target population regardless of individual-level disease status. This strategy requires high levels of coverage and compliance. Previous studies have assessed individual and structural factors affecting MDA coverage, but there is a need to better understand the influence and expressions of community dynamics and social structures, such as social cohesion. We conducted a social science study concurrent to an MDA clinical trial for malaria control in The Gambia; ethnographic research was conducted prior to, throughout, and between MDA implementation July-November 2018, January-March 2019, and July-November 2019. We assessed how social cohesion, as expressed by the trial population, affects trial coverage through an in-depth ethnographic analysis of two trial villages, using observations, interviews, and focus group discussions with community members who took the trial medication and those who did not. We found that the villages had unique expressions of social cohesion. This was reflected through community participation in the trial implementation and may have affected coverage and compliance. The village with low coverage expressed a form of social cohesion where members followed advice to participate through a hierarchal system but did not actively participate in the MDA or its implementation. The village with high coverage expressed social cohesion as more participatory: individuals took the directive to participate but contextualized the trial implementation to their needs and wants. We analyze these different expressions of social cohesion and the important differences they make for the coverage and compliance levels reached in the two different villages.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands; Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000, Antwerpen, Belgium; Medical Anthropology Research Center, Universitat Rovira I Virgili, Carrer de l'Escorxador, 43003, Tarragona, Spain.
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgili, Carrer de l'Escorxador, 43003, Tarragona, Spain.
| | - Claudia Nieto-Sanchez
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000, Antwerpen, Belgium.
| | - Ebrima Manneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Azucena Bardají
- ISGlobal, Barcelona Institute for Global Health - Campus Clinic, Hospital Clinic - Universitat de Barcelona, Carrer Rosselló, 08036, Barcelona, Spain.
| | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
| | - Joske Bunders-Aelen
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
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