Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania.
RTI International, Dar es Salaam, Tanzania.
Malar J. 2017 Aug 14;16(1):332. doi: 10.1186/s12936-017-1982-x.
Mass drug administration (MDA) appears to be effective in reducing the risk of malaria parasitaemia. This study reports on programmatic coverage and compliance of MDA using artemisinin-based combination therapy (ACT) in four shehias (smallest administration unit) that had been identified as hotspots through Zanzibar's malaria case notification surveillance system.
Mass drug administration was done in four shehias selected on the basis of: being an established malaria hot spot; having had mass screening and treatment (MSaT) 2-6 weeks previously; and exceeding the epidemic alert threshold of 5 cases within a week even after MSaT. Communities were sensitized and MDA was conducted using a house-to-house approach. All household members, except pregnant women and children aged less than 2 months, were provided with ACT medicine. Two weeks after the MDA campaign, a survey was undertaken to investigate completion of ACT doses.
A total of 8816 [97.1% of eligible; 95% confidence interval (CI) 96.8-97.5] people received ACT. During post MDA surveys, 2009 people were interviewed: 90.2% reported having completed MDA doses; 1.9% started treatment but did not complete dosage; 4.7% did not take treatment; 2.0% were absent during MDA and 1.2% were ineligible (i.e. infants <2 months and pregnant women). Main reasons for failure to complete treatment were experience of side-effects and forgetting to take subsequent doses. Failure to take treatment was mainly due to fear of side-effects, reluctance due to lack of malaria symptoms and caregivers forgetting to give medication to children.
Mass drug administration for malaria was well accepted by communities at high risk of malaria in Zanzibar, with high participation and completion rates. Further work to investigate the potential of MDA in accelerating Zanzibar's efforts towards malaria elimination should be pursued.
大规模药物治疗（MDA）似乎可以有效降低疟疾寄生虫血症的风险。本研究报告了在通过桑给巴尔疟疾病例通报监测系统确定的四个谢希亚（最小管理单位）中，使用青蒿素为基础的联合疗法（ACT）进行 MDA 的方案覆盖范围和依从性。
根据以下标准选择四个谢希亚进行大规模药物治疗：已经是疟疾热点地区；在 2-6 周前进行了大规模筛查和治疗（MSaT）；即使在 MSaT 之后，一周内仍超过 5 例的流行警戒阈值。对社区进行宣传，并采用挨家挨户的方式进行 MDA。除孕妇和 2 个月以下的儿童外，为所有家庭提供 ACT 药物。MDA 运动后两周，进行了一项调查，以调查 ACT 剂量的完成情况。
共有 8816 人[合格人数的 97.1%；95%置信区间（CI）为 96.8-97.5]接受了 ACT。在 MDA 后调查期间，对 2009 人进行了访谈：90.2%的人报告已完成 MDA 剂量；1.9%的人开始治疗但未完成剂量；4.7%的人未接受治疗；2.0%的人在 MDA 期间不在场；1.2%的人不合格（即 2 个月以下的婴儿和孕妇）。未完成治疗的主要原因是出现副作用和忘记服用后续剂量。未接受治疗主要是由于担心副作用、缺乏疟疾症状而不愿意以及护理人员忘记给儿童服药。
在桑给巴尔疟疾高危社区，大规模药物治疗得到了很好的接受，参与率和完成率都很高。应该进一步开展工作，研究 MDA 在加速桑给巴尔消除疟疾工作方面的潜力。
