在高传播环境中实施基于人群的大规模药物治疗疟疾：来自乌干达东北部的经验。
Implementing population-based mass drug administration for malaria: experience from a high transmission setting in North Eastern Uganda.
机构信息
Pilgrim Africa, Kampala, Uganda.
Global Health Institute, University of Antwerp, Antwerp, Belgium.
出版信息
Malar J. 2019 Aug 9;18(1):271. doi: 10.1186/s12936-019-2902-z.
BACKGROUND
Mass drug administration (MDA) is a suggested mean to accelerate efforts towards elimination and attainment of malaria-free status. There is limited evidence of suitable methods of implementing MDA programme to achieve a high coverage and compliance in low-income countries. The objective of this paper is to assess the impact of this MDA delivery strategy while using coverage measured as effective population in the community and population available.
METHODS
Population-based MDA was implemented as a part of a larger program in a high transmission setting in Uganda. Four rounds of interventions were implemented over a period of 2 years at an interval of 6 to 8 months. A housing and population census was conducted to establish the eligible population. A team of 19 personnel conducted MDA at established village meeting points as distribution sites at every village. The first dose of dihydroartemisinin-piperaquine (DHA-PQ) was administered via a fixed site distribution strategy by directly observed treatment on site, the remaining doses were taken at home and a door-to-door follow up strategy was implemented by community health workers to monitor adherence to the second and third doses.
RESULTS
Based on number of individuals who turned up at the distribution site, for each round of MDA, effective coverage was 80.1%, 81.2%, 80.0% and 80% for the 1st, 2nd, 3rd and 4th rounds respectively. However, coverage based on available population at the time of implementing MDA was 80.1%, 83.2%, 82.4% and 82.9% for rounds 1, 2, 3 and 4, respectively. Intense community mobilization using community structures and mass media facilitated community participation and adherence to MDA.
CONCLUSION
A hybrid of fixed site distribution and door-to-door follow up strategy of MDA delivery achieved a high coverage and compliance and seemed feasible. This model can be considered in resource-limited settings.
背景
大规模药物治疗（MDA）是一种加速消除疟疾和实现无疟疾状态的建议手段。在低收入国家，实施 MDA 规划以实现高覆盖率和高依从性的适宜方法的证据有限。本文的目的是评估在使用社区中有效人群和可获得人群来衡量覆盖率的情况下，这种 MDA 交付策略的影响。
方法
在乌干达高传播环境中，作为更大规划的一部分，实施了基于人群的 MDA。在 2 年期间，每隔 6-8 个月进行四轮干预。进行了住房和人口普查，以确定合格人口。一个由 19 人组成的小组在每个村庄的指定村庄会议点作为分发点开展 MDA。第一轮双氢青蒿素-哌喹（DHA-PQ）通过现场直接观察治疗的固定地点分发策略进行给药，其余剂量在家中服用，并由社区卫生工作者实施上门随访策略，以监测第二和第三剂的依从性。
结果
基于每次 MDA 分发点出现的人数，第一轮、第二轮、第三轮和第四轮 MDA 的有效覆盖率分别为 80.1%、81.2%、80.0%和 80%。然而，在实施 MDA 时可获得人群的覆盖率分别为第一轮、第二轮、第三轮和第四轮的 80.1%、83.2%、82.4%和 82.9%。利用社区结构和大众媒体进行密集的社区动员促进了社区参与和 MDA 的依从性。
结论
MDA 交付的固定地点分发和上门随访相结合策略实现了高覆盖率和高依从性，似乎是可行的。这种模式可以在资源有限的环境中考虑。
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