Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.
Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.
J Infect Dis. 2022 May 4;225(9):1611-1620. doi: 10.1093/infdis/jiab259.
Haiti is planning targeted interventions to accelerate progress toward malaria elimination. In the most affected department (Grande-Anse), a combined mass drug administration (MDA) and indoor residual spraying (IRS) campaign was launched in October 2018. This study assessed the intervention's effectiveness in reducing Plasmodium falciparum prevalence.
An ecological quasi-experimental study was designed, using a pretest and posttest with a nonrandomized control group. Surveys were conducted in November 2017 in a panel of easy access groups (25 schools and 16 clinics) and were repeated 2-6 weeks after the campaign, in November 2018. Single-dose sulfadoxine-pyrimethamine and primaquine was used for MDA, and pirimiphos-methyl as insecticide for IRS.
A total of 10 006 participants were recruited. Fifty-two percent of the population in the intervention area reported having received MDA. Prevalence diminished between 2017 and 2018 in both areas, but the reduction was significantly larger in the intervention area (ratio of adjusted risk ratios, 0.32 [95% confidence interval, .104-.998]).
Despite a moderate coverage, the campaign was effective in reducing P. falciparum prevalence immediately after 1 round. Targeted MDA plus IRS is useful in preelimination settings to rapidly decrease the parasite reservoir, an encouraging step to accelerate progress toward malaria elimination.
海地正计划采取针对性干预措施，以加速实现消除疟疾目标。在受影响最严重的省份（大湾省），2018 年 10 月发起了一次联合大规模药物治疗（MDA）和室内滞留喷洒（IRS）运动。本研究评估了该干预措施在降低恶性疟原虫流行率方面的效果。
设计了一项生态准实验研究，采用了无随机对照的预测试验和后测试。2017 年 11 月，在一组易于接触的群体（25 所学校和 16 个诊所）中进行了调查，并在 2018 年 11 月运动后 2-6 周重复进行了调查。MDA 使用了单剂量磺胺多辛-乙胺嘧啶和伯氨喹，IRS 使用了马拉硫磷作为杀虫剂。
共招募了 10006 名参与者。干预地区 52%的人口报告已接受 MDA。2017 年至 2018 年间，两个地区的疟疾病例均有所减少，但干预地区的降幅明显更大（调整后的风险比，0.32[95%置信区间，0.104-0.998]）。
尽管覆盖率适中，但该运动在一轮后立即有效降低了恶性疟原虫的流行率。在消除前阶段，有针对性的 MDA 加 IRS 有助于快速减少寄生虫储存量，这是加速消除疟疾进展的一个令人鼓舞的步骤。
