Ferriss Ellen Leah, Dieye Yakou, Cissé Moustapha, Dieng Sow Gnagna, Lankia Jean Louis, Diedhiou Damien, Sall Abiboulaye, Souane Tamba, Thiam Tidiane, Sene Doudou, Doucouré Elhadji, Diallo Ibrahima, Bennett Adam, Guinovart Caterina
PATH, 2201 Westlake Ave Ste 200, Seattle, WA, 98121, USA.
PATH, Rue Saint John Perse X F, Dakar, Sénégal.
Malar J. 2025 Jan 25;24(1):27. doi: 10.1186/s12936-025-05245-5.
The World Health Organization conditionally recommends reactive drug administration to reduce malaria transmission in settings approaching elimination. However, few studies have evaluated the impact of reactive focal drug administration (rFDA) in sub-Saharan Africa, and none have evaluated it under programmatic conditions. In 2016, Senegal's national malaria control programme introduced rFDA, the presumptive treatment of compound members of a person with confirmed malaria, and reactive mass focal drug administration (rMFDA), an expanded effort including neighbouring compounds during an outbreak, in 10 low transmission districts in the north of the country. This evaluation sought to measure the impact of rFDA and rMFDA on malaria incidence.
An interrupted time series analysis was conducted with routine surveillance data on health post-level monthly confirmed malaria case counts from the District Health Information Software (DHIS2). The study evaluated the change in incidence following rFDA and rMFDA rollout (level change), which ranged from August 2016 to November 2019, and monthly thereafter (trend change), using an adjusted negative binomial regression model with data from January 2015 through January 2020. The model was used to estimate the number of cases averted via a counterfactual simulation.
No incidence rate reductions were estimated immediately following rollout (level change: incidence rate ratio (IRR) = 1.00, 95% credible interval (CI) = 0.76, 1.33). However, rFDA and rMFDA were associated with a 4% monthly decline in incidence relative to the baseline trend (trend change: IRR = 0.96, 95% CI = 0.95, 0.98). Over the study period, RFDA and rMFDA were estimated to avert 2,070 (95% CI = 577, 4,367) of 4,108 (95% CI = 2,620, 6,425) malaria cases.
RFDA and rMFDA were associated with reduced malaria incidence in northern Senegal, supporting their use in malaria control in very low transmission areas. However, additional strategies are likely needed to achieve elimination in this setting.
世界卫生组织有条件地建议采取反应性药物给药措施，以在接近疟疾消除的环境中减少疟疾传播。然而，很少有研究评估反应性局部药物给药（rFDA）在撒哈拉以南非洲的影响，且尚无研究在项目实施条件下对其进行评估。2016年，塞内加尔国家疟疾控制项目在该国北部10个低传播地区引入了rFDA（即对确诊疟疾病例的同住家庭成员进行推定治疗）以及反应性大规模局部药物给药（rMFDA，即在疫情期间对邻近社区扩大实施的措施）。本评估旨在衡量rFDA和rMFDA对疟疾发病率的影响。
利用地区卫生信息软件（DHIS2）中卫生站层面每月确诊疟疾病例数的常规监测数据进行中断时间序列分析。该研究评估了2016年8月至2019年11月期间rFDA和rMFDA推出后发病率的变化（水平变化），以及此后每月的变化（趋势变化），使用了一个经过调整的负二项回归模型，数据涵盖2015年1月至2020年1月。该模型用于通过反事实模拟估计避免的病例数。
在推出后立即未估计到发病率降低（水平变化：发病率比（IRR）=1.00，95%可信区间（CI）=0.76，1.33）。然而，相对于基线趋势，rFDA和rMFDA与发病率每月下降4%相关（趋势变化：IRR=0.96，95%CI=0.95，0.98）。在研究期间，估计rFDA和rMFDA在4108例（95%CI=2620，6425）疟疾病例中避免了2070例（95%CI=577，4367）。
rFDA和rMFDA与塞内加尔北部疟疾发病率降低相关，支持在极低传播地区将其用于疟疾控制。然而，在这种情况下可能还需要其他策略来实现消除疟疾的目标。
