CitationBoyce, Ross M.; Hollingsworth, Brandon D.; Baguma, Emma; Xu, Erin; Goel, Varun; Brown-Marusiak, Amanda; Muhindo, Rabbison; Reyes, Raquel; Ntaro, Moses; & Siedner, Mark J., et al. (Online ahead of print). Dihydroartemisinin-Piperaquine Chemoprevention and Malaria Incidence after Severe Flooding: Evaluation of a Pragmatic Intervention in Rural Uganda. Clinical Infectious Diseases.
AbstractBACKGROUND: Malaria epidemics are a well-described phenomenon after extreme precipitation and flooding, which account for nearly half of global disasters over the past two decades. Yet few studies have examined mitigation measures to prevent post-flood malaria epidemics.
METHODS: We conducted an evaluation of a malaria chemoprevention program implemented in response to severe flooding in western Uganda. Children ≤12 years of age from one village were eligible to receive 3 monthly rounds of dihydroartemisinin-piperaquine (DP). Two neighboring villages served as controls. Malaria cases were defined as individuals with a positive rapid diagnostic test result as recorded in health center registers. We performed a difference-in-differences analysis to estimate changes in the incidence and test positivity of malaria between intervention and control villages.
RESULTS: A total of 554 children received at least one round of chemoprevention with 75% participating in at least two rounds. Compared to control villages, we estimated a 53.4% reduction (aRR 0.47, 95% CI 0.34 - 0.62, p<.01) in malaria incidence and a 30% decrease in the test positivity rate (aRR=0.70, CI 0.50 - 0.97, p=0.03) in the intervention village in the six months post-intervention. The impact was greatest among children receiving the intervention, but decreased incidence was also observed in older children and adults (aRR=0.57, CI 0.38-0.84, p<.01).
CONCLUSIONS: Three rounds of chemoprevention with DP delivered under pragmatic conditions reduced the incidence of malaria after severe flooding in western Uganda. These findings provide a proof-of-concept for the use of malaria chemoprevention to reduce excess disease burden associated with severe flooding.
Reference TypeJournal Article
Year PublishedOnline ahead of print
Journal TitleClinical Infectious Diseases
Author(s)Boyce, Ross M.
Hollingsworth, Brandon D.
Siedner, Mark J.
Staedke, Sarah G.
Juliano, Jonathan J.
Mulogo, Edgar M.
ORCiDBoyce, R - 0000-0002-9489-6324
Goel - 0000-0002-2933-427X