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Dihydroartemisinin-Piperaquine Chemoprevention and Malaria Incidence after Severe Flooding: Evaluation of a Pragmatic Intervention in Rural Uganda

Citation

Boyce, 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.

Abstract

BACKGROUND: 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.

URL

http://dx.doi.org/10.1093/cid/ciab781

Reference Type

Journal Article

Year Published

Online ahead of print

Journal Title

Clinical Infectious Diseases

Author(s)

Boyce, Ross M.
Hollingsworth, Brandon D.
Baguma, Emma
Xu, Erin
Goel, Varun
Brown-Marusiak, Amanda
Muhindo, Rabbison
Reyes, Raquel
Ntaro, Moses
Siedner, Mark J.
Staedke, Sarah G.
Juliano, Jonathan J.
Mulogo, Edgar M.

Article Type

Regular

Continent/Country

Uganda

ORCiD

Boyce, R - 0000-0002-9489-6324
Goel - 0000-0002-2933-427X