Feasibility of large-scale mass drug administration for malaria in Angumu health zone, Ituri, Democratic Republic of Congo

Angumu is a highly malaria endemic area in North-Eastern DRC, with displaced people having relocated from an area with lower exposure to malaria. In Angumu, there are high levels of mortality linked with malaria, and crude and under-5 mortality rates have been shown to be above the emergency threshold in 2020 population survey data. In addition, healthcare systems are over-burdened due to population displacement, together with deterioration in access to healthcare caused by the COVID-19 pandemic. 
MDA was implemented in the region by 227 teams, involving two community health workers each. The first MDA round, carried out between September and October 2020, reached 74,847 people (133%), and the second was executed during November 2020, reaching 75,487 people (134%). The third MDA round ran between December 2020 and January 2021, reaching 78,227 people (139%). There were 679 mild and three severe (0.9%, of all those receiving MDA) adverse events (AE’s) reported during the first round, and 425 mild and three severe (0.57%) AE’s during the second round. None of the severe AE’s reported were causally linked with MDA, after investigation. The average weekly number of malaria cases decreased by 81% (151 vs. 29) in MDA-targetted areas, as compared with a drop of 33% (139 vs. 93) in non-targetted areas.

The intervention was based on three MDA rounds, spaced at least 28 days apart, for adults and children aged over 2 months, covering a total population of 56,353. For the first two rounds the antimalarial drug was amodiaquine-artesunate (AQAS), and for the third round artesunate-pyronaridine (Pyramax) was administered.
Door-to-door distribution was chosen to reduce risk of COVID-19 transmission. First doses were directly observed and notification of adverse events was implemented.

Study type: Cross-sectional population-based retrospective study.
Outcome measures: administrative coverage, reduction in weekly confirmed malaria cases reported from MSF-supported health facilities before and after MDA delivery, and differences between targetted (6 facilities) and non-targetted health areas (14 facilities).

MSF Scientific Days International 2021 [19th May - Session 3]

Drug-based Strategies
Health Systems & Op. Research
Humanitarian Emergencies
Vulnerable Populations

Oct 2020 — Jan 2021

Dem. Rep. of Congo

Mass Drug Administration (MDA)