Abstract
Angumu health zone in Ituri, Democratic Republic of Congo) is a highly malaria-endemic area with an overburdened health system and hosting internally displaced persons (IDP). The World Health Organization recommends mass drug administration (MDA) for malaria in complex emergencies. Therefore, three MDA rounds with high coverage were implemented in four health areas by Ministry of Public Health and Médecins sans Frontières from September 2020 to January 2021. We compared reported mortality and morbidity in locations where MDA has been performed and locations where it has not.
A population-based retrospective mortality survey was conducted in March 2021. Two-stage cluster sampling was used in villages; all IDP sites were surveyed with systematic random sampling.
Data was collected for 2554 households and 15470 individuals, of whom 721 died in the 18-month recall period. The under-five mortality rate (U5MR) decreased in the locations where MDA had been implemented from 2.32[1.48–3.16] “before” the MDA to 1.10[0.5–1.71] deaths/10,000 children under 5 years/day “after”, whereas it remained stable from 2.74 [2.08–3.40] to 2.67 [1.84–3.50] deaths/10,000 children/day in the same time periods in locations where MDA had not been implemented. The U5MR and malaria-specific mortality was significantly higher in non-MDA locations after MDA was implemented (aRR = 2.17[1.36–3.49] and 2.60[1.56–4.33] respectively for all-cause and malaria-specific mortality among children < 5 years). Morbidity (all age and < 5 years, all cause or malaria-specific) appeared lower in MDA locations 2.5 months after last round: reported malaria-specific morbidity was 14.7%[11–18] and 25.0%[19–31] in villages and IDP sites where MDA had been implemented, while it was 30.4%[27–33] and 49.3%[45–54] in villages and IDP sites with no MDA.
The documented sharp decrease of under-5 mortality and morbidity confirms that MDA has the potential to become an important malaria-control tool in emergency settings. Based on these results, new MDA rounds, along with Indoor residual spraying campaigns, have been planned in the health zone in 2022. A set of surveys will be conducted before, during and after these rounds to confirm the effect observed in 2021 and assess its duration.
