Conference Material > Abstract
Robinson E, van Braak F, Rose L, Yadenzi MS
MSF Scientific Days International 2021: Research. 2021 May 19
INTRODUCTION
Protracted conflict in CAR has led to widespread political unrest and fragile health systems. Hyperendemic malaria is the main cause of morbidity. Alongside global calls to prioritise malaria prevention during the COVID-19 pandemic, MSF initiated mass drug administration (MDA) for children aged between three months and 15 years within three communes of the Bossangoa health district between 17 August and 24 November 2020. The MDA comprised three cycles of dihydroartemisin-piperaquine (DHA-PQ), given at four-week intervals. We evaluated coverage and clinical impact of the MDA, and describe community perspectives.
METHODS
We conducted a two-stage cluster household survey between 22 November and 9 December 2020. We undertook structured interviews with the heads of households and with eligible children, focusing on participation in the MDA. Participation was verified against the MDA card, if available. Using routine MSF surveillance data, we compared the following indicators during the MDA intervention to the same periods of time during 2018 and 2019: consultations, confirmed malaria cases, and positivity rates of malaria rapid diagnostic tests (mRDT’s) in MSF facilities in the intervention area, overall and by age group (≥5; <5 years); hospital admissions and in-hospital deaths with a primary diagnosis of severe malaria among children <15 years from the MDA intervention area. Following each cycle we conducted nine focus groups discussions (FGD’s) with caregivers, community leaders, and community health workers (CHW’s) Participants were selected using purposive sampling. The topic guide inluded the key themes of reasons for participation, difficulties encountered, satisfaction, and experiences throughout the MDA.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the national ERB of CAR.
RESULTS
In total, we distributed 134,117 DHA-PQ courses. Among eligible children, 93.1% (95% confidence interval, CI, 85.6-96.8) received all three cycles. We estimated significant reductions only for confirmed outpatient malaria cases overall (9.2%; 95% CI 5.6-12.8), and among those aged <5 years (20.5%; 95% CI 15.3-25.8). Following the first MDA cycle, FGD participants described positive perceptions and high adherence with regard to MDA, linked with the involvement of community leaders. Participants reported reductions in childhood malaria, as well as reduced household expenditure on healthcare. Rumours about ‘drug trials’ and concerns about side effects were initial reasons for refusal, however these concerns were overcome after seeing the positive impact on participating children. Participants’ recommendations included continuing the programme and expanding eligibility.
CONCLUSION
This is one of the first such MDA’s in CAR; our experience demonstrates MDA is feasible in complex emergencies. Although preliminary analysis of routine surveillance data suggested a limited impact on malaria diagnoses, community acceptance was high. Of note, outpatient surveillance data was limited to three structures in only one commune, and not available for the specific target ages of the MDA. Participants noted positive perceptions of impact, with a desire for repeated MDA’s. Further analysis will help to further elucidate the potential impact, and inform recommendations.
Protracted conflict in CAR has led to widespread political unrest and fragile health systems. Hyperendemic malaria is the main cause of morbidity. Alongside global calls to prioritise malaria prevention during the COVID-19 pandemic, MSF initiated mass drug administration (MDA) for children aged between three months and 15 years within three communes of the Bossangoa health district between 17 August and 24 November 2020. The MDA comprised three cycles of dihydroartemisin-piperaquine (DHA-PQ), given at four-week intervals. We evaluated coverage and clinical impact of the MDA, and describe community perspectives.
METHODS
We conducted a two-stage cluster household survey between 22 November and 9 December 2020. We undertook structured interviews with the heads of households and with eligible children, focusing on participation in the MDA. Participation was verified against the MDA card, if available. Using routine MSF surveillance data, we compared the following indicators during the MDA intervention to the same periods of time during 2018 and 2019: consultations, confirmed malaria cases, and positivity rates of malaria rapid diagnostic tests (mRDT’s) in MSF facilities in the intervention area, overall and by age group (≥5; <5 years); hospital admissions and in-hospital deaths with a primary diagnosis of severe malaria among children <15 years from the MDA intervention area. Following each cycle we conducted nine focus groups discussions (FGD’s) with caregivers, community leaders, and community health workers (CHW’s) Participants were selected using purposive sampling. The topic guide inluded the key themes of reasons for participation, difficulties encountered, satisfaction, and experiences throughout the MDA.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the national ERB of CAR.
RESULTS
In total, we distributed 134,117 DHA-PQ courses. Among eligible children, 93.1% (95% confidence interval, CI, 85.6-96.8) received all three cycles. We estimated significant reductions only for confirmed outpatient malaria cases overall (9.2%; 95% CI 5.6-12.8), and among those aged <5 years (20.5%; 95% CI 15.3-25.8). Following the first MDA cycle, FGD participants described positive perceptions and high adherence with regard to MDA, linked with the involvement of community leaders. Participants reported reductions in childhood malaria, as well as reduced household expenditure on healthcare. Rumours about ‘drug trials’ and concerns about side effects were initial reasons for refusal, however these concerns were overcome after seeing the positive impact on participating children. Participants’ recommendations included continuing the programme and expanding eligibility.
CONCLUSION
This is one of the first such MDA’s in CAR; our experience demonstrates MDA is feasible in complex emergencies. Although preliminary analysis of routine surveillance data suggested a limited impact on malaria diagnoses, community acceptance was high. Of note, outpatient surveillance data was limited to three structures in only one commune, and not available for the specific target ages of the MDA. Participants noted positive perceptions of impact, with a desire for repeated MDA’s. Further analysis will help to further elucidate the potential impact, and inform recommendations.
Conference Material > Slide Presentation
Robinson E, van Braak F, Rose L, Yadenzi MS
MSF Scientific Days International 2021: Research. 2021 May 19
Journal Article > ResearchFull Text
Malar J. 2024 May 15; Volume 23 (Issue 1); 146.; DOI:10.1186/s12936-024-04968-1
Robinson E, Ouabo A, Rose L, van Braak F, Vyncke J, et al.
Malar J. 2024 May 15; Volume 23 (Issue 1); 146.; DOI:10.1186/s12936-024-04968-1
BACKGROUND
In 2020, during the COVID-19 pandemic, Médecins Sans Frontières (MSF) initiated three cycles of dihydroartemisin-piperaquine (DHA-PQ) mass drug administration (MDA) for children aged three months to 15 years within Bossangoa sub-prefecture, Central African Republic. Coverage, clinical impact, and community members perspectives were evaluated to inform the use of MDAs in humanitarian emergencies.
METHODS
A household survey was undertaken after the MDA focusing on participation, recent illness among eligible children, and household satisfaction. Using routine surveillance data, the reduction during the MDA period compared to the same period of preceding two years in consultations, malaria diagnoses, malaria rapid diagnostic test (RDT) positivity in three MSF community healthcare facilities (HFs), and the reduction in severe malaria admissions at the regional hospital were estimated. Twenty-seven focus groups discussions (FGDs) with community members were conducted.
RESULTS
Overall coverage based on the MDA card or verbal report was 94.3% (95% confidence interval (CI): 86.3–97.8%). Among participants of the household survey, 2.6% (95% CI 1.6–40.3%) of round 3 MDA participants experienced illness in the preceding four weeks compared to 30.6% (95% CI 22.1–40.8%) of MDA non-participants. One community HF experienced a 54.5% (95% CI 50.8–57.9) reduction in consultations, a 73.7% (95% CI 70.5–76.5) reduction in malaria diagnoses, and 42.9% (95% CI 36.0–49.0) reduction in the proportion of positive RDTs among children under five. A second community HF experienced an increase in consultations (+ 15.1% (− 23.3 to 7.5)) and stable malaria diagnoses (4.2% (3.9–11.6)). A third community HF experienced an increase in consultations (+ 41.1% (95% CI 51.2–31.8) and malaria diagnoses (+ 37.3% (95% CI 47.4–27.9)). There were a 25.2% (95% CI 2.0–42.8) reduction in hospital admissions with severe malaria among children under five from the MDA area. FGDs revealed community members perceived less illness among children because of the MDA, as well as fewer hospitalizations. Other indirect benefits such as reduced household expenditure on healthcare were also described.
CONCLUSION
The MDA achieved high coverage and community acceptance. While some positive health impact was observed, it was resource intensive, particularly in this rural context. The priority for malaria control in humanitarian contexts should remain diagnosis and treatment. MDA may be additional tool where the context supports its implementation.
In 2020, during the COVID-19 pandemic, Médecins Sans Frontières (MSF) initiated three cycles of dihydroartemisin-piperaquine (DHA-PQ) mass drug administration (MDA) for children aged three months to 15 years within Bossangoa sub-prefecture, Central African Republic. Coverage, clinical impact, and community members perspectives were evaluated to inform the use of MDAs in humanitarian emergencies.
METHODS
A household survey was undertaken after the MDA focusing on participation, recent illness among eligible children, and household satisfaction. Using routine surveillance data, the reduction during the MDA period compared to the same period of preceding two years in consultations, malaria diagnoses, malaria rapid diagnostic test (RDT) positivity in three MSF community healthcare facilities (HFs), and the reduction in severe malaria admissions at the regional hospital were estimated. Twenty-seven focus groups discussions (FGDs) with community members were conducted.
RESULTS
Overall coverage based on the MDA card or verbal report was 94.3% (95% confidence interval (CI): 86.3–97.8%). Among participants of the household survey, 2.6% (95% CI 1.6–40.3%) of round 3 MDA participants experienced illness in the preceding four weeks compared to 30.6% (95% CI 22.1–40.8%) of MDA non-participants. One community HF experienced a 54.5% (95% CI 50.8–57.9) reduction in consultations, a 73.7% (95% CI 70.5–76.5) reduction in malaria diagnoses, and 42.9% (95% CI 36.0–49.0) reduction in the proportion of positive RDTs among children under five. A second community HF experienced an increase in consultations (+ 15.1% (− 23.3 to 7.5)) and stable malaria diagnoses (4.2% (3.9–11.6)). A third community HF experienced an increase in consultations (+ 41.1% (95% CI 51.2–31.8) and malaria diagnoses (+ 37.3% (95% CI 47.4–27.9)). There were a 25.2% (95% CI 2.0–42.8) reduction in hospital admissions with severe malaria among children under five from the MDA area. FGDs revealed community members perceived less illness among children because of the MDA, as well as fewer hospitalizations. Other indirect benefits such as reduced household expenditure on healthcare were also described.
CONCLUSION
The MDA achieved high coverage and community acceptance. While some positive health impact was observed, it was resource intensive, particularly in this rural context. The priority for malaria control in humanitarian contexts should remain diagnosis and treatment. MDA may be additional tool where the context supports its implementation.
Journal Article > ResearchFull Text
Trop Med Int Health. 2022 January 3; Volume 27 (Issue 2); 207-215.; DOI:10.1111/tmi.13716
Mesic A, Ishaq S, Khan WH, Mureed A, Mar HT, et al.
Trop Med Int Health. 2022 January 3; Volume 27 (Issue 2); 207-215.; DOI:10.1111/tmi.13716
OBJECTIVES
To describe the effect of adaptations to a person-centred care with short oral regimens on retention in care for rifampicin-resistant TB (RR-TB) in Kandahar province, Afghanistan.
METHODS
The study included people with RR-TB registered in the programme between 01 October 2016 and 18 April 2021. From 19 November 2019, the programme implemented a trial investigating the safety and effectiveness of short oral RR-TB regimens. During the trial, person-centred care was adapted. We included the data from people living with RR-TB treated in the period before and after the care model was adapted and applied Kaplan-Meier statistics to compare rates of retention in care.
RESULTS
Of 236 patients registered in the RR-TB programme, 146 (61.9%) were registered before and 90 (38.1%) after the model of care was adapted. Before adaptations enhancing person-centred care, pre-treatment attrition was 23.3% (n = 34/146), whilst under the adapted care model it was 5.6% (n = 5/90). Attrition on treatment was 22.3% (n = 25/112) before adaptations, whilst during the study period none of the participants were lost-to-follow-up on treatment and 3.3% died (n = 3/90).
CONCLUSIONS
As person-centred care delivery and treatment regimens were adapted to better fit-specific contextual challenges and the needs of the target population, retention in care improved amongst people with RR-TB in Kandahar, Afghanistan.
To describe the effect of adaptations to a person-centred care with short oral regimens on retention in care for rifampicin-resistant TB (RR-TB) in Kandahar province, Afghanistan.
METHODS
The study included people with RR-TB registered in the programme between 01 October 2016 and 18 April 2021. From 19 November 2019, the programme implemented a trial investigating the safety and effectiveness of short oral RR-TB regimens. During the trial, person-centred care was adapted. We included the data from people living with RR-TB treated in the period before and after the care model was adapted and applied Kaplan-Meier statistics to compare rates of retention in care.
RESULTS
Of 236 patients registered in the RR-TB programme, 146 (61.9%) were registered before and 90 (38.1%) after the model of care was adapted. Before adaptations enhancing person-centred care, pre-treatment attrition was 23.3% (n = 34/146), whilst under the adapted care model it was 5.6% (n = 5/90). Attrition on treatment was 22.3% (n = 25/112) before adaptations, whilst during the study period none of the participants were lost-to-follow-up on treatment and 3.3% died (n = 3/90).
CONCLUSIONS
As person-centred care delivery and treatment regimens were adapted to better fit-specific contextual challenges and the needs of the target population, retention in care improved amongst people with RR-TB in Kandahar, Afghanistan.