Malaria Journal
Volume 16, Issue 1, 2017

Intermittent preventive treatment for malaria among children in a refugee camp in Northern Uganda: lessons learned (Article) (Open Access)

Coldiron M.E.* , Lasry E. , Bouhenia M. , Das D. , Okui P. , Nyehangane D. , Mwanga J. , Langendorf C. , Elder G. , Salumu L. , Grais R.F.
  • a Epicentre, 8 Rue Saint-Sabin, Paris, France
  • b Médecins Sans Frontières, New York, United States
  • c Epicentre, 8 Rue Saint-Sabin, Paris, France
  • d Epicentre, 8 Rue Saint-Sabin, Paris, France
  • e National Malaria Control Programme, Ministry of Health, Kampala, Uganda
  • f Epicentre, Mbarara, Uganda
  • g Epicentre, Mbarara, Uganda
  • h Epicentre, 8 Rue Saint-Sabin, Paris, France
  • i Epicentre, 8 Rue Saint-Sabin, Paris, France
  • j Epicentre, 8 Rue Saint-Sabin, Paris, France
  • k Epicentre, 8 Rue Saint-Sabin, Paris, France

Abstract

Northern Uganda hosts a large population of refugees from South Sudan, and malaria is one of the major health problems in the area. In 2015, intermittent preventive treatment for malaria (IPTc) was implemented in two refugee camps among children aged 6 months to 14 years. Three distributions of dihydroartemisinin-piperaquine (DP) were conducted at 8-week intervals. The first dose was directly administered at IPTc distribution sites and the second and third doses were given to caregivers to administer at home. A multi-faceted evaluation was implemented, including coverage surveys, malaria prevalence surveys, reinforced surveillance, and pharmacovigilance. Programme coverage exceeded 90% during all three distributions with a total of 40,611 participants. Compared to same period during the previous year (only available data), the incidence of malaria in the target populations was reduced (IRR 0.73, 95% CI 0.69-0.77 among children under 5 years old; IRR 0.70, 95% CI 0.67-0.72 among children aged 5-14 years). Among those not targeted for intervention, the incidence between the 2 years increased (IRR 1.49, 95% CI 1.42-1.56). Cross-sectional surveys showed a prevalence of parasitaemia (microscopy or PCR) of 12.9-16.4% (95% CI 12.6-19.3) during the intervention, with the highest prevalence among children aged 5-14 years, but with a large increase 8 weeks after the final distribution. A total of 57 adverse events were reported during the intervention period, including one severe adverse event (death from varicella). Adverse events were of mild to moderate severity, and were mainly dermatologic and gastrointestinal. This is the first documentation of an IPTc programme in a refugee camp. The positive impact of DP on the incidence of malaria, together with its favourable safety profile, should lead to further use of IPTc in similar settings. Expanding coverage groups and decreasing intervals between distributions might provide more benefit, but would need to be balanced with the operational implications of a broader, more frequent distribution schedule. © 2017 The Author(s).

Author Keywords

South Sudan Anti-malarials Uganda Quinolines Malaria Artemisinin Refugee

Index Keywords

parasitology human Drug Combinations Malaria medication compliance dihydroartemisinin plus piperaquine Quinolines piperaquine dihydroartemisinin Uganda drug surveillance program Cross-Sectional Studies quinoline derivative health program cross-sectional study Humans Adolescent Antimalarials male antimalarial agent preschool child female Infant Child, Preschool refugee camp Refugee Camps polymerase chain reaction prevalence Incidence population research Article Parasitemia intervention study drug safety microscopy disease severity artemisinin derivative Artemisinins drug combination practice guideline documentation Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85019913833&doi=10.1186%2fs12936-017-1869-x&partnerID=40&md5=418fa3c818bbecfc87e20e8c8d97943d
DOI: 10.1186/s12936-017-1869-x
ISSN: 14752875
Cited by: 3
Original Language: English