Conclusion
malaria
MALARIA
This trial showed that a significant protective impact of MDA was sustained for long times (5–7 months) after a treatment round, a surprising result in high transmission. The 2013 Cochrane review of MDA explicitly evaluated studies for sustained impact beyond 6 months, finding only a few low transmission trials that met this criterion [Limitations of this study include the fact that population-based interventions were assigned without blinding or randomization. Although qPCR prevalence in all three arms was similar at baseline in 2016, the MDA + IRS arm was arbitrarily assigned to the sub-county with the highest number of clinical cases in 2014 when the study was first conceived. Performing targeted sub-district level IRS had not been practiced in Uganda at the time, and bureaucratic reasons dictated early, clinically justified identification of the sub-counties receiving IRS. Due to prohibitive cost constraints in creating large-scale IRS clusters, and the concern of contamination through mosquito flight at smaller scales (for instance, at village level), a single large community intervention cluster (an entire subcounty, with 18–30 villages) was used for each arm. As equipoise precluded the establishment of a control arm without any malaria prevention in place, and also the use of MDA without IRS, it is not possible to separately distinguish the effect of ITNs vs no control or to evaluate the impact of MDA in the absence of IRS. Only the first dose of MDA was observed, with the second and third dose inferred from collection of empty blister packs. If compliance was imperfect, MDA coverage would be lower than assumed, which would reduce the additional impact of MDA. Intervention impact on prevalence, with one exception, was measured at timepoints 5–7 months from each of the four rounds of intervention; these measures are unable to provide a comprehensive window into the population response to the intervention at shorter intervening time periods.As previously reported, campaign-style all-ages MDA was both easy to implement [Many high burden countries after the pandemic are seeing large rises in case numbers. To continue to make global gains against malaria, it’s necessary to optimize and target tools for burden reduction in high transmission areas. Vector control is still the mainstay of prevention, but chemoprevention strategies are an important additional tool for burden reduction in high transmission settings, as noted by the new WHO conditional recommendation [