Background
Methods
Inclusion criteria to assess eligibility for review: | |
1. All randomized and non-randomized studies of mass administration of anti-malarials, including cluster-randomized trials, non-randomized controlled studies and uncontrolled before-and-after studies that measured at least one outcome of interest in the target population | |
2. Additional: inclusion of secondary papers related to MDA | |
Exclusion criteria to assess eligibility for review: | |
1. Individually randomized studies | |
2. Studies in which the primary focus was not MDA (e.g. historical program reviews that merely made mention of MDA activities, community surveys done in conjunction with MDA) | |
3. Studies using an indirect approach to MDA, where anti-malarials are added to essential foodstuffs, usually dietary salt | |
4. Historical accounts of mass quinine distribution in the early 20th century | |
5. Studies targeting short-term residents of malaria endemic areas (e.g. military, laborers) | |
6. Studies written in languages other than English | |
7. All intermittent preventive treatment (IPT) studies (e.g. delivering treatment to infants and young children, treating malaria-related febrile illness, home based treatments and comparison of delivery methods; factors that would greatly bias the choice of participation) |
Author, year, country | Epidemiology (baseline parasitemia) | Study type and the context | Anti-malarial | Coverage/% | Additional interventions |
---|---|---|---|---|---|
Kingsbury 1931, Malaysia [58] | 28% (Malaria incidence had been high for many years in the rubber estate) | Non-RCT Plasmoquine was administered to all individuals living in rubber plantation and the control population was chosen from another rubber plantation estate. The population composed of labourers working in rubber industry and the considerable fluctuation of population was observed over the years | Plasmoquine | 97 | Larviciding |
Kligler 1931, Palestine [59] | 69.4% in children age 0–14 years old | Before and after study carried out in 5 villages adjacent to Huleh marsh | Plasmochine + quinine | 80 | NR |
Gribben 1933, Trinidad and Tobago [28] | NR (259 cases treated during October–December 1931; and 96 cases treated during July 1932 | Before and after study (compared malaria cases seeking treatment before MDA and after MDA) | Plasmoquine + quinine | 80 | Lake draining and oiling |
Henderson 1934, Sudan [29] | NR. Heavily infected village | Non-RCT. 160 members of an isolated community in Sudan (~1/2 of population) | Quinoplasmine + plasmoquine | 100 | Larviciding |
White 1934, India [60] | 55% | Non-RCT Children of age 0–10 years living in a railway settlement and an adjacent village were selected for both control and intervention | Euquinine, plasmochin | 94 | Larviciding |
Ray 1948, India [61] | 0.7% in adults to 35% in children | Before and after study conducted in tea estate in India | Paludrine | 75 | IRS |
Banerjea 1949, India [62] | 4.37% | Non-RCT. The study was conducted in rural west Bengal | Proguanil | 89 | NR |
Van Goor 1950(C), Indonesia [63] | 26 5–40% | Before and After study Different study arms examining the efficacy of monotherapy mainly with varying prophylactic doses of proguanil (a small subgroup was given chloroquine). The goal was to establish an optimal dosing regimen | Proguanil and chloroquine | 90 | NR |
Norman 1952, India [64] | NR | Descriptive The chemoprophylaxis in Assam Valley tea estate populations (laborers and their families) was conducted for 6 months. Half of the populations did not take the medicine as evidenced in their examined urine | Proguanil | 52 | NR |
Archibald 1956, Nigeria [65] | 48.7% (5–10 years) | Non-RCT Children with 5–10 years age group were selected for the chemotherapy | Pyrimethamine | 80 | NR |
Clyde 1958, Tanzania [66] | 82.6% | Before and after Labourers on tea estate in eastern Usumbara Mountains | Pyrimethamine | 82 | IRS |
Van Dijk 1958, Netherlands New Guinea (PNG) [67] | 11.2% | Before and after Inhabitants of 30 villages in Demta district | Chloroquine | 93 | IRS with DDT |
Afridi 1959, Pakistan [68] | NR | Non-RCT Population at villages near Daur river in Hazara district of west Pakistan | Pyrimethamine | 96 | NR |
Van Dijk 1961, Netherlands New Guinea (PNG) [69] | 17.5% | Before and after Inhabitants of Inanwatan. Area is unstable hyperendemic | Chloroquine | 97.2 | NR |
Metselaar 1961, Netherlands New Guinea [70] | 12–28% | Before and after The population lived near lake Sentani and were likely to sleep in garden houses | Chloroquine + pyrimethamine | 90 | IRS with DDT |
Ho 1965, China [71] | NR | Descriptive Mass screen and treat study | Chloroquine + primaquine, pyrimethamine + primaquine | 95 | ND |
Ossi 1967, Iraq [72] | NR Annual incidence of malaria cases 2221 | Before and after Chemoprophylaxis was conducted in Basrah city with the highest malaria incidence | Chloroquine + pyrimethamine | 57 5 | IRS with DDT |
Singh 1968, India [73] | 0.98 cases/1000/population/month | Before and after All people in 29 villages in Azamgarh but in subsequent rounds only targeted febrile cases, their contacts and housemates | Chloroquine, primaquine | 72.7 | IRS with DDT |
Lakshmanacharyulu 1968, India [74] | 56.3% | Before and after Labourers within a dam and canal project area previously not know to be malaria endemic | Chloroquine + pyrimethamine | 80 | IRS with DDT, larviciding |
Onori 1972, Syria [75] | Average monthly number of malaria cases: 46.6 | Before and After All individuals in Ghab Village | Chloroquine + pyrimethamine | 85 | IRS with DDT |
Najera 1973, Nigeria [76] | 19% | Non-RCT All villagers older than 3 months from Kankiya district in North Central State | Chloroquine + pyrimethamine | 85.9 | IRS with DDT |
Schliessmann 1973, Haiti [77] | 0.02/1000 population/month | Descriptive No details on drug or the regimen Population of 3 localities within Section Rurale I Varreux | NR | 40 | IRS with DDT |
Paik 1974a, British Soloman Islands [78] | 27.8% | Before and after study Only children aged 2–9 years of north coastal areas of Nggela island group | Chloroquine + pyrimethamine | 90 | IRS with DDT |
Paik 1974b, British Soloman Islands [78] | 18/1000 population/month | Before and after Study Population of Gilbertese settlements in western district. Sleeping outdoor is common here | Chloroquine + primaquine | 90 | NR |
Kondrashin 1985, India [79] | In 1980: Pv: 3.4/1000pop/month and Pf: 1.9/1000pop/month | Before and after Inhabitants of 8 PHC (Primary Health Centre) catchment area in five malaria endemic districts of Andhra Pradesh | Chloroquine + primaquine | 85 | IRS |
Strickland 1986, Pakistan [80] | 24.9% | Before and after All individuals above age 3 years. Suspected cases of malaria were treated with chloroquine and individuals with parasitemia were treated with Sulfadoxine and Pyrimethamine | Sulfadoxine, pyrimethamine | 67.3 | NR |
Hii 1987, Malaysia [81] | 46.3–55.6% | Before and after The intervention intended to determine the effects of impregnated bed nets. Improver and lack of use and damage to the bed nets and reluctance of the population to take the drugs were noticed | SP + primaquine | 81.6 | ITNs |
Babione 1996, Central America (multiple locations) [82] | NR | Descriptive Field test in El Salvador. Population and intervention not well described | Chloroquine + primaquine | 77.5 | IRS with DDT, larviciding |
Author, year and country | Epidemiology (baseline parasitemia) | Study type | Anti-malarial | Additional interventions |
---|---|---|---|---|
Butler 1943, South Pacific [36] | 12–16% | Before and after Study was largely a review of the Us Navy’s malaria control program implemented on an unspecified occupied island in the South Pacific. Natives of 2 villages were recruited into the study | Mepacrine | NR |
Berberian 1948a, Lebanon [26] | NR | Non-RCT All persons aged above 6 months of Saideh village | Chloroquine | NR |
Chaudhuri 1950a, India [83] | 50% | Non-RCT Only children were participants in the study | Proguanil | NR |
Edeson 1957, Malaysia [84] | 29% | Non-RCT All ages except infants. Inhabitants of rural rice growing area of Negri Sembilan state | Proguanil | NR |
Gabaldon 1959, Venezuela [39] | 0.24% | Before and after Population of eastern and western Venezuela. All persons aged >1 month | Pyrimethamine | IRS with DDT |
Clyde 1961a, Tanzania [32] | Morbidity rate: 76.1% Parasitemia in european children: 11.5% | Before and after Europeans living in Tanga | Quinine | Bed nets |
Charles 1962, Ghana [33] | 55.3% | Before and after All aged residents of Akrofu villages | Pyrimethamine | NR |
Sehgal 1968, India [37] | 1.8% | Before and after All individuals except the very sick, old and the pregnant women | NR | Irs with ddt |
Omer 1978, Sudan [85] | 40.5% | Non-RCT All residents of 4 villages in Gezira ecological area of Northern Sudan | Chloroquine | NR |
Maccormack 1983, Tanzania [47] | NR | Non-RCT The age range of the participants was 0–15 years | Chloroquine | NR |
Dapeng 1996, China [38] | 0.8/1000 population/month in 1984 | Before and after All residents within high incidence areas in 4 counties in Xinyang prefecture | Chloroquine + primaquine | Irs with ddt, itns |
Song 2010, Cambodia [43] | 2–50% | Before and after All residents above 1 year from 17 villages with parasite rates 20% or higher in Kampong Speu Province | Artemisinin + piperaquine + primaquine | NR |
Author, year and country | Epidemiology (baseline parasitemia) | Population coverage/% | Type of study and the context | Anti-malarial(s) | Additional interventions |
---|---|---|---|---|---|
Archibald 1960, Nigeria [45] | 48.7% | 89.7 | Non-RCT Inhabitants of villages in Western Sokoto malaria control campaign | Chloroquine + pyrimethamine | |
Clyde 1962, Tanzania [46] | 59.8–64% | 95 | Before and after Participants of all ages were recruited | Amodiaquine + primaquine | IRS with DDT |
Roberts 1964a, Kenya [40] | 23% | 95 | Non-RCT Participants of all ages were recruited and were from highlands in Kenya from 2 districts | Pyrimethamine | |
Garfield 1983, Nicaragua [27] | 0.42–0.83 cases/1000 population/month | 70 | Before and after (nationwide) Medicine was administered to all persons aged >1 year over 3 days given once to the entire population | Chloroquine + primaquine | |
Baukapur 1984, India [34] | 0.18/1000 population/month | 76 | Before and after All persons in 2 villages in Valsad District in Gujarat. Migratory population came from malarious areas during study period | Chloroquine | NR |
Pribadi 1986, Indonesia [31] | 13.2% | 93.7 | Before and after Mass chemoprophylaxis among all the individuals in Berakit village | Chloroquine | |
Doi 1989b, Indonesia [44] | 30% | 100 | Before and after All aged participants were treated | SP + primaquine | NR |
Kaneko 2000, Vanuatu [35] | 62% | 88.3 | Before and after MDA was conducted with all individuals in Aneityum islands | Chloroquine + primaquine + SP | |
Von Seidlein 2003, Gambia [42] | 41.6% | 85 | RCT/Cluster RCT Individuals older than 6 months and all non-pregnant women in 9 villages and placebo in other 9 villages | AS + SP | |
Shekalaghe 2011, Tanzania [12] | 0% by microscope and 2.6% by PCR | 93 | RCT/Cluster RCT Individuals above 1 year were included. People who had received ACTs in 2 weeks prior to the study, pregnant women and people with anaemia received different drug regimen. Four each intervention and control randomly assigned | AS + SP + primaquine | Vector control, larviciding |
Lwin 2015, Thai–Myanmar border [25] | 7.3% by microscopy and 18.4% by uPCR in one study village | 40 | Before and after Study population consisted of all the villagers excluding children <14 years and pregnant women in Thai–Myanmar border | Dihydro-artemesinin + peperaquine | NR |
Community engagement data extraction and analysis
Results
The nature of the reviewed articles
Author, year, country | Community engagement | Other relevant factors | |||
---|---|---|---|---|---|
Health education | Incentives | Community (health) structures | Human resource mobilization | ||
Butler 1943, South Pacific [36] | Bulletins, announcements, short talks and movies | NR | The medical officer provided direction and information dissemination | Local community members provided manual labor | Mild initial intolerance to the anti-malarial consisted mainly of nausea, vomiting and diarrhoea. Less than 1% of participants showed absolute intolerance, usually manifested by repeated vomiting |
Berberian 1948a, Lebanon [26] | NR | NR | Discussion with village head and elders were held and the study was started after their consensus | NR | Villagers were grateful and demanded for the anti-malarials to an extent that villagers in the control arm were also provided with the anti-malarials which reduced the people in control arm. The population was mobile. For instance, only 160 out of 200 were present in one of the village |
Chaudhuri 1950a, India [83] | NR | NR | Young men from the village established themselves to form an anti-malarial society and were affiliated to central anti-malarial society | A local man worked as a volunteer to visit door to door of the villagers. A filed assistant was appointed for drug distribution | Some villagers migrated out of the village because of the perennial fear of malaria. Within the village, some villagers were reluctant to swallow the tablets in front of the study staff and preferred to keep it to take later. Adverse events such as vomiting affected others from taking them. There were propaganda about the ill-effects of the medicine which was eventually resolved |
Edeson 1957, Malaysia [84] | NR | NR | In each valley, committees were formed to serve as channels through which villagers were informed about the blood surveys or house spraying and villagers could express their views to the committee as well | Village volunteer was responsible for drug distribution | Even though medicine were distributed by a volunteer, there was no actual supervision of participants taking antimalarial) |
Gabaldon 1959, Venezuela [39] | NR | Incentives (lottery tickets) were provided for those completing MDA. A bonus incentive was given to MDA distributors if their sector was found malaria free | Nurses at local dispensaries coordinated with the study in keeping the record of any cases of malaria and preparing the slides | Involvement of rural visitors as staff (two types: drug dispensers and blood slide makers/collectors) who were supervised by inspectors and sub-inspectors A local doctor was engaged in conversation with few villagers who were reluctant to take the medicine | There were relapses observed in the groups of 5–14 years and 15 years or more after the completion of MDA. These groups took less than designated 18 treatments. This was attributed to the greater mobility, consequently, it was difficult to find them at their houses |
Clyde 1961a, Tanzania [32] | Articles for general public were written in 2 local newspapers | NR | German Hospitals as health structures were already present | The medical facilities and treatment was initiated by German health workers and in the established hospitals by Germans | Government’s consensus was sought for the initiation of Malaria control program in Tanga (research site) |
Charles 1962, Ghana [33] | Weekly health education class was conducted. Residents were also prepared by preliminary educational propaganda | NR | The trial formed part of the pilot malaria eradication project supported by Ghana government, WHO and UNICEF | Anti-malarial distribution was delegated to the formed team consisting of 2 volunteers who were selected from representative clans of the community | The study town had successfully participated in previous community development projects and the community was deemed to be cooperative. However, reluctance to take the medicine was noticed particularly in children and some informed that the tablets were sold or shared with other villagers |
Sehgal 1968, India [37] | Health education through audio-visual aids and using local literature (language). Intimate and personal persuasion was applied for resisting tribal population | Incentives were paid as an advance for building houses | Central to community level health structures and social structures were utilized which included additional staffs recruitment at various positions | Augmentation of staffs were done in existing positions. In addition, lower qualified community members were recruited for the work | Geographical inaccessibility was a major barrier for the malaria control program. Reluctance of staffs to work and reluctance of tribal population to the intervention were major barriers which were subsequently resolved |
Omer 1978, Sudan [85] | NR | NR | Ministry of Health was involved in providing the technicians for the check-up of blood slides. Local health structure such as public health office, local school and youth organizations were directly involved | A school teacher was asked to supervise who was under resident public health officer supervising the operation. 2 or 3 people, generally from the youth organization, helped the night before and in the morning to encourage people to participate | The people in the village were cooperative and appreciated the medical services rendered to them during the previous survey. The purpose of the chemoprophylaxis was explained to them (but no details on how was it conducted) and they volunteered to cooperate |
MacCormack 1983, Tanzania [47] | Health education through meetings was delivered in tier approach to key community persons who in turn educated families | NR | Anti-malarial supplied by WHO, government committed to the Malaria control plan and health structures present at the rural site coordinated with the project | The direction and operation of the project was taken care by the medical director of the hospital in the study area. Officials and staffs at local hospital were involved | As many as 28% of children complained of vomiting and 56% complained of itching, and other unfavourable qualities of chloroquines were indicated for the reluctance to adhere to the medicine |
Dapeng 1996, China [38] | Before introducing the malaria control program in the community, health education through the primary health care system, by means of meetings, films, posters, and videos were conducted thus encouraging villagers to participate | NR | Malaria control program was carried out through the existing primary health care system already in place | Additional experts from the provincial and central level were involved in field research, guidance and evaluation. Village doctors were responsible for the chemoprophylaxis and the clinical care of the patients | The control program involving malaria treatment and chemoprophylaxis was less successful than the vector control. Bed net impregnation was more accepted in the community than DDT spraying as it killed flea, lice and bedbugs as well |
Song 2010, Cambodia [43] | Village leaders cooperated in educating the general (study) population | NR | Local health workers from the community and volunteers from the village were involved in the study | Village malaria workers were recruited to distribute drugs and monitor drug administration | The anti-malarial were redistributed in 4 of the study villages because of the lack of anticipated reduction in malaria. Improper distribution and inadequate training of VMWs were attributed for the lack of reduction and some VMWs were subsequently replaced |
Author, year, country | Health education | Incentives | Community (health) structures | Human resource mobilization | Other relevant factors |
---|---|---|---|---|---|
Archibald 1960, Nigeria [45] | NR | NR | Cooperation was sought with the village authorities (local native authority and the Emir in Council of 3 study village). The purpose of the study was explained to local councils and meetings were conducted with the family heads | The drug administration was carried out by authorities in-charge and staff (medical officer, the superintendent of rural health and the health sister) at the local health care centre The local drug distribution team consisted a team leader, a female community attendant, a native authority representative from each ward and the locally recruited labourer | The acceptance of the small tasteless tablet of pyrimethamine was far better than the chloroquine which was often vomited by toddlers. The bitter taste, big size and the number of chloroquine tablets all were disadvantage for the administration |
Clyde 1962, Tanzania [46] | Information dissemination through health education sessions and demonstration of the advantage of the project | NR | Cooperation of the public was achieved through involvement of community leaders. Community leaders were sought for any raised problems and various reasons for defaulters | A medical worker paid visits for treatment on a personal basis to everyone in the study site. Persistent follow up of defaulters was carried out | Authors attributed the success to correct approach to the villagers through the community leaders and promotion of awareness through health education and demonstration of the advantages of the project |
Roberts 1964a, Kenya [40] | NR | NR | A joint collaboration with Ministry of Health of Kenya, WHO and UNICEF. Malaria control was handed over to the district health office (medical officer). Propaganda was introduced about the study, meetings were held with the inhabitants such as at trading centers, dispensaries and schools. A concerted program was organized to inform all the population about the objective of the campaign | The advisory capacity was provided from the medical headquarters and ministry of health. The daily operation of the project was carried out by the district health inspector School masters and agricultural scouts were involved as monitors and guides. 100 men were selected, trained and recruited on the work | A joint collaboration and successfully devolved the responsibilities to host government and local structures |
Garfield, 1983, Nicaragua [27] | Literacy follow up classes, health promotion activities were conjoint work with other diseases too | NR | Malaria control program in Nicaragua was one of a series of national health campaign | 70,000 anti-malaria volunteers trained to conduct a census, provide door to door education about malaria, promote community participation, package and distribute drugs and keep records. In addition, about 10% of the country’s total population was estimated to have taken part in promotional activities | Apart from the coverage of 70% of the whole population, the other benefits were the value of national level census, the long term impact of modifications in malaria control strategies based on campaign results, and the impact of increased citizen awareness on case finding and malaria control efforts |
Baukapur 1984, India [34] | Health education was carried out at different levels. Community health volunteers played a major role in increasing the awareness in the community | NR | The local health structure and additional health personnel and resources from district headquarters were utilized in this program | Trained microscopists, leave reserve staffs, community health volunteers, malaria staffs from the district headquarter to local structures were involved in the malaria control program | The study utilized both local and district level health staffs in both technical and non-technical works (health education) related to the malaria control work |
Pribadi 1986, Indonesia [31] | A comprehensible learning module for the community was prepared to provide the health education. Health education to children were also provided by the village teachers (cadres) | NR | The regular monthly meetings of the cadres and the periodical meetings with the health centre officer was conducted concerning the cases of malaria. The health centre and the sub-health centre both were provided with a paramedic who was trained at blood slide preparation and treatment | Nine key persons from the sub village, consisting of school-teachers, heads of the RT’s and active young people were selected (cadres/facilitators) who were chosen by villagers co-ordinated by village heads. The cadres were trained on malaria signs and symptoms and treatment. The volunteers/cadres were appointed to distribute the learning module to each house in the village | Adverse events were reported from some villagers and discussions were held to counteract the misunderstandings and were treated at local health center |
Doi 1989b, Indonesia [44] | NR | NR | Malaria control was one of the activities among other community health activities. A local school teacher, health center staffs and village volunteers were involved in the implementation of the project | Part of a national initiative. A health center staff was responsible for testing the blood samples, examination of spleen and similarly, two community health volunteers were responsible for recorders and guides | The project operated under the national initiative and the size of the project within the national initiative was proportionately small |
Kaneko 2000, Vanuatu [35] | Aggressive health education were conducted and were attributed for the sustained compliance with the bed net programme. Information dissemination on MDA medicine through meetings were conducted after the incidence of adverse events | NR | The district malaria supervisor and the staff of the central malaria section directed the local malaria intervention activities. Several meetings with community were conducted to explain the purpose and the objective of the MDA. | 12 village volunteers were selected and trained as MDA staff and were responsible for drug administration. One village volunteer was selected by the local health committee for the training of malaria microscopy. Thus trained community microscopist and registered nurse cooperated to guard against the future introduction of malaria | The adverse event such as vomiting and the number of tablets decreased compliance. The meeting was held to answer their questions and additional information was provided to the villagers. In addition, Chloroquine was removed from the regimen after 4th round |
Von Seidlein 2003, Gambia [42] | NR | NR | Discussion and co-operation with national and district level, members of the government district health team was sought Meetings were conducted in villages in the presence of national and district level government officials to explain the objective and methods of study and in addition, questions were answered during the meetings Village elders were engaged in the meetings to discuss about participation at the MDA. The consent of participation was given by the village head | A translator and fieldworker was appointed for consent process with the participants during drug administration. Similarly, two health center staff recorded the visits of individuals living in the study village | Because of likely human and mosquito movement between villages, apart from 9 each intervention and placebo-controlled villages, 24 other neighbouring villages were treated which were not included in the study |
Shekalaghe 2011, Tanzania [12] | NR | NR | Meetings were conducted in all villages and the study was explained to all village leaders and local ten-cell leaders (balozi). A stepwise consent process was applied. At first, the verbal approval was obtained from these local leaders. Verbal household consent was sought after explaining about the study at their household. Three health facilities in the study area were involved in passive case detection The concept of asymptomatic malaria and the benefits of participation was discussed during community meetings | Seven study teams consisting of one medically trained individual (medical doctor or medical officer) and 1 or 2 field workers were responsible for consenting, screening participants for the safety and administering drugs All balozis were involved in the monitoring of movement of people in the study area. The approach to give local leaders a central role in explaining the study purposes, drug administration and monitoring migration were considered to influence the community participation | Each household received a household ID card and were entitled to free health care at the local health centers Number of tablets (24 tablets/3 days; 7/day for 2 days and 10 for 3rd day) were complained as burdensome by some participants A symptom diary was provided to the parents for their children, where they were asked to record the daily occurrence of fever, headache and body pains |
Lwin 2015, Thai-Myanmar border [25] | NR | NR | The cross-sectional survey results were discussed with the communities and different containment strategies were discussed. Chemoprophylaxis was endorsed by the residents of the village. Community leaders and key workers were consulted about the project, and approval was obtained from the Tak Province Community Ethics Advisory Board (T-CAB). The T-CAB consists of representatives from both the local ethnic Karen and Burman border communities which has been the primary ethics review body for health care interventions along the border for past 6 years | Village malaria workers were trained in detection and treatment | Community participation was low mainly because of difficult access to the communities, which resulted from the terrain and political instability |