PMID- 32797101
OWN - NLM
STAT- MEDLINE
DCOM- 20200924
LR  - 20200924
IS  - 1549-1676 (Electronic)
IS  - 1549-1277 (Print)
IS  - 1549-1277 (Linking)
VI  - 17
IP  - 8
DP  - 2020 Aug
TI  - A multiphase program for malaria elimination in southern Mozambique (the Magude 
      project): A before-after study.
PG  - e1003227
LID - 10.1371/journal.pmed.1003227 [doi]
LID - e1003227
AB  - BACKGROUND: Malaria eradication remains the long-term vision of the World Health 
      Organization (WHO). However, whether malaria elimination is feasible in areas of 
      stable transmission in sub-Saharan Africa with currently available tools remains 
      a subject of debate. This study aimed to evaluate a multiphased malaria 
      elimination project to interrupt Plasmodium falciparum malaria transmission in a 
      rural district of southern Mozambique. METHODS AND FINDINGS: A before-after study 
      was conducted between 2015 and 2018 in the district of Magude, with 48,448 
      residents living in 10,965 households. Building on an enhanced surveillance 
      system, two rounds of mass drug administrations (MDAs) per year over two years 
      (phase I, August 2015-2017), followed by one year of reactive focal mass drug 
      administrations (rfMDAs) (phase II, September 2017-June 2018) were deployed with 
      annual indoor residual spraying (IRS), programmatically distributed long-lasting 
      insecticidal nets (LLINs), and standard case management. The four MDA rounds 
      covered 58%-72% of the population, and annual IRS reported coverage was >70%. 
      Yearly parasite surveys and routine surveillance data were used to monitor the 
      primary outcomes of the study-malaria prevalence and incidence-at baseline and 
      annually since the onset of the project. Parasite prevalence by rapid diagnostic 
      test (RDT) declined from 9.1% (95% confidence interval [CI] 7.0-11.8) in May 2015 
      to 2.6% (95% CI 2.0-3.4), representing a 71.3% (95% CI 71.1-71.4, p < 0.001) 
      reduction after phase I, and to 1.4% (95% CI 0.9-2.2) after phase II. This 
      represented an 84.7% (95% CI 81.4-87.4, p < 0.001) overall reduction in all-age 
      prevalence. Case incidence fell from 195 to 75 cases per 1,000 during phase I 
      (61.5% reduction) and to 67 per 1,000 during phase II (65.6% overall reduction). 
      Interrupted time series (ITS) analysis was used to estimate the level and trend 
      change in malaria cases associated with the set of project interventions and the 
      number of cases averted. Phase I interventions were associated with a significant 
      immediate reduction in cases of 69.1% (95% CI 57.5-77.6, p < 0.001). Phase II 
      interventions were not associated with a level or trend change. An estimated 
      76.7% of expected cases were averted throughout the project (38,369 cases averted 
      of 50,005 expected). One malaria-associated inpatient death was observed during 
      the study period. There were 277 mild adverse events (AEs) recorded through the 
      passive pharmacovigilance system during the four MDA rounds. One serious adverse 
      event (SAE) that resulted in death was potentially related to the drug. The study 
      was limited by the incomplete coverage of interventions, the quality of the 
      routine and cross-sectional data collected, and the restricted accuracy of ITS 
      analysis with a short pre-intervention period. CONCLUSION: In this study, we 
      observed that the interventions deployed during the Magude project fell short of 
      interrupting P. falciparum transmission with the coverages achieved. While new 
      tools and strategies may be required to eventually achieve malaria elimination in 
      stable transmission areas of sub-Saharan Africa, this project showed that 
      innovative mixes of interventions can achieve large reductions in disease burden, 
      a necessary step in the pathway towards elimination. TRIAL REGISTRATION: 
      ClinicalTrials.gov NCT02914145.
FAU - Galatas, Beatriz
AU  - Galatas B
AUID- ORCID: 0000-0002-9546-6385
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Saute, Francisco
AU  - Saute F
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Marti-Soler, Helena
AU  - Marti-Soler H
AUID- ORCID: 0000-0002-7127-205X
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
FAU - Guinovart, Caterina
AU  - Guinovart C
AUID- ORCID: 0000-0001-8118-2026
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
FAU - Nhamussua, Lidia
AU  - Nhamussua L
AUID- ORCID: 0000-0003-4867-6301
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Simone, Wilson
AU  - Simone W
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Munguambe, Humberto
AU  - Munguambe H
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Hamido, Camilo
AU  - Hamido C
AUID- ORCID: 0000-0002-2219-5895
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Montana, Julia
AU  - Montana J
AUID- ORCID: 0000-0003-0454-0306
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Muguande, Olinda
AU  - Muguande O
AD  - Fundacao para o Desenvolvimento da Comunidade, Maputo, Mozambique.
FAU - Maartens, Francois
AU  - Maartens F
AD  - Good Bye Malaria, Johannesburg, South Africa.
FAU - Luis, Fabiao
AU  - Luis F
AUID- ORCID: 0000-0002-9972-2788
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Paaijmans, Krijn
AU  - Paaijmans K
AUID- ORCID: 0000-0003-4837-2818
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
AD  - School of Life Sciences, Center for Evolution and Medicine, Biodesign Center for 
      Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, United 
      States of America.
FAU - Mayor, Alfredo
AU  - Mayor A
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
AD  - CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
FAU - Bassat, Quique
AU  - Bassat Q
AUID- ORCID: 0000-0003-0875-7596
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
AD  - CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
AD  - ICREA, Pg. Lluis Companys 23, Barcelona, Spain.
FAU - Menendez, Clara
AU  - Menendez C
AUID- ORCID: 0000-0002-2641-6907
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
AD  - CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
FAU - Macete, Eusebio
AU  - Macete E
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
AD  - National Institute of Health, Ministry of Health, Maputo, Mozambique.
FAU - Rabinovich, Regina
AU  - Rabinovich R
AUID- ORCID: 0000-0003-1065-0173
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States 
      of America.
FAU - Alonso, Pedro L
AU  - Alonso PL
AD  - ISGlobal, Hospital Clinic-Universitat de Barcelona, Barcelona, Spain.
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
FAU - Candrinho, Baltazar
AU  - Candrinho B
AD  - National Malaria Control Program, Ministry of Health, Maputo, Mozambique.
FAU - Aide, Pedro
AU  - Aide P
AD  - Centro de Investigacao em Saude de Manhica, Maputo, Mozambique.
AD  - National Institute of Health, Ministry of Health, Maputo, Mozambique.
LA  - eng
SI  - ClinicalTrials.gov/NCT02914145
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20200814
PL  - United States
TA  - PLoS Med
JT  - PLoS medicine
JID - 101231360
RN  - 0 (Antimalarials)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antimalarials/*administration & dosage
MH  - Child
MH  - Child, Preschool
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Infection Control/*methods/trends
MH  - Malaria, Falciparum/epidemiology/*prevention & control/*transmission
MH  - Male
MH  - Middle Aged
MH  - Mosquito Control/*methods/trends
MH  - Mozambique
MH  - Young Adult
PMC - PMC7428052
COIS- The authors have declared that no competing interests exist. CM is a member of 
      the Editorial Board of PLOS Medicine.
EDAT- 2020/08/17 06:00
MHDA- 2020/09/25 06:00
PMCR- 2020/08/14
CRDT- 2020/08/16 06:00
PHST- 2020/02/25 00:00 [received]
PHST- 2020/07/17 00:00 [accepted]
PHST- 2020/08/16 06:00 [entrez]
PHST- 2020/08/17 06:00 [pubmed]
PHST- 2020/09/25 06:00 [medline]
PHST- 2020/08/14 00:00 [pmc-release]
AID - PMEDICINE-D-20-00604 [pii]
AID - 10.1371/journal.pmed.1003227 [doi]
PST - epublish
SO  - PLoS Med. 2020 Aug 14;17(8):e1003227. doi: 10.1371/journal.pmed.1003227. 
      eCollection 2020 Aug.