Table 1 Summary of MDA characteristics at both sites
Battambang | Preah Vihear | |
|---|---|---|
Sites | Four villages (two intervention villages in 2015 and two intervention villages in 2016). Total population 2366 | Eight intervention villages simultaneously Total population 7583 |
Site selection | Selected based on P. falciparum prevalence survey results and village malaria worker treatment records | Selected based on P. falciparum prevalence survey results and presence of K13 mutated parasites |
Anti-malarial | DHA–PPQ | DHA–PPQ |
Preparation period | Long (8 weeks, plus 4 weeks in the study villages): discussions on strategy and safety delayed the protocol approval and in effect increased preparation time | Short (about 6 weeks) Late approval of the protocol reduced the time available to plan the project, planned to be done in the dry season |
Drug administration procedure | Central. DOT by local health centre nurses (central village location in 2015; at a central location or house-to-house in 2016) | House to house. DOT ensured by teams going from house to house |
MDA schedule | Three doses over 3 days—at monthly intervals for 3 months. Post-MDA, weekly identification of newcomers, especially forest returnees. A single 3-day course of DHA–PPQ offered new arrivals 12 months following MDA | Three doses over 3 days—at monthly intervals for 3 months. Decision taken to halt after low participation, MDA stopped after round one |
Timing of MDA | July to September (early rainy season) 2015 in the first two villages and 2016 in the remaining two villages | March–April 2015 (pre-rainy season) |
Safety monitoring and follow-up | Direct solicitation of adverse events over 3 days of drug administration by local health centre nurses, and again on the 7th day by village volunteers to record and assist with any adverse events. 30 days of passive follow up | External medical teams (two MoH nurses/village—two MSF physician) present in villages during 3 days of DOT + 2 days later follow up adverse events. MSF nurses were also present 24 h per day in health facilities during intake 1-month post-MDA |
Informed consent | Community meetings and census used to explain study to each household head. Individual written signed consent | Community meetings to explain MDA. Verbal consent from community leaders and household heads. Written consent from individual participants |
Incentives | KHR 10000 (~ US$2.5) per round and participant for round 1 (none for rounds 2 and 3 in 2016) | None |
Other benefits | Free health service for minor conditions during MDA, provided by local health centre staff and supervised by a study physician | Healthcare was provided by an MSF nurse and MD in health facilities (additional to usual local staff). Transport was provided to referral facilities. Other medical costs were reimbursed until 1 month after intake |