Mass drug hand-out curbed Liberian malaria

Almost 15,000 people dodged malaria while Ebola devastated West Africa in 2014, thanks to preventative drugs on an enormous scale doled out by Médecins Sans Frontières.

The life-saving treatments targeted a 10th of Liberia’s population and saw the number of malaria cases plummet – even though most people didn’t take their medication.

The analysis, published in PLOS One by an international team, shows large-scale drug treatments are promising ways to fight malaria.

Malaria is curable and preventable – if suitable healthcare can be accessed. Almost half the world’s population is at risk of the disease, but according to the World Health Organisation, 90% of malaria deaths last year were in Sub-Saharan Africa.

To complicate matters, malaria is often impossible to distinguish from Ebola without taking a blood sample to a laboratory. They share symptoms, such as high fever.

So when the Ebola outbreak hit West Africa in 2014, malaria cases were misdiagnosed. Some people with malaria were put in the same hospitals as those with Ebola, dangerously exposing them to the virus and overcrowding hospitals.

This is when Médecins Sans Frontières stepped in.

From October to December 2014, they distributed vouchers entitling two rounds of the malaria medication to hundreds of thousands of people in Liberia’s capital city Monrovia. All in all, 1,259,699 courses were given out.

The medication called ASAQ (artesunate/amodiaquine) is a standard treatment for uncomplicated malaria. It’s been widely used since 2003.

“With malaria, we were certainly concerned about any intervention that may lead to drug resistance,” says study co-author Amanda Tiffany, an epidemiologist from Epicentre in Geneva, Switzerland.

“In this case, however, ASAQ has been shown to be a very safe drug and was already well known by the community as it is the first-line malaria treatment in Liberia.”

And it worked: self-reported fever dropped from 4.2% to 1.5% in only a month. In other words, the mass drug administration meant 14,821 fewer fever episodes in Monrovia.

To top it off, mathematical modelling in early 2015 suggested that in future, if three rounds of the malaria prevention drugs were given to 70% of Liberia’s population, as many as 700,000 malaria cases could be avoided.

The scientists write in this instance, though, the drugs weren’t always taken correctly. The majority of participants, if they felt healthy, held on to the drugs in case of any future malaria episodes rather than taking them as a preventative measure.

And they note that for better results, mass drug administrations should be coupled with adequate healthcare and long-term interventions.

So why haven’t malaria preventative treatments been distributed on this scale before?

Tiffany says complicated logistics were the main problem. A massive portion of the community had to stop what they were doing to take part in education sessions which were part of the campaign.

“For malaria, in particular, such campaigns are still novel and challenging as they involve the distribution of medication to predominately healthy people that is to be taken, unsupervised, over three days,” Tiffany says.

And, she adds, mass drug distribution isn’t always the right intervention for every context.