For the past 15 years, Pilgrim Africa has been investigating effective control interventions for highly burdened communities, with a special focus on innovation in the combination of indoor residual spraying (IRS) and malaria mass drug administration (MDA), and different types of integrated community case management.
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Between 2016 and 2019, Pilgrim Africa conducted a community trial of IRS and MDA in 85 high transmission villages in Uganda. A dynamic cohort of ~50,000 people were assigned to receive either: MDA+IRS, IRS, or standard of care (SOC)
(bednets and case management). The odds of being found infected at long time points after MDA was administered were 80% lower among MDA+IRS recipients, an additional 15% protection over that conferred by IRS.
From 2019-2021, Pilgrim Africa conducted a large, controlled cluster randomized trial to compare the effects of (1) active community case management (ProCCM) with PBO nets designed to combat resistance (2) ordinary, integrated community case management (iCCM) with PBO nets after withdrawal of IRS. ProCCM was found to relieve outpatient burden at health facilities, but conferred no additional protection against infection than iCCM. At the end of the trial, malaria prevalence was the same in both groups, and matched that of a third group with iCCM and a mix of PBO and standard nets that did not have previous IRS.
After a district-wide pilot of MDA and IRS in 2008 conducted in partnership with the Uganda’s Ministry of Health emptied health wards of malaria patients, we wondered if MDA and IRS combined might have more effect than either intervention in isolation. Modeling showed that synchronous IRS and MDA have a cooperative, synergistic effect whose combined impact exceeds the additive impact of isolated campaigns, and grows with transmission intensity.
