Repeated cross-sectional population-based surveys, routine malaria data analysis and entomological surveillance to estimate key malaria outcomes after malaria interventions (mass drug administration and indoor residual spraying) in Angumu health zone, Ituri Province, Democratic Republic of Congo

Principal investigator

Lise Grout

Location

Congo (Democratic Republic of the)
Topic

Malaria
Methodology

Observational study
Reference

OCG026-05
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Study status

Concept
Protocol & ERB
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Archived

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Purpose of study

The last retrospective mortality survey in Angumu conducted in March 2021 showed that the crude and under-five mortality rates was still above the emergency threshold before the MDA, despite of the active support of MSF in the zone since 2019. It also showed a big decrease of the U5MR and malaria-specific mortality in MDA locations during and right after the three rounds of MDA. However, the study conducted in March 2021 did not allow to assess the longer-term effect of the MDA on mortality in the population. This study will therefore allow us to estimate the effect on mortality over the year following the 3 rounds of MDA conducted in 2020. Moreover, the MDA conducted in 2020 used ASAQ for two rounds, which is the first line treatment for malaria in DRC. The National programme for malaria control (PNLP) therefore requested MSF not to use ASAQ in subsequent MDAs. For the MDA in 2022, DHAP and pyramax will be used. There is a need to assess the short and longer-term effect of the MDAs conducted with these drugs. Additionally, this time the MDA will be conducted in conjunction with IRS. IRS will also be conducted (without MDA) in 5 additional HAs. And 4 HAs will receive neither MDA nor IRS (but will continue receiving MSF support for test and treat in the SSCs and health centers). There is therefore a need to document and assess the short and longer-term effect of combining MDA and IRS. Finally, the support of MSF in some health areas in the zone makes it difficult to use routine data reported to the MoH or to MSF to estimate the prevalence malaria in the different health areas and determine whether there are some health areas with higher prevalence. It appears important for the continuation of MSF activities in relation with malaria in the zone to have a more objective estimation of malaria prevalence in the different health areas. Estimating the burden of typhoid infection is challenging. Blood culture, the gold standard for both diagnosis and surveillance, requires microbiological laboratory facilities that are not available in Angumu, leading to under-detection of the true burden of disease. This is exacerbated by low estimated diagnostic sensitivity of just 60%. New advances in typhoid detection show enormous potential to address this problem. Hemolysin E (HlyE), a pore-forming toxin, is a sensitive and specific serologic marker for diagnosing typhoidal Salmonella, and new serologic and analytic tools enable measurement of population-level enteric fever incidence from cross-sectional serosurveys using HlyE IgG and IgA. However, the analytical techniques used are highly specialized, and currently can only be performed by the research team at Massachusetts General Hospital (Boston, MA, USA) who developed the methods.