Short-term Impact of Mass Drug Administration With Dihydroartemisinin Plus Piperaquine on Malaria in Southern Province Zambia: A Cluster-Randomized Controlled Trial

J Infect Dis. 2016 Dec 15;214(12):1831-1839. doi: 10.1093/infdis/jiw416.


Background: Mass drug administration (MDA) using dihydroartemisinin plus piperaquine (DHAp) represents a potential strategy to clear Plasmodium falciparum infections and reduce the human parasite reservoir.

Methods: A cluster-randomized controlled trial in Southern Province, Zambia, was used to assess the short-term impact of 2 rounds of community-wide MDA and household-level (focal) MDA with DHAp compared with no mass treatment. Study end points included parasite prevalence in children, infection incidence, and confirmed malaria case incidence.

Results: All end points significantly decreased after intervention, irrespective of treatment group. Parasite prevalence from 7.71% at baseline to 0.54% after MDA in lower-transmission areas, resulting in an 87% reduction compared with control (adjusted odds ratio, 0.13; 95% confidence interval, .02-.92; P = .04). No difference between treatment groups was observed in areas of high transmission. The 5-month cumulative infection incidence was 70% lower (crude incidence rate ratio, 0.30; 95% confidence interval, .06-1.49; P = .14) and 58% lower (0.42; .18-.98; P = .046) after MDA compared with control in lower- and higher-transmission areas, respectively. No significant impact of focal MDA was observed for any end point.

Conclusions: Two rounds of MDA with DHAp rapidly reduced infection prevalence, infection incidence, and confirmed case incidence rates, especially in low-transmission areas.

Clinical trials registration: NCT02329301.

Keywords: elimination; malaria; mass drug administration.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Antimalarials / administration & dosage*
  • Artemisinins / administration & dosage*
  • Chemoprevention / methods
  • Child, Preschool
  • Drug Therapy / methods
  • Family Characteristics
  • Female
  • Humans
  • Incidence
  • Infant
  • Malaria, Falciparum / drug therapy*
  • Malaria, Falciparum / epidemiology
  • Malaria, Falciparum / prevention & control*
  • Male
  • Prevalence
  • Quinolines / administration & dosage*
  • Treatment Outcome
  • Zambia / epidemiology


  • Antimalarials
  • Artemisinins
  • Quinolines
  • artenimol
  • piperaquine

Associated data