A study published in the Malaria Journal last week suggests that to combat malaria, the outmoded approach of mass anti-malarial drug administration may be effective, but only if local community leaders play a prominent role.
Mass anti-malarial drug administration (MDA) consists of medicating all individuals in a community regardless of whether they are infected to interrupt the transmission of the disease as opposed to the conventional approach of only medicating those infected.
The study monitored villages in Battambang’s Samlot district as they received treatment in phases over several months for the deadly plasmodium falciparum parasite.
The authors argue that many dropped out due to a lack of trust in those administering the drugs, and blamed continued sickness on the medication’s purported side-effects. They suggest the problem can be addressed by engaging community leaders.
“An approach to community engagement, which involved community members taking prominent roles and prioritzing a single simple message seemingly had a positive impact on coverage,” they write.
For Didier Menard, the head of the Malaria Molecular Epidemiology Unit at the Pasteur Institute in Cambodia, the pros and cons of MDA require more research before it can be adopted as a strategy.
“People doing [MDA] in Southeast Asia never gave evidence as to the effectiveness,” he said, adding that it may even spur more resistance.
“By using more and more drugs, there will be more and more resistance in the villages,” he said. According to experts, MDA has been linked to the rise of resistance to the anti-malarial drug chloraquine in the 1950s and ’60s.
Menard said for MDA to eliminate malaria it would require a detailed strategy – which he said does not exist at the moment. “For example, how do you want to reach all villages in Cambodia?”
He also said that reasons for dropouts were multifaceted and partially based on culture. “It seems very difficult to get the villagers to adhere [to the programme] . . . We need to have more anthropological data on how to improve it,” he said.
Pasteur researcher Khim Nimol agreed that fighting malaria could only be effective with the help of local leaders.
“They know the people [in the village], their families, and it’s easier to contact them,” she said. But “we have to train them on how to treat and prevent”, she said something that would require extensive resources.
Ministry of Health spokesman Ly Sovann directed questions to Huy Rekol, director of the National Center for Malaria, who could not be reached yesterday.
According to the CNM, over 23,000 cases of malaria were reported in Cambodia last year. The Ministry aims to eliminate plasmodium falciparum malaria by 2030.