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Knowledge, attitudes, and practices (KAP) surveys on malaria and antimalarial mass drug administration (MDA) have not received much attention in the Union of the Comoros. This study is a household-based cross-sectional survey using a multi-stage sampling technique aiming at investigating KAP toward malaria and antimalarial MDA with artemisinin-piperaquine among heads of households on Grande Comore Island, the largest island of the Comoros. A predefined structured questionnaire containing socio-demographic characteristics and questions about malaria and antimalarial MDA was administered to 1,368 randomly selected heads of households from 10 malaria-endemic villages on Grande Comore Island. The results showed that 81.4% of the heads of households knew that malaria is a transmissible disease, 77.6% recognized mosquitoes as the vectors of malaria, and 70.8% recognized fever as one of the frequent symptoms of malaria; 40.8% of respondents remembered the name of the antimalarial drug used for MDA, and 62.1% remembered the color of the antimalarial tablets; and 65.1% chose to go to a public health center to seek treatment as their first option within 24 hr of the onset of initial malaria symptoms. This study found that most heads of households had a reasonable level of knowledge about malaria and antimalarial MDA. However, only 7.3% obtained full points on all knowledge-related questions. Misconceptions about malaria cause, transmission, diagnostic method, and antimalarial MDA exist in the community of Grande Comore Island. As the Comoros continues to put great efforts to go toward malaria elimination, the community's KAP on malaria and antimalarial MDA is crucial to guarantee the community's long-term adherence to malaria elimination interventions and could become key to guaranteeing malarial elimination in the Comoros. Therefore, there is a great need to improve malaria prevention awareness through strengthening malaria education and promoting behavioral change. Heads of households should be the core target of malaria education and behavioral change for malaria elimination.

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RESUMEN

Background: Mass drug administration (MDA) is a powerful tool for malaria control, but the medicines to use, dosing, number of rounds, and potential selection of drug resistance remain open questions. Methods: Two monthly rounds of artemisinin-piperaquine (AP), each comprising 2 daily doses, were administered across the 7 districts of Grande Comore Island. In 3 districts, low-dose primaquine (PMQLD) was also given on the first day of each monthly round. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and genetic markers of potential drug resistance were evaluated. Results: Average population coverages of 80%-82% were achieved with AP in 4 districts (registered population 258 986) and AP + PMQLD in 3 districts (83 696). The effectiveness of MDA was 96.27% (95% confidence interval [CI], 95.27%-97.06%; P < .00001) in the 4 AP districts and 97.46% (95% CI, 94.54%-98.82%; P < .00001) in the 3 AP + PMQLD districts. In comparative statistical modeling, the effectiveness of the 2 monthly rounds on Grande Comore Island was nearly as high as that of 3 monthly rounds of AP or AP + PMQLD in our earlier study on Anjouan Island. Surveys of pre-MDA and post-MDA samples showed no significant changes in PfK13 polymorphism rates, and no PfCRT mutations previously linked to piperaquine resistance in Southeast Asia were identified. Conclusions: MDA with 2 monthly rounds of 2 daily doses of AP was highly effective on Grande Comore Island. The feasibility and lower expense of this 2-month versus 3-month regimen of AP may offer advantages for MDA programs in appropriate settings.

RESUMEN

After decades of efforts, malaria is still a major public health problem in many countries, especially in sub-Saharan Africa. Mass drug administration (MDA) has been one of the interventions used to control malaria. China, the largest and most populous country in the world, has recently achieved malaria elimination with MDA within its strategy. Therefore, knowing the history of the use of MDA, and its advantages and challenges are crucial to better implement MDA as a component of malaria control and elimination strategy. This narrative review focused on the use of MDA from the past to present, the experiences of successful and failed MDA interventions to control malaria in Africa, Asia, and South Pacific region, the challenges faced, as well as China's experience in malaria control and elimination. A direct search using key words and phrases was conducted using the web search engines Google and Google Scholar, peer-reviewed journal websites and PubMed database to mainly screen articles on MDA studies with positive and negative results, the World Health Organization guidelines, and other MDA-related reports. We also summarized our historical field experiences on MDA in malaria control to provide informed perspective on the challenges of MDA. Following the spirit of innovation, a comprehensive strategy with MDA at its core and each additional measure compensating one another's shortage based on different malaria transmission settings and stratification could be the highlight of future malaria control and elimination strategy to help achieve the vision of a malaria-free world.

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