Mass Drug Administration Strategies for Malaria Elimination

Mass drug administration (MDA) involves the provision of antimalarial treatment to entire populations or defined high-risk groups, irrespective of infection status, with the objective of interrupting transmission and depleting the human parasite reservoir. Approaches range from community-wide rounds of artemisinin-based combination therapies to targeted regimens such as primaquine campaigns against Plasmodium vivax hypnozoites. Variants include focal MDA in transmission hotspots, reactive drug administration in response to detected cases, and intermittent preventive treatment of vulnerable subpopulations. Success depends on high coverage, adherence, drug safety in glucose-6-phosphate dehydrogenase-deficient individuals, robust pharmacovigilance and integration with vector control measures. Operational challenges include community acceptance, logistical constraints in remote or mobile populations, and the emergence of drug resistance. Models indicate that when MDA is coupled with early diagnosis and treatment, and sustained by strong surveillance systems, it can accelerate the decline of malaria incidence even in low-transmission settings. Lessons learned from Greater Mekong Subregion pilot projects and African trials underscore the need for tailored strategies, comprehensive community engagement and coordination with existing health services to achieve subnational elimination and eventually global eradication.

Research from Nature Portfolio

A cross-sectional exploration of targeted mass primaquine treatment (TPT) in a vivax-endemic township of northern Myanmar identified key barriers to participation. Despite achieving 85% initial screening coverage, only half of eligible residents completed the full primaquine regimen, largely due to exclusion of individuals with glucose-6-phosphate dehydrogenase deficiency, occupational absences and limited awareness. Qualitative interviews revealed that mobile agricultural and mining workers were underrepresented, and concerns about side effects reduced uptake. The study recommends adapting inclusion criteria for vulnerable groups, expanding community sensitisation campaigns and strengthening local engagement to improve completion rates and support vivax elimination objectives.

Mass Drug Administration Strategies for Malaria Elimination publication trend

The graph below shows the total number of articles in mass drug administration strategies for malaria elimination across all publications each year (not limited to Nature Index journals).

Technical terms

Mass Drug Administration (MDA): Administration of antimalarial drugs to entire populations or groups regardless of infection status to interrupt transmission.

Targeted Mass Drug Administration (TDA): Focused MDA in specific hotspots or high-risk populations identified through surveillance.

Intermittent Preventive Treatment (IPT): Scheduled antimalarial administration to at-risk groups (e.g. pregnant women, forest goers) to prevent infection.

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency: A hereditary enzyme deficiency that increases risk of haemolysis with certain antimalarials, notably primaquine.

Artemisinin-Based Combination Therapy (ACT): The combination of fast-acting artemisinin derivatives with partner drugs to treat falciparum malaria and mitigate resistance.

Directly Observed Treatment (DOT): Supervised administration of medication by a health worker to ensure adherence and safety.

References

1. Factors hindering coverage of targeted mass treatment with primaquine in a malarious township of northern Myanmar in 2019–2020. Scientific Reports (2023).
2. Impact of targeted drug administration and intermittent preventive treatment for forest goers using artesunate–pyronaridine to control malaria outbreaks in Cambodia. Tropical Medicine and Health (2024).
3. Effectiveness, Safety, and Acceptability of Primaquine Mass Drug Administration in Low-Endemicity Areas in Southern Thailand: Proof-of-Concept Study. JMIR Public Health and Surveillance (2024).
4. Effect of generalised access to early diagnosis and treatment and targeted mass drug administration on Plasmodium falciparum malaria in Eastern Myanmar: an observational study of a regional elimination programme. The Lancet (2018).