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Mass drug administration
The administration of drugs to whole populations irrespective of disease status is referred to as mass drug administration (MDA).
This article describes the administration of antimalarial drugs to whole populations an intervention which has been used as a malaria-control measure for more than 70 years. Recent proposals to eliminate or even to eradicate malaria have led to a renewed interest in mass drug administrations in areas with very high malaria endemicity.〔Brian Greenwood The use of anti-malarial drugs to prevent malaria in the population of malaria endemic areas; ''Am. J. Trop. Med. Hyg.'' 70(1), pp1–7〕 Drugs have been administered either directly as a full therapeutic course of treatment or indirectly through the fortification of salt. Mass drug administrations were generally unsuccessful in interrupting transmission but, in some cases, had a marked effect on parasite prevalence and on the incidence of clinical malaria. MDAs are likely to encourage the spread of drug-resistant parasites and so have only a limited role in malaria control. They may have a part to play in the management of epidemics and in the control of malaria in areas with a very short transmission season. In order to reduce the risk of spreading drug resistance, MDAs should use more than one drug and, preferably include a drug, such as an artemisinin, which has an effect on gametocytes. MDAs have low acceptance in areas with low malaria endemicity.
Another example of mass drug administration is mass deworming of children to remove helminth infections (intestinal worms).
==Background and history==
Reports of attempts to control malaria through mass treatment with antimalarial drugs date back to at least 1932.〔Barber, M. et al. (1932) Malaria studies on the Firestone rubber plantation in Liberia, West Africa. Am J Hyg 15 (3), 601n = 1 fallacy633〕 In the 1950s, the WHO included mass drug administration (MDA) of antimalarial drugs as a tool for malaria eradication ‘in exceptional conditions when conventional control techniques have failed.〔WHO. (1951) Technical Report Series #38〕 In 1971, the WHO expert committee on malaria still recommended MDA in special circumstances.〔WHO. (1971) Technical Report Series #467〕 Subsequently, MDA was linked to the emergence of drug resistance and its overall benefit was questioned. Concomitantly, the goal of malaria eradication was replaced by one of prevention of malaria morbidity and mortality through the provision of effective treatment. Considering the short lasing benefit of mass drug administration one modification has been to repeat mass drug administrations which has led to the development of intermittent preventive therapy.
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