title: Mass testing and treatment for malaria in low transmission areas in Amhara Region, Ethiopia.
abstract: In areas with ongoing malaria transmission, strategies to clear parasites from populations can reduce infection and transmission. The objective of this paper was to describe a malaria mass testing and treatment (MTAT) intervention implemented in six kebeles (villages) in Amhara Region, Ethiopia, at the beginning of the 2014 transmission season.
  
  
  
  Intervention kebeles were selected based on incidence of passively detected Plasmodium falciparum and mixed (P. falciparum and P. vivax) malaria cases during the 2013 malaria transmission season. All households in intervention kebeles were targeted; consenting residents received a rapid diagnostic test (RDT) and RDT-positive individuals received artemether-lumefantrine for P. falciparum/mixed infections or chloroquine for P. vivax. Data were collected on MTAT participation, sociodemographic characteristics, malaria risk factors, and RDT positivity.
  
  
  
  Of 9162 households targeted, 7974 (87.0 %) participated in the MTAT. Among the 35,389 residents of these households, 30,712 (86.8 %) received an RDT. RDT-positivity was 1.4 % (0.3 % P. vivax, 0.7 % P. falciparum, 0.3 % mixed), ranging from 0.3 to 5.1 % by kebele; 39.4 % of RDT-positive individuals were febrile, 28.5 % resided in the same household with another RDT-positive individual, 23.0 % were not protected by vector control interventions [mosquito net or indoor residual spray (IRS)], and 7.1 % had travel history. For individuals under 10 years of age, the odds of being RDT-positive was significantly higher for those with fever, recent use of anti-malarial drugs or residing in the same household with another RDT-positive individual; 59.0 % of RDT-positive individuals had at least one of these risk factors. For individuals 10 years of age and older, the odds of being RDT positive was significantly higher for those with reported travel, fever, recent use of anti-malarial drugs, no use of vector control, and those residing in the same household as another RDT-positive individual; 71.2 % of RDT-positive individuals had at least one of these risk factors.
  
  
  
  In the Ethiopia setting, an MTAT intervention is operationally feasible and can be conducted with high coverage. RDT-positivity is low and varies widely by kebele. While several risk factors are significantly associated with RDT-positivity, there are still many RDT-positive individuals who do not have any of these risk factors. Strategies that target populations for testing and treatment based on these risk factors alone are likely to leave many infections undetected.
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA.
authors.forename: Callie A
authors.initials: CA
authors.lastname: Scott
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Asnakew K
authors.initials: AK
authors.lastname: Yeshiwondim
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Belendia
authors.initials: B
authors.lastname: Serda
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA. cguinovart@path.org.
authors.forename: Caterina
authors.initials: C
authors.lastname: Guinovart
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Berhane H
authors.initials: BH
authors.lastname: Tesfay
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Adem
authors.initials: A
authors.lastname: Agmas
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Melkamu T
authors.initials: MT
authors.lastname: Zeleke
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Girma S
authors.initials: GS
authors.lastname: Guesses
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Asmamaw L
authors.initials: AL
authors.lastname: Ayenew
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Worku M
authors.initials: WM
authors.lastname: Workie
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), 2201 Westlake Avenue, Suite 200, Seattle, WA, 98121, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Steketee
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Stand #16806, Trinity Park, Alick Nkhata Road, Mass Media Area, Lusaka, 10101, Zambia.
authors.forename: Duncan
authors.initials: D
authors.lastname: Earle
authors.affiliation: Amhara National Regional State Health Bureau, P.O. Box 495, Bahir Dar, Ethiopia.
authors.forename: Belay
authors.initials: B
authors.lastname: Bezabih
authors.affiliation: PATH Malaria Control and Elimination Partnership in Africa (MACEPA), Getu Commercial Center, Rear Side, 1st-4th Floors, PO Box 493, 1110, Addis Ababa, Ethiopia.
authors.forename: Asefaw
authors.initials: A
authors.lastname: Getachew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000175:diagnosis* / Q000188:drug therapy; D004338:Drug Combinations; D004358:Drug Therapy / Q000379:methods*; D004983:Ethanolamines / Q000008:administration & dosage*; D005002:Ethiopia; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy; D016780:Malaria, Vivax / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes
keywords: Ethiopia; Malaria; Mass test and treat; Plasmodium falciparum; Plasmodium vivax