Community-based malaria mass drug administration in a moderate transmission setting in Ghana: Pilot randomise control trial

Abstract Asymptomatic malaria parasitaemia represents a major reservoir sustaining malaria transmission and contributes substantially to morbidity, particularly through anaemia in children. Community-based malaria mass drug administration (MDA) has been proposed as a strategy to accelerate progress toward malaria elimination and reduce disease burden. This study assessed the impact of repeated MDA on malaria parasitaemia, haemoglobin levels and anaemia in rural Ghana. We conducted an open-label, cluster-randomized trial in eight communities between July 2021 and March 2023. Four communities received nine rounds of MDA with artemether–lumefantrine administered every other month, while four communities served as controls and received no MDA. Cross-sectional surveys were conducted at baseline and endline to measure malaria parasite prevalence using rapid diagnostic tests in all participants and haemoglobin levels among children under 15 years. Adjusted prevalence ratios (aPR) were estimated using log-binomial regression models, controlling for baseline malaria prevalence and insecticide-treated net use, with analyses conducted for the overall population and stratified by age. At endline, malaria parasite prevalence was markedly lower in intervention communities (1.4%) compared with control communities (25.6%), corresponding to a 94% reduction in prevalence (aPR 0.06, 95% CI 0.03–0.11, p < 0.001). Age-stratified analyses showed a greater reduction among children aged 15 years or younger compared with individuals older than 15 years. Anaemia prevalence declined threefold in intervention communities, with children under 15 years showing significantly lower odds of all-cause anaemia, particularly among children under five years. Repeated rounds of MDA substantially reduced malaria parasite prevalence and improved anaemia outcomes. Further evaluation across diverse ecological zones in Ghana is warranted to inform malaria elimination policies.