1. Implementation of seasonal malaria chemoprevention was associated with reductions in malaria cases and deaths during high transmission periods.
2. Seasonal malaria chemoprevention for children in the sub-Sahel regions of Africa demonstrated an overall cost of $3.63 USD per child.
Evidence Rating Level: 2 (Good)
Study Rundown: The sub-Sahel region of Africa, which ranges from southern Senegal to northern Cameroon, is heavily burdened by a high rate of morbidity and mortality from malaria. Seasonal malaria chemoprevention (SMC), using sulfadoxine-pyrimethamine and amodiaquine, has been proven in many studies to be effective at combatting the disease. The Achieving Catalytic Expansion of SMC in the Sahel (ACCESS-SMC) project sought to implement SMC on a larger scale across seven countries in the sub-Sahel region. This observational study focused on evaluating the feasibility and effectiveness of delivering SMC to children in these areas during high transmission seasons in 2015 and 2016. Overall, SMC proved to be highly effective at reducing the incidence and mortality of malaria. Adverse events were minimal, with all children recovering from the few serious events that had occurred. SMC was also cost-effective, with an estimated average cost for four cycles of SMC ranging from $2.91USD to $30.73 USD per child, depending on the region. An important limitation of this study is the lack of complete control over reports. For example, although few serious adverse events occurred, it is possible any number of them were not reported. Likewise, although researchers used community outreach to deliver doses of SMC door-to-door, not all doses administered were supervised, potentially skewing results if some were not taken. Nonetheless, this is a strong study with convincing results for the efficacy of SMC and lends support to the possibility of upscaling to further regions afflicted by malaria.
In-Depth [prospective cohort]: This observational study evaluated the effectiveness, safety, cost, and impact of SMC on malarial incidence and mortality in children younger than 5 years. Treatment consisted of co-blister packs of sulfadoxine-pyrimethamine and amodiaquine (SP+AQ). Overall, in Burkina Faso, Chad, The Gambia, Guinea, Mali, Niger, and Nigeria, 3 650 455 children received 12 467 933 monthly SMC treatments in 2015 and 7 551 491 children received 25 117 480 SMC monthly treatments in 2016. SMC treatments were administered over four monthly cycles by community health workers. Overall, 54.5% (95% confidence interval [CI] 50.4-58.7) of children received all four treatments and 86.4% (95% CI 83.4-89.3) received at least one treatment in 2015. In 2016, 53.0% (95% CI 48.5-57.4) received all four treatments and 91.7% (95% CI 89.3-94.2) received at least one treatment. The pooled estimated effectiveness of SMC in reducing the incidence of malaria was 88.2% (95% CI 78.7-93.4) within 28 days of treatment and 61.4% (95% CI 47.4-71.8) 29-42 days post treatment. Reported adherence to the regime ranged from 86.8% (95% CI 81.7-90.7) to 99.8% (95 CI 99.0-99.9), depending on the region. A total of 779 safety reports directly related to SMC were reported, of which 36 were serious, including rash, fevers, gastrointestinal disorders and Quincke’s edema; all children recovered from these events and no severe skin reactions were reported. The total cost of the program in 2016 was 22.8 million USD, averaging to roughly $2.91 USD to $30.73 USD per child treatment, depending on the region.
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