Sulfadoxine-pyrimethamine plus amodiaquine to children aged 3–59 months is delivered as seasonal malaria chemoprevention (SMC) in areas where transmission is highly seasonal such as Chad and other Sahelian countries. Although clinical trials show a 75% reduction in malaria cases, evidence of SMC’s impact at scale remains limited. Using data from the Chadian National Health Management Information System, we analyzed associations between SMC implementation during July–October and monthly district-level malaria incidence (suspected and confirmed outpatient cases) among children aged 0–59 months at health facilities in 23 health districts with SMC implementation during 2013–2018. Generalized additive models were fitted with separate cyclic cubic spline terms for each district to adjust for seasonality in cases. SMC implementation in Chad was associated, compared with no implementation, with lower monthly counts of both suspected (rate ratio [RR]: 0.82, 95% CI: 0.72–0.94. P = 0.006) and confirmed malaria cases (RR: 0.81, 95% CI: 0.71–0.93, P = 0.003), representing around 20% reduction in malaria incidence. Sensitivity analyses showed effect sizes of up to 28% after modifying model assumptions. Caution should be exercised in interpreting our findings, which may not be comparable with other studies, and may over- or underestimate impact of SMC; not all malaria cases present at health facilities, not all suspected cases are tested, and not all facilities report cases consistently. This study’s approach presents a solution for employing readily available routine data to evaluate the impact of health interventions at scale without extensive covariate data. Further efforts are needed to improve the quality of routine data in Chad and elsewhere.
Mobile phones are increasingly used in community health programmes, but the use of video job-aids that can be displayed on smart phones has not been widely exploited. We investigated the use of video job-aids to support the delivery of seasonal malaria chemoprevention (SMC) in countries in West and Central Africa. The study was prompted by the need for training tools that could be used in a socially distanced manner during the COVID-19 pandemic. Animated videos were developed in English, French, Portuguese, Fula and Hausa, illustrating key steps for administering SMC safely, including wearing masks, washing hands, and social distancing. Through a consultative process with the national malaria programmes of countries using SMC, successive versions of the script and videos were reviewed to ensure accurate and relevant content. Online workshops were held with programme managers to plan how to use the videos in SMC staff training and supervision, and the use of the videos was evaluated in Guinea through focus groups and in-depth interviews with drug distributors and other staff involved in SMC delivery and through direct observations of SMC administration. Programme managers found the videos useful as they reinforce messages, can be viewed at any time and repeatedly, and when used during training sessions, provide a focus of discussion and support for trainers and help retain messages. Managers requested that local specificities of SMC delivery in their setting be included in tailored versions of the video for their country, and videos were required to be narrated in a variety of local languages. In Guinea, SMC drug distributors found the video covered the all the essential steps and found the video easy to understand. However, not all key messages were followed as some of the safety measures, social distancing and wearing masks, were perceived by some as creating mistrust amongst communities. Video job-aids can potentially provide an efficient means of reaching large numbers of drug distributors with guidance for safe and effective distribution of SMC. Not all distributors use android phones, but SMC programmes are increasingly providing drug distributors with android devices to track delivery, and personal ownership of smartphones in sub-Saharan Africa is growing. The use of video job-aids for community health workers to improve the quality delivery of SMC, or of other primary health care interventions, should be more widely evaluated.
Background and Objective: In 2005, Chad, like several other WHO countries, withdrew chloroquine as a first-line treatment for Plasmodium falciparum malaria in response to WHO recommendations related to the reason for the increase in treatment failures and the global spread of chloroquine resistance. Artemisinin-based combination therapy (ACTs), Artemether-lumefantrine, has replaced chloroquine as the first-choice treatment for malaria. The present study assessed pfcrt polymorphism in Plasmodium falciparum isolates in Massakory. Methodology and Results: Blood samples for PCR analysis were collected on Whatman 3MM filter paper in Massakory during a therapeutic efficacy study (TES) conducted from December 14, 2019 to March 14, 2020. Genomic DNA was extracted from 113 dried blood spots with the QIAamp DNA Micro Kit (Qiagen, Valencia, CA) as per manufacturer's protocol and amplified by nested-PCR with pfcrt specific primer. The amplification products were revealed by electrophoresis on 2% agarose gel and then sequenced according to Sanger method. A total of 71 sequences were readable. The pfcrt analysis showed that of the 71 readable sequences, high mutation prevalence: 66 (92.96%) IET, 2 (4.22%) IDT and 3 (4.22%) MNK wild pfcrt isolates. Conclusion: These results challenge the highest health authorities in the country. The government, through the Ministry of Public Health and National Solidarity and the National Malaria Control Program, must raise awareness for the effective withdrawal of chloroquine. This action will promote on the one hand the re-emergence of parasites sensitive to chloroquine, and on the other hand make possible the reintroduction of chloroquine in the treatment of simple malaria after the suppression of drug pressure.
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