Evaluation of pilot implementation of seasonal malaria chemoprevention on morbidity in young children in Northern Sahelian Ghana

Abstract

Background In Sahelian Africa, the risk of malaria increases with the arrival of the rains, particularly in young children. Following successful trials, the World Health Organization (WHO) recommended the use of seasonal malaria chemoprevention (SMC) in areas with seasonal peak in malaria cases. This study evaluated the pilot implementation of SMC in Northern Ghana. Methods Fourteen communities each serving as clusters were selected randomly from Lawra District of Upper West Region as intervention area and West Mamprusi District in the Northern Region as the non-intervention area. The intervention was undertaken by the National Malaria Control Programme in collaboration with regional health directorates using sulfadoxine-pyrimethamine plus amodiaquine and standard WHO protocols. Before and after surveys for malaria parasitaemia and haemoglobin levels as well as monitoring for malaria morbidity and mortality were undertaken. Results At the end of the intervention, participant retention was 92.9% (697/731) and 89.5% (634/708) in the intervention and the non-intervention areas, respectively. The proportion of children with asexual parasites reduced by 19% (p = 0.000) in the intervention and increased by 12% (p = 0.000) in the non-intervention area. Incidence rates of severe malaria were 10 and 20 per 1000 person-years follow up in the intervention and comparison areas, respectively with P.E of 45% (p = 0.62). For mild malaria, it was 220 and 170 per 1000 person-years in intervention and comparison area, respectively with PE of - 25% (p = 0.31). The proportion of children with anaemia defined as Hb< 11.0 g/dl reduced from 14.2% (52.8–38.6%) in the intervention area as compared to an increase of 8.1% (54.5% to 62.6) the non-intervention arm, Mean Hb reduced by 0. 24 g/dl (p = 0.000) in the non-intervention area and increased of 0.39 g/dl (p = 000) in the intervention area. Conclusions The feasibility and effectiveness of SMC introduction in Northern Ghana was demonstrated as evidenced by high study retention, reduction in malaria parasitaemia and anaemia during the wet season.

Plasmodium falciparum infection and naturally acquired immunity to malaria antigens among Ghanaian children in northern Ghana

“…Ghana adopted SMC in 2014, and is in place in Northern Ghana ( Id et al, 2019 ; Adjei et al, 2022 ). The intervention targets children younger than 5 years of age and has previously been shown to reduce parasite carriage and malaria morbidity among SMC recipients ( Ansah et al, 2021 ; Ambe et al, 2020 ; Druetz, 2018 ; Yaro et al, 2011 ; Dicko et al, 2011 ). The present study supports these earlier findings, as the lowest risk of parasitemia and perceived malaria was found among the youngest study participants ( Fig.…”

“…An estimated 228 million malaria cases, and 602,000 deaths were recorded in Africa in 2020 ( WHO, 2021 ). A combination of several malaria-control strategies, including the use of long-lasting insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), enhanced diagnosis and treatment with artemisinin-based combination treatment (ACT), intermittent preventive treatment (IPT) in pregnancy (IPTp) and in infancy (IPTi), are widely employed in endemic communities in Africa to reduce this burden ( Ansah et al, 2021 ; WHO, 2012 ; WHO, 2016 ).…”

“…In addition to the above, the WHO recommends since 2012 the use of seasonal malaria chemoprevention (SMC) as part of a paradigm shift from “one size fits all” to targeting malaria control strategies to specific populations and locations, ( WHO, 2012 ; WHO, 2013 ). This strategy has proven effective, cost-effective, safe, and feasible for the prevention of malaria among children younger than 5 years of age in areas with highly seasonal P. falciparum transmission ( Ansah et al, 2021 ; ACCESS-SMC Partnership, 2020 ; Meremikwu et al, 2012 ). SMC is therefore now widely adopted in several countries, especially in the Sahel and sub-Sahel regions of West Africa ( Coldiron et al, 2017 ; Ashley and Yeka, 2020 ; Ambe et al, 2020 ), where the WHO recommends sulfadoxine-pyrimethamine plus amodiaquine as the drugs of choice ( WHO, 2012 ; WHO, 2013 ).…”

“…The P. falciparum prevalence range between 16% and 28% in Southern Ghana, but can be as high as 51% in Northern Ghana, reflecting a higher transmission intensity ( Dieng et al, 2019 ; Diallo et al, 2017 ; Amoah et al, 2019 ). Ghana adopted SMC in 2014, and following pilot studies in 2015 ( Ansah et al, 2021 ) that showed that SMC provided subtantial protection against malaria and parasite carriage it is now implemented in Northern Ghana ( Id et al, 2019 ; Adjei et al, 2022 ).…”

Plasmodiums Typing and its Possible Correspondence to the Patients’ Typological Belonging

“…Ethno-age typological aspect finds its reflection about children morbidity (in part, the seasonal one that can define malaria course and the patients' typologies on seasonality) and prevention variations on malaria in different countries, country parts, areas, districts and even citiesfor example, in Northern Sahelian Ghana [21], health district of Koutiala, Mali [22]. Separate works on ethno-age aspect are devoted to treatment and prevention peculiarities in the adult.…”