Impact of seasonal malaria chemoprevention on prevalence of malaria infection in malaria indicator surveys in Burkina Faso and Nigeria

Abstract

BackgroundIn 2012, the WHO issued a policy recommendation for the use of seasonal malaria chemoprevention (SMC) to children 3–59 months in areas of highly seasonal malaria transmission. Clinical trials have found SMC to prevent around 75% of clinical malaria. Impact under routine programmatic conditions has been assessed during research studies but there is a need to identify sustainable methods to monitor impact using routinely collected data.MethodsData from Demographic Health Surveys were merged with rainfall, geographical and programme data in Burkina Faso (2010, 2014, 2017) and Nigeria (2010, 2015, 2018) to assess impact of SMC. We conducted mixed-effects logistic regression to predict presence of malaria infection in children aged 6–59 months (rapid diagnostic test (RDT) and microscopy, separately).ResultsWe found strong evidence that SMC administration decreases odds of malaria measured by RDT during SMC programmes, after controlling for seasonal factors, age, sex, net use and other variables (Burkina Faso OR 0.28, 95% CI 0.21 to 0.37, p<0.001; Nigeria OR 0.40, 95% CI 0.30 to 0.55, p<0.001). The odds of malaria were lower up to 2 months post-SMC in Burkina Faso (1-month post-SMC: OR 0.29, 95% CI 0.12 to 0.72, p=0.01; 2 months post-SMC: OR: 0.33, 95% CI 0.17 to 0.64, p<0.001). The odds of malaria were lower up to 1 month post-SMC in Nigeria but was not statistically significant (1-month post-SMC 0.49, 95% CI 0.23 to 1.05, p=0.07). A similar but weaker effect was seen for microscopy (Burkina Faso OR 0.38, 95% CI 0.29 to 0.52, p<0.001; Nigeria OR 0.53, 95% CI 0.38 to 0.76, p<0.001).ConclusionsImpact of SMC can be detected in reduced prevalence of malaria from data collected through household surveys if conducted during SMC administration or within 2 months afterwards. Such evidence could contribute to broader evaluation of impact of SMC programmes.

Malaria trends in districts that were targeted and not-targeted for seasonal malaria chemoprevention in children under five years of age in Guinea, 2014–2021

“…28, 29 However, these studies relied on large samples of at-risk populations (i.e., CU5), either following case / control study designs, 28, 29 or using nationally representative surveys such as Demographic and Health Surveys or Malaria Indicator Surveys. 30, 31 While such approaches are certainly robust, they can be onerous, time-consuming, and costly, and may not allow for continuous monitoring of the intervention across all SMC implementation areas.…”

Mass Azithromycin Distribution to Prevent Child Mortality in Burkina Faso

“…The Nouna district experiences heavy seasonal rainfall from June through September, with malarial deaths subsequently peaking from August to November. Each year, 4 monthly rounds of SMC with sulfadoxine-pyremethamine and amodiaquine were distributed to children aged 3 to 59 months from July through October . The Nouna district experienced escalating geopolitical insecurity over the study period, and some communities originally included in the study became inaccessible due to security concerns.…”

“…Each year, 4 monthly rounds of SMC with sulfadoxine-pyremethamine and amodiaquine were distributed to children aged 3 to 59 months from July through October. 9 The Nouna district experienced escalating geopolitical insecurity over the study period, and some communities originally included in the study became inaccessible due to security concerns. These communities either ceased to participate or were able to reenter the study during a later census.…”

Malaria prevention in children: an update

“…In 2012, the WHO recommended SMC with four monthly rounds of sulfadoxine-pyrimethamine plus amodiaquine (SPþAQ) for children aged 3- ]. Recent postimplementation studies report a 17-75% reduction in RDT-positive malaria cases in children under five, demonstrating a range of measured efficacy influenced by transmission, uptake, compliance, and drug resistance, although most centered around 60-75% [10][11][12][13]. In a highly endemic area in Uganda, comparison of two districts implementing SPþAQ SMC versus a control district documented 92% efficacy against clinical malaria [14 & ].…”