Impact of seasonal malaria chemoprevention on hospital admissions and mortality in children under 5 years of age in Ouelessebougou, Mali

Abstract

Background: Seasonal malaria chemoprevention is widely implemented in Sahel and sub-Sahel countries in Africa. Few studies have assessed the impact of the SMC on hospital admission and death when it is implemented in the health system. This retrospective study assessed the impact of seasonal malaria chemoprevention (SMC) on hospitalizations and deaths of children under 5 years of age during the second year of implementation of SMC in the health district of Ouelessebougou in Mali. Methods: In February 2017, a survey was conducted to assess hospital admissions and deaths in children under 5 years of age in two health sub-districts where SMC was implemented in 2015 and two health sub-districts where SMC was not implemented. The survey reviewed deaths and hospitalizations of children under 5, in the four health sub-districts. The crude and specific incidence rates of hospitalizations and deaths were determined in both groups and expressed per 1000 children per year. A negative binomial regression model and a Cox model were used to estimate the relative risks of hospitalization and death after adjusting for confounders. The R software was used for data analysis. Results: A total of 6638 children under 5 years of age were surveyed, 2759 children in the SMC intervention areas and 3879 children in the control areas. All causes mortality rate per 1000 person-years was 8.29 in the control areas compared to 3.63 in the intervention areas; age and gender adjusted mortality rate ratio 0.44 (95% CI 0.22-0.91), p = 0.027. The incidence rate of all causes hospital admissions was 19.60 per 1000 person-years in the intervention group compared to 33.45 per 1000 person-years in the control group, giving an incidence rate ratio (IRR) adjusted for age and gender of 0.61 (95% CI 0.44-0.84), p = 0.003. Conclusion: The implementation of SMC was associated with a substantial reduction in hospital admissions and allcause mortality. Trial registration ClinicalTrials.gov NCT02646410.

Malaria Outbreak Facilitated by Appearance of Vector-Breeding Sites after Heavy Rainfall and Inadequate Preventive Measures: Nwoya District, Northern Uganda, February–May 2018

“…A secondary data analysis of the Uganda Malaria Indicator Survey of 2014 reported an increasing malaria parasite prevalence among children under 5 years associated with severity of anemia [33]. Studies in Ethiopia [34], Nigeria [35], and Mali [36] reported the increased focus of malaria prevention strategies to children under 5 years as being the most affected. In a community level study in Malawi, children under 5 years and those between 5 and 19 years were reported to benefit equally from community bed net coverage [37].…”

“…It is possible that children <5 years were less affected than the 5-18 age group because the children are given priority by their guardians to sleep under LLINs, compared with older children. Even at national strategic level, this phenomenon is depicted where children under 5 years are targeted for chemoprevention [35,36] and targeted bed net distribution [25][26][27].…”

Evaluation of seasonal malaria chemoprevention in two areas of intense seasonal malaria transmission: Secondary analysis of a household-randomised, placebo-controlled trial in Houndé District, Burkina Faso and Bougouni District, Mali

“…The current WHO recommendation specifies that SMC can be administered up to 4 times each year, although 5 monthly courses of SMC were deployed in South East Senegal and were highly effective and safe [6]. Evaluation of SMC at scale suggests that this intervention has an important impact on uncomplicated malaria, hospital admissions for malaria, and malaria deaths (the ACCESS-SMC partnership, submitted) [7][8][9][10][11]. However, despite the benefits of SMC, countries where SMC is currently deployed include some of the largest contributors to the global malaria burden, including northern Nigeria, Burkina Faso, and Mali [12].…”

“…Evaluation of SMC at scale suggests that this intervention has an important impact on uncomplicated malaria, hospital admissions for malaria, and malaria deaths (the ACCESS-SMC partnership, submitted) [ 7 – 11 ]. However, despite the benefits of SMC, countries where SMC is currently deployed include some of the largest contributors to the global malaria burden, including northern Nigeria, Burkina Faso, and Mali [ 12 ].…”

Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: an End-User Perspective Study

“…SMC has been shown to prevent approximately 75% of all clinical malaria episodes and a similar proportion of severe malaria episodes, even where insecticide treated net usage is high [5]. In addition, a recent retrospective study from Issiaka et al demonstrated that the implementation of SMC was associated with a substantial reduction in hospital admissions and allcause mortality in the health district of Ouelessebougou, Mali [6]. In Senegal, SMC has been used in children up to 10 years old based on the ndings that the malaria burden was also high in the 5 to 10 years old group [7].…”