Implementation, coverage and equity of large-scale door-to-door delivery of Seasonal Malaria Chemoprevention (SMC) to children under 10 in Senegal

Abstract

SMC has been introduced widely in the Sahel since its recommendation by WHO in 2012. This study, which provided evidence of feasibility that supported the recommendation, included school-age and pre-school children. School-age children were not included in the 2012 recommendation but bear an increasing proportion of cases. In 2006, consultations with health-staff were held to choose delivery methods. The preferred approach, door-to-door with the first daily-dose supervised by a community-health-worker (CHW), was piloted and subsequently evaluated on a large-scale in under-5’s in 2008 and then in under-10’s 2009–2010. Coverage was higher among school-age children (96%(95%CI 94%,98%) received three treatments in 2010) than among under 5’s (90%(86%,94%)). SMC was more equitable than LLINs (odds-ratio for increase in coverage for a one-level rise in socioeconomic-ranking (a 5-point scale), was 1.1 (0.95,1.2) in 2009, compared with OR 1.3 (1.2,1.5) for sleeping under an LLIN. Effective communication was important in achieving high levels of uptake. Continued training and supervision were needed to ensure CHWs adhered to treatment guidelines. SMC door-to-door can, if carefully supervised, achieve high equitable coverage and high-quality delivery. SMC programmes can be adapted to include school-age children, a neglected group that bears a substantial burden of malaria.

Elucidating Mechanisms of Drug-Resistant Plasmodium falciparum

“…Meta-analysis of data from Africa nonetheless has shown an overall benefit of using more frequent doses of SP in IPTp, along with the use of insecticide-treated bed nets, and also suggests that dihydroartemisinin (DHA; the active ART metabolite) + PPQ could be an effective substitute (Desai et al, 2018). SP + ADQ has also proven to be effective in reducing the incidence of malaria when administered monthly as a 3-day course (Bâ et al, 2018). Thus, while SP alone has lost considerable efficacy because of mutations in the target enzymes and pathway, it can still be beneficial as a well-tolerated and safe component of a combination therapy or with more frequent dosing as a monotherapy.…”

Spatio-temporal variation of malaria hotspots in Central Senegal, 2008–2012

“…The trial of seasonal malaria chemoprevention (SMC) was implemented in this area from 2008 to 2010 [16,[23][24][25]. The SMC protocol consisted in administering a combination of sulfadoxine-pyrimethamine and amodiaquine to children (under 5 years of age in 2008 and under 10 years of age in 2009-2010) once a month from September to November.…”

Application of Functional Data Analysis to Identify Patterns of Malaria Incidence, to Guide Targeted Control Strategies

“…The data used for this study were collected between January 2008 and December 2012 during a field trial of Seasonal Malaria Chemoprevention (SMC) among children from 575 villages in west-central Senegal [23,24]. This area is a part of the two national rural health districts, Bambey and Fatick, where the national malaria control program estimated the incidence under 5 cases/1000 person-years in 2018 [25].…”