Seasonal malaria chemoprevention combined with community case management of malaria in children under 10 years of age, over 5 months, in south-east Senegal: A cluster-randomised trial

Abstract

BackgroundSeasonal malaria chemoprevention (SMC) is recommended in the Sahel region of Africa for children under 5 years of age, for up to 4 months of the year. It may be appropriate to include older children, and to provide protection for more than 4 months. We evaluated the effectiveness of SMC using sulfadoxine-pyrimethamine plus amodiaquine given over 5 months to children under 10 years of age in Saraya district in south-east Senegal in 2011.Methods and findingsTwenty-four villages, including 2,301 children aged 3–59 months and 2,245 aged 5–9 years, were randomised to receive SMC with community case management (CCM) (SMC villages) or CCM alone (control villages). In all villages, community health workers (CHWs) were trained to treat malaria cases with artemisinin combination therapy after testing with a rapid diagnostic test (RDT). In SMC villages, CHWs administered SMC to children aged 3 months to 9 years once a month for 5 months. The study was conducted from 27 July to 31 December 2011. The primary outcome was malaria (fever or history of fever with a positive RDT). The prevalence of anaemia and parasitaemia was measured in a survey at the end of the transmission season. Molecular markers associated with resistance to SMC drugs were analysed in samples from incident malaria cases and from children with parasitaemia in the survey. SMC was well tolerated with no serious adverse reactions. There were 1,472 RDT-confirmed malaria cases in the control villages and 270 in the SMC villages. Among children under 5 years of age, the rate difference was 110.8/1,000/month (95% CI 64.7, 156.8; p < 0.001) and among children 5–9 years of age, 101.3/1,000/month (95% CI 66.7, 136.0; p < 0.001). The mean haemoglobin concentration at the end of the transmission season was higher in SMC than control villages, by 6.5 g/l (95% CI 2.0, 11; p = 0.007) among children under 5 years of age, and by 5.2 g/l (95% CI 0.4, 9.9; p = 0.035) among children 5–9 years of age. The prevalence of parasitaemia was 18% in children under 5 years of age and 25% in children 5–9 years of age in the control villages, and 5.7% and 5.8%, respectively, in these 2 age groups in the SMC villages, with prevalence differences of 12.5% (95% CI 6.8%, 18.2%; p < 0.001) in children under 5 years of age and 19.3% (95% CI 8.3%, 30.2%; p < 0.001) in children 5–9 years of age. The pfdhps-540E mutation associated with clinical resistance to sulfadoxine-pyrimethamine was found in 0.8% of samples from malaria cases but not in the final survey. Twelve children died in the control group and 14 in the SMC group, a rate difference of 0.096/1,000 child-months (95% CI 0.99, 1.18; p = 0.895). Limitations of this study include that we were not able to obtain blood smears for microscopy for all suspected malaria cases, such that we had to rely on RDTs for confirmation, which may have included false positives.ConclusionsIn this study SMC for children under 10 years of age given over 5 months was feasible, well tolerated, and effective in preventing malaria episodes, and reduced th...

Effect of routine seasonal malaria chemoprevention on malaria trends in children under 5 years in Dangassa, Mali

“…An improvement of haemoglobin level (Table 1) was observed over the intervention period (September to November). The above observations could be attributed to SMC as it has been shown in many other studies about the protective effect of SMC on malaria in children in Africa [12][13][14]. The regular monthly administration of SP + AQ allows maintenance of drug concentration in blood and prevents parasite growth and avoids red blood cell destruction, which in turn prevents haemoglobin level decrease by malaria parasites [14,15].…”

“…IPT during the malaria transmission season improved malaria epidemiological trends in children [16]. A substantial reduction of malaria indicators in children was already reported in Mali [8,12] and elsewhere in Africa [14,17,18], which was attributed to SMC implementation in addition to other control interventions, such as IPT and LLINs. The beneficial effect of SMC on malaria clinical incidence has been reported by many other studies [15,19,20].…”

Malaria epidemiology in Kobeni department, southeastern Mauritania from 2015 to 2017

“…young children and pregnant women, but also older children and adults of all age in Kobeni. In this context, seasonal ASAQ Artesunate-amodiaquine, AL Artesunate-lumefantrine, SP Sulfadoxinepyrimethamine, CQ Chloroquine, AS-SP Artesunate-sulfamethoxypyrazine-pyrimethamine malaria chemoprevention (SMC) could be useful in preventing malaria episodes and associated parasitaemia and anaemia in children under 5 years and even in older children (up to 10 years) in the region [40]. Indeed, SMC was recommended in 2012 by the WHO for children aged 3-59 months living in areas with highly seasonal malaria transmission, as in the Sahelian region in Africa [41].…”

Impact of Seasonal Malaria Chemoprevention in Children 5 to 10 Years in Kita and Bafoulabe Districts, Mali.

“…In Senegal, the neighboring country, JL Ndiaye et al found a substantial bene t of SMC among children 5-9 years of age, on hemoglobin and the prevalence of parasitemia (8). Several studies have shown the epidemiological impact of SMC in school age children in clinical trials (8)(9)(10). Touré et al in 2016 found that the proportion of children over 5 years of age carrying malaria parasites was higher in all seasons compared to younger children in Sélingué, Mali due to malaria control policy focused on children under ve and pregnant women.…”

“…(7). In Senegal, the neighboring country, JL Ndiaye et al found a substantial bene t of SMC among children 5-9 years of age, on hemoglobin and the prevalence of parasitemia (8). Several studies have shown the epidemiological impact of SMC in school age children in clinical trials (8)(9)(10).…”