Seasonal malaria chemoprevention in the Sahel subregion of Africa: a cost-effectiveness and cost-savings analysis

Gilmartin, Colin; Nonvignon, Justice; Cairns, Matthew; Milligan, Paul; Bocoum, Fadima Yaya; Winskill, Peter; Moroso, Diego; Collins, David H.

doi:10.1016/s2214-109x(20)30475-7

Cited by 33 publications

(23 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These results represent the first large-scale evaluation of SMC implemented by national programs and provide the first evidence of an impact on malaria deaths. Earlier studies in Burkina Faso and Mali showed effects on prevalence [ 46 , 47 ] and cost-saving benefits [ 9 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…SMC could also avert millions of cases and thousands of deaths among children living in areas with highly seasonal malaria transmission [3]. In terms of cost, a multicountry cost-effectiveness analysis found that the weighted average economic cost of administering four monthly SMC cycles was US $3.63 per child, and ultimately, that SMC is a highly cost-effective intervention that substantially reduces malaria diagnostic and treatment costs [9]. SMC has been recommended by the WHO since 2012, for use in areas where more than 60% of annual malaria incidence occurs within 4 consecutive months, where there is a high burden of malaria in children, and where SPAQ retain their antimalarial efficacy [6,10].…”

Section: Implementation Of Seasonal Malaria Chemoprevention In Africamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study

Wharton-Smith¹,

Baker²,

Roca-Feltrer³

et al. 2021

JMIR Res Protoc

View full text Add to dashboard Cite

Background Malaria is a significant cause of morbidity and mortality in children aged under 5 years in Mozambique. The World Health Organization recommends seasonal malaria chemoprevention (SMC), the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ), to children aged 3-59 months during rainy season. However, as resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel in West Africa. Objective This protocol describes the first phase of a pilot project that aims to assess the protective effect of SP and AQ when used for SMC and investigate the levels of molecular markers of resistance of Plasmodium falciparum to antimalarial medicines in the study districts. In addition, it is important to understand whether SMC is a feasible and acceptable intervention in the context of Nampula Province, Mozambique. Methods This study will adopt a hybrid effectiveness-implementation design to conduct a mixed methods evaluation with six objectives: a molecular marker study, a nonrandomized controlled trial, an analysis of reported malaria morbidity indicators, a documentation exercise of the contextual SMC adaptation, an acceptability and feasibility assessment, and a coverage and quality assessment. Results Ethical approval for this study was granted by the Mozambican Ministry of Health National Bioethics Committee on September 15, 2020. Data collection began in October 2020, and data analysis is expected to be completed by August 2021. Conclusions This research will make a unique contribution to our understanding of whether the combination of SP and AQ, when used for SMC, can confer a protective effect against malaria in children aged 3-59 months in a region where malaria transmission is seasonal and SP resistance is expected to be high. If the project is successful, subsequent phases are expected to provide a more comprehensive assessment of the effectiveness and sustainability of SMCs. International Registered Report Identifier (IRRID) DERR1-10.2196/27855

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Implementation Of Seasonal Malaria Chemoprevention In Africamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study

Wharton-Smith¹,

Baker²,

Roca-Feltrer³

et al. 2021

JMIR Res Protoc

View full text Add to dashboard Cite

show abstract

“…60%) of clinical malaria cases occur during a period of 4 months, the clinical attack rate of malaria is greater than 0.1 attack per transmission season in the target age group, and SP plus AQ (SPAQ) remains efficacious. 1 Seasonal malaria chemoprevention is considered a costeffective intervention, [2][3][4][5] with annual cost of delivery per child in Chad in 2016 estimated at US$3.86, and costs of US$10.26 and US$39.20 per malaria case and disability-adjusted life year averted among eligible children. 4 It has also been found to be a highly efficacious intervention in terms of reduction of malaria morbidity, prevalence of malaria parasitemia, malaria-related hospital admissions, and mortality.…”

Section: Introductionmentioning

confidence: 99%

Modeled Impact of Seasonal Malaria Chemoprevention on District-Level Suspected and Confirmed Malaria Cases in Chad Based on Routine Clinical Data (2013–2018)

Richardson

Moukénet

Diar

et al. 2021

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Sulfadoxine-pyrimethamine plus amodiaquine to children aged 3–59 months is delivered as seasonal malaria chemoprevention (SMC) in areas where transmission is highly seasonal such as Chad and other Sahelian countries. Although clinical trials show a 75% reduction in malaria cases, evidence of SMC’s impact at scale remains limited. Using data from the Chadian National Health Management Information System, we analyzed associations between SMC implementation during July–October and monthly district-level malaria incidence (suspected and confirmed outpatient cases) among children aged 0–59 months at health facilities in 23 health districts with SMC implementation during 2013–2018. Generalized additive models were fitted with separate cyclic cubic spline terms for each district to adjust for seasonality in cases. SMC implementation in Chad was associated, compared with no implementation, with lower monthly counts of both suspected (rate ratio [RR]: 0.82, 95% CI: 0.72–0.94. P = 0.006) and confirmed malaria cases (RR: 0.81, 95% CI: 0.71–0.93, P = 0.003), representing around 20% reduction in malaria incidence. Sensitivity analyses showed effect sizes of up to 28% after modifying model assumptions. Caution should be exercised in interpreting our findings, which may not be comparable with other studies, and may over- or underestimate impact of SMC; not all malaria cases present at health facilities, not all suspected cases are tested, and not all facilities report cases consistently. This study’s approach presents a solution for employing readily available routine data to evaluate the impact of health interventions at scale without extensive covariate data. Further efforts are needed to improve the quality of routine data in Chad and elsewhere.

show abstract

“…SMC has been implemented in Burkina Faso since 2014 (8) and evidence demonstrates its feasibility, cost-effectiveness and impact on malaria morbidity and mortality at scale (9,10). In 2019, approximately 15,000 infants (aged 3-12 months) and 15,000 young children (aged 13-59 months) received SMC in the health district of Mangodara (11).…”

Section: Introductionmentioning

confidence: 99%

Extending Seasonal Malaria Chemoprevention To Five Cycles: A Pilot Study of Feasibility and Acceptability in Mangodara District, Burkina Faso

Traoré¹,

Donovan²,

Sawadogo³

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundSeasonal malaria chemoprevention (SMC) involves administering antimalarial drugs at monthly intervals during the high malaria transmission period to children aged 3 to 59 months as recommended by the World Health Organization. Typically, a full SMC course is administered over four monthly cycles from July to October, coinciding with the rainy season. However, an analysis of rainfall patterns suggest that the malaria transmission season is now longer and starting as early as June in the south of Burkina Faso, leading to a rise in cases prior to the first cycle. This study assessed the acceptability and feasibility of extending SMC from four to five cycles to coincide with the earlier rainy season in Mangodara health district.MethodsThe mixed-methods study was conducted between July and November 2019. Quantitative data were collected through end-of-cycle and end-of-round household surveys to determine the effect of the additional cycle on the coverage of SMC in Mangodara. The data were then compared with 22 other districts where SMC was implemented by Malaria Consortium. Eight focus group discussions were conducted with caregivers and community distributors and 11 key informant interviews with community, programme and national-level stakeholders. These aimed to determine perceptions of the acceptability and feasibility of extending SMC to five cycles.Results The extension was perceived as acceptable by caregivers, community distributors and stakeholders due to the positive impact on the health of children under five. However, many community distributors expressed concern over the feasibility, mainly due to the clash with farming activities in June. Stakeholders highlighted the need for more evidence on the impact of the additional cycle on parasite resistance prior to scale-up. End-of-cycle survey data showed no difference in coverage between five SMC cycles in Mangodara and four cycles in the 22 comparison districts.Conclusions The additional cycle should begin early in the day in order to not coincide with the agricultural activities of community distributors. Continuous sensitisation at community level is critical for the sustainability of SMC and acceptance of an additional cycle. Further studies are required to understand the effectiveness, including cost-effectiveness, of tailoring SMC according to the rainy season.

show abstract

Seasonal malaria chemoprevention in the Sahel subregion of Africa: a cost-effectiveness and cost-savings analysis

Cited by 33 publications

References 13 publications

Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study

Assessment of the Feasibility, Acceptability, and Impact of Implementing Seasonal Malaria Chemoprevention in Nampula Province, Mozambique: Protocol for a Hybrid Effectiveness-Implementation Study

Modeled Impact of Seasonal Malaria Chemoprevention on District-Level Suspected and Confirmed Malaria Cases in Chad Based on Routine Clinical Data (2013–2018)

Extending Seasonal Malaria Chemoprevention To Five Cycles: A Pilot Study of Feasibility and Acceptability in Mangodara District, Burkina Faso

Contact Info

Product

Resources

About