Seasonal malaria chemoprevention packaged with malnutrition prevention in northern Nigeria: A pragmatic trial (SMAMP study) with nested case-control

Abstract

Integrating seasonal malaria chemoprevention (SMC), recommended by the WHO since 2012 to prevent malaria infection, with nutrition interventions may improve health outcomes and operational efficiencies. This study assessed the effects of co-packaging interventions on distribution coverage, nutrition, and clinical malaria outcomes in northern Nigeria. From August to November 2014, community volunteers delivered sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) door-to-door each month to approximately 7,000 children aged 6–24 months in seven wards of Madobi, Kano State, Nigeria. In three of the wards children additionally received a lipid-based nutrient supplement (LNS–medium quantity), Plumpy Doz. Coverage, adherence, and anthropometric outcomes were assessed through baseline, midline, and endline household surveys. A facility-based case-control study was also conducted to estimate impact on clinical malaria outcomes. Coverage of SP-AQ was similar between arms at 89% (n = 2,409 child-months [88–90%]) in the SP-AQ only arm and 90% (n = 1,947 child-months [88–92%]) in the SP-AQ plus LNS arm (p = 0.52). Coverage of LNS was 83% (n = 2,409 child-months [81–84%]). Whilst there were marked changes in anthropometric status between baseline, midline and endline, these were largely accounted for by socioeconomic status and must be interpreted with care due to possible measurement issues, especially length-based indices. Overall nutritional status of our most robust measure, weight-for-age, does appear to have improved by endline, but was similar in the two study arms, suggesting no additional benefit of the LNS. While the odds of clinical malaria among those who received the intended intervention were lower in each study arm compared to children who did not receive interventions (SP-AQ only OR = 0.23 [0.09–0.6]; SP-AQ plus LNS OR = 0.22 [0.09–0.55]), LNS was not shown to have an additional impact. Coverage of SMC was high regardless of integrating LNS delivery into the SMC campaign. Supplementation with LNS did not appear to impact nutritional outcomes, but appeared to enhance the impact of SP-AQ on clinical odds of malaria. These results indicate that combining nutritional interventions with seasonal malaria chemoprevention in high-risk areas can be done successfully, warranting further exploration with other products or dosing.Trial Registration: ISRCTN 11413895

Factors Associated With The Adherence To Unsupervised Daily Dose To Seasonal Malaria Chemoprevention In Builsa North District, Upper East Region Of Ghana

“…While this was not in SMC's setting, a study comparing various malaria preventive regimens in Ugandan children showed that adherence to a 3-day course of dihydroartemisinin-piperaquine was much higher when reported by the caregiver (~100%) compared to the unbiased concentration of drugs [7]. A lower adherence was found using a longitudinal study in Nigeria by Ward et al Their research found that the adherence was 83.8% [8]. Several factors may explain these observations, and a mix of these reasons rather than one alone is likely responsible.…”

Nutritional status in young children prior to the malaria transmission season in Burkina Faso and Mali, and its impact on the incidence of clinical malaria

“…Even though this study does not provide clear evidence about an association between malnutrition and malaria risk, it shows clearly that both conditions are causing a high disease burden. The use of SMC as a platform for nutritional interventions requires further investigation, and could have important impacts on nutritional status and malaria burden [ 17 ].…”

“…Given current interest in incorporating nutritional screening or other nutritional interventions with SMC delivery [ 17 ], it is important to understand more about the nutritional status of children immediately prior to the rainy season, when SMC delivery begins. Clarifying the direct effect of malnutrition on malaria risk would help in understanding whether nutritional interventions might have the potential to assist with malaria control in the Sahel region.…”

Nutritional Status and Asymptomatic Infection in Young Children in Two Different Endemic Areas after Seasonal Malaria Chemoprevention Campaign in Mali

“…In Plasmodium falciparum endemic areas, children having stunting and underweight were more infected by Plasmodium, but parasite density remains lower [21,22]. reduce parasite density and improve nutritional status in children [23]. Other parameters as family income, mother's characteristics, other pathologies were not investigated and could be influenced children nutritional status [24][25][26] are the limit of this study.…”