Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali
Abstract Background Seasonal malaria chemoprevention (SMC) is a new strategy recommended by WHO in areas of highly seasonal transmission in March 2012. Although randomized controlled trials (RCTs) have shown SMC to be highly effective, evidence and experience from routine implementation of SMC are l...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-08-01
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| Series: | Malaria Journal |
| Online Access: | http://link.springer.com/article/10.1186/s12936-017-1974-x |
| _version_ | 1818193030105006080 |
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| author | Fatou Diawara Laura C. Steinhardt Almahamoudou Mahamar Tiangoua Traore Daouda T. Kone Halimatou Diawara Beh Kamate Diakalia Kone Mouctar Diallo Aboubacar Sadou Jules Mihigo Issaka Sagara Abdoulaye A. Djimde Erin Eckert Alassane Dicko |
| author_facet | Fatou Diawara Laura C. Steinhardt Almahamoudou Mahamar Tiangoua Traore Daouda T. Kone Halimatou Diawara Beh Kamate Diakalia Kone Mouctar Diallo Aboubacar Sadou Jules Mihigo Issaka Sagara Abdoulaye A. Djimde Erin Eckert Alassane Dicko |
| author_sort | Fatou Diawara |
| collection | DOAJ |
| description | Abstract Background Seasonal malaria chemoprevention (SMC) is a new strategy recommended by WHO in areas of highly seasonal transmission in March 2012. Although randomized controlled trials (RCTs) have shown SMC to be highly effective, evidence and experience from routine implementation of SMC are limited. Methods A non-randomized pragmatic trial with pre-post design was used, with one intervention district (Kita), where four rounds of SMC with sulfadoxine + amodiaquine (SP + AQ) took place in August–November 2014, and one comparison district (Bafoulabe). The primary aims were to evaluate SMC coverage and reductions in prevalence of malaria and anaemia when SMC is delivered through routine programmes using existing community health workers. Children aged 3–59 months from 15 selected localities per district, sampled with probability proportional to size, were surveyed and blood samples collected for malaria blood smears, haemoglobin (Hb) measurement, and molecular markers of drug resistance in two cross-sectional surveys, one before SMC (July 2014) and one after SMC (December 2014). Difference-in-differences regression models were used to assess and compare changes in malaria and anaemia in the intervention and comparison districts. Adherence and tolerability of SMC were assessed by cross-sectional surveys 4–7 days after each SMC round. Coverage of SMC was assessed in the post-SMC survey. Results During round 1, 84% of targeted children received at least the first SMC dose, but coverage declined to 67% by round 4. Across the four treatment rounds, 54% of children received four complete SMC courses. Prevalence of parasitaemia was similar in intervention and comparison districts prior to SMC (23.4 vs 29.5%, p = 0.34) as was the prevalence of malaria illness (2.4 vs 1.9%, p = 0.75). After SMC, parasitaemia prevalence fell to 18% in the intervention district and increased to 46% in the comparison district [difference-in-differences (DD) OR = 0.35; 95% CI 0.20–0.60]. Prevalence of malaria illness fell to a greater degree in the intervention district versus the comparison district (DD OR = 0.20; 95% CI 0.04–0.94) and the same for moderate anaemia (Hb < 8 g/dL) (DD OR = 0.26, 95% CI 0.11–0.65). The frequency of the quintuple mutation (dhfr N51I, C59R and S108N + dhps A437G and K540E) remained low (5%) before and after intervention in both districts. Conclusions Routine implementation of SMC in Mali substantially reduced malaria and anaemia, with reductions of similar magnitude to those seen in previous RCTs. Improving coverage could further strengthen SMC impact. Trial registration clinical trial registration number NCT02894294 |
| first_indexed | 2024-12-12T00:39:55Z |
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| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-12-12T00:39:55Z |
| publishDate | 2017-08-01 |
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| series | Malaria Journal |
| spelling | doaj.art-425f28894f274aa0aac0d5e94280024a2022-12-22T00:44:17ZengBMCMalaria Journal1475-28752017-08-0116111210.1186/s12936-017-1974-xMeasuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, MaliFatou Diawara0Laura C. Steinhardt1Almahamoudou Mahamar2Tiangoua Traore3Daouda T. Kone4Halimatou Diawara5Beh Kamate6Diakalia Kone7Mouctar Diallo8Aboubacar Sadou9Jules Mihigo10Issaka Sagara11Abdoulaye A. Djimde12Erin Eckert13Alassane Dicko14Malaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoMalaria Branch, Centers for Disease Control and PreventionMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoMaternal and Child Survival Program, Save the ChildrenNational Malaria Control ProgramMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoPresident’s Malaria Initiative-US Agency for International DevelopmentMalaria Branch, Centers for Disease Control and PreventionMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoPresident’s Malaria Initiative, USAID Bureau for Global Health, Office of Health, Infectious Diseases, and NutritionMalaria Research & Training Center, Faculty of Pharmacy and Faculty of Medicine and Dentistry, University of Sciences Techniques and Technologies of BamakoAbstract Background Seasonal malaria chemoprevention (SMC) is a new strategy recommended by WHO in areas of highly seasonal transmission in March 2012. Although randomized controlled trials (RCTs) have shown SMC to be highly effective, evidence and experience from routine implementation of SMC are limited. Methods A non-randomized pragmatic trial with pre-post design was used, with one intervention district (Kita), where four rounds of SMC with sulfadoxine + amodiaquine (SP + AQ) took place in August–November 2014, and one comparison district (Bafoulabe). The primary aims were to evaluate SMC coverage and reductions in prevalence of malaria and anaemia when SMC is delivered through routine programmes using existing community health workers. Children aged 3–59 months from 15 selected localities per district, sampled with probability proportional to size, were surveyed and blood samples collected for malaria blood smears, haemoglobin (Hb) measurement, and molecular markers of drug resistance in two cross-sectional surveys, one before SMC (July 2014) and one after SMC (December 2014). Difference-in-differences regression models were used to assess and compare changes in malaria and anaemia in the intervention and comparison districts. Adherence and tolerability of SMC were assessed by cross-sectional surveys 4–7 days after each SMC round. Coverage of SMC was assessed in the post-SMC survey. Results During round 1, 84% of targeted children received at least the first SMC dose, but coverage declined to 67% by round 4. Across the four treatment rounds, 54% of children received four complete SMC courses. Prevalence of parasitaemia was similar in intervention and comparison districts prior to SMC (23.4 vs 29.5%, p = 0.34) as was the prevalence of malaria illness (2.4 vs 1.9%, p = 0.75). After SMC, parasitaemia prevalence fell to 18% in the intervention district and increased to 46% in the comparison district [difference-in-differences (DD) OR = 0.35; 95% CI 0.20–0.60]. Prevalence of malaria illness fell to a greater degree in the intervention district versus the comparison district (DD OR = 0.20; 95% CI 0.04–0.94) and the same for moderate anaemia (Hb < 8 g/dL) (DD OR = 0.26, 95% CI 0.11–0.65). The frequency of the quintuple mutation (dhfr N51I, C59R and S108N + dhps A437G and K540E) remained low (5%) before and after intervention in both districts. Conclusions Routine implementation of SMC in Mali substantially reduced malaria and anaemia, with reductions of similar magnitude to those seen in previous RCTs. Improving coverage could further strengthen SMC impact. Trial registration clinical trial registration number NCT02894294http://link.springer.com/article/10.1186/s12936-017-1974-x |
| spellingShingle | Fatou Diawara Laura C. Steinhardt Almahamoudou Mahamar Tiangoua Traore Daouda T. Kone Halimatou Diawara Beh Kamate Diakalia Kone Mouctar Diallo Aboubacar Sadou Jules Mihigo Issaka Sagara Abdoulaye A. Djimde Erin Eckert Alassane Dicko Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali Malaria Journal |
| title | Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali |
| title_full | Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali |
| title_fullStr | Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali |
| title_full_unstemmed | Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali |
| title_short | Measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in Kita, Mali |
| title_sort | measuring the impact of seasonal malaria chemoprevention as part of routine malaria control in kita mali |
| url | http://link.springer.com/article/10.1186/s12936-017-1974-x |
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