Evaluation of Seasonal Malaria Chemoprevention in Kita
Condition: Malaria; Anemia
MeSH terms: Malaria
Study type: Observational [Patient Registry]

Summary: 
      Seasonal malaria chemoprevention (SMC) is a new strategy recommended by World Health
      Organization in 2012 for areas of highly seasonal transmission such as the Sahel. Although
      randomized controlled trials have shown SMC to be highly effective, evidence and experience
      from routine implementation of SMC has been lacking. For these reasons, we conducted a
      comprehensive evaluation of the coverage, adherence, and impact of SMC on malaria infection
      and disease and anemia when delivered through routine programs using existing community
      health workers in the Kayes region in Mali. Our evaluation used a pre-post design with
      cross-sectional surveys and abstraction of routine health information system data in an
      intervention district (Kita) where SMC was implemented through the health system, and a
      comparison district (Bafoulabe) where SMC was not implemented.
    

Detailed description: 
      Seasonal malaria chemoprevention (SMC) is a new strategy recommended by World Health
      Organization in 2012 for areas of highly seasonal transmission such as the Sahel. Although
      randomized controlled trials (RCTs) have shown SMC to be highly effective, evidence and
      experience from routine implementation of SMC has been lacking. For these reasons, we
      conducted a comprehensive evaluation of the coverage, adherence, and impact of SMC on malaria
      infection and disease, and anemia when delivered through routine programs using existing
      community health workers in the Kayes region in Mali. A pre-post design was used, with one
      intervention district, Kita where four rounds of SMC with Sulfadoxine-Pyrimethamine plus
      Amodiaquine (SP+AQ) took place in August-November 2014, and one comparison district,
      Bafoulabe. Cross-sectional surveys were carried out in children aged 3-59 months from 30
      randomly selected localities (15/district) at baseline and in follow-up to assess the impact
      of SMC on malaria parasitemia, fever, malaria illness, and anemia. The baseline survey was
      performed in July 2014 prior to the start of SMC implementation and the post-intervention
      (follow-up) surveys took place in December 2014. Blood samples were collected for thick/thin
      smears for malaria and hemoglobin measurement in two cross-sectional surveys, one prior to
      SMC in July 2014 and one after SMC in December 2014. The impact on malaria morbidity was
      assessed using routine data on confirmed malaria cases extracted from the registers by the
      research team in nine of the 47 community health centers in Kita and seven of the 24 health
      centers in Bafoulabe. Cross-sectional surveys were also carried out about 7 days after each
      of the four rounds of SMC to assess caregivers' adherence to the administration of SMC drugs
      and determine the frequency of adverse events in the intervention district of Kita. Coverage
      was assessed by cross-sectional in children 3-59 months in 30 randomly selected clusters in
      the district of Kita using interview of the caregivers and information on the SMC card in
      December 2014.
    

Intervention name(s): implementation of seasonal malaria chemoprevention
Intervention type(s): Other
Intervention description(s): administration of therapeutic doses of antimalarials (Sulfadoxine-pyrimethamine [SP] + Amodiaquine [AQ]) at monthly intervals during the high malaria transmission season in children 3-59 months of age.
Observational model: Ecologic or Community
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Children aged 3-59 months of age
      
Keywords: malaria; chemoprevention; season; anemia; impact; coverage; children