In a recent webinar, Malaria Consortium and the leaders of the national malaria control programmes in Uganda and Mozambique presented the latest implementation research from both countries exploring whether seasonal malaria chemoprevention (SMC) can be a viable strategy for the prevention of malaria outside of the Sahel.
To-date, this life-saving intervention has not been used in other areas of Africa where malaria transmission is seasonal because of concerns over widespread resistance to the antimalarials used in SMC: sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). The webinar, ‘Taking SMC to new geographies” presented promising initial findings from the two studies.
Preliminary data shows that despite concerns around resistance, SMC in Uganda and Mozambique does work. Malaria cases were significantly less likely to occur in the intervention areas compared to the control area without SMC, and results demonstrate that SMC is feasible, acceptable, safe and effective in preventing malaria in children under five in both countries.
More research is needed to better understand the chemoprevention efficacy of SPAQ in the context of high resistance, as well as the impact of SMC on the resistance profile. Further webinars are planned throughout 2022 to continue the conversation on this research.
The full recording of the webinar is available to view at the bottom of this article. Key results and recommendations from the presentations are summarised below.
SMC in Uganda
A phase 1 feasibility, acceptability and impact study took place in Karamoja region in 2021. This region consistently registers the highest malaria prevalence in Uganda.
Key results presented by Dr Jimmy Opigo, Programme Manager, National Malaria Control Division, Uganda
- SMC in Karamoja is feasible, with coverage is similar to levels seen in the Sahel region
- SMC was acceptable among community members, SMC implementers and policymakers
- The protective effect of SP+AQ was good. In a non-randomised controlled trial, children in SMC districts were 92% less likely to develop clinical malaria during the peak transmission season than those in non-SMC districts. Breakthrough malaria cases in SMC districts were rare
SMC in Mozambique
A similar study was also carried out in Mozambique in 2020/21, in the north-eastern province of Nampula.
Key results presented by Dr Baltazar Candrinho, Programme Director, Mozambique NMCP
- SMC was safe, feasible, acceptable and highly effective in Nampula
- Despite high rates of sulfadoxine and pyrimethamine resistance, one annual round of SMC does not appear to have had a negative impact on the resistance profile
Phase 2 of the study will involve a cohort study to assess the chemoprevention efficacy of SPAQ to clear existing infections and prevent new ones in the context of high parasite resistance and will gather more robust evidence of the effectiveness of SMC to inform policy change
The bigger picture: Preparing for the potential scale-up of SMC in east and southern Africa
Further considerations and next steps presented by Craig Bonnington, Malaria Consortium
- Better understanding the chemoprevention efficacy of SPAQ, including the role of drug dosing and parasite resistance, will help predict future effectiveness of SMC and inform the scale-up of the intervention in east and southern Africa
- Alternative SMC drug regimens that could replace SPAQ in the longer term, for example, dihydroartemisinin-piperaquine (DP), should be explored
- Rapid assessments or modelling are needed to determine areas where SMC is likely to be a viable malaria prevention strategy
Results from phase 2 of the SMC implementation study in Mozambique will be available in mid-2022. We are planning a similar phase 2 study in Uganda, which will commence in May 2022, with results expected by the end of the year. Meanwhile, we will engage with the global SMC community about further building the evidence base to take SMC to new geographies and shape the future of SMC.
Watch the webinar in full below:
This research was made possible through philanthropic funding and a grant from the Bill & Melinda Gates Foundation. You can learn more about Malaria Consortium’s SMC programme on our dedicated page. You can also sign up for our quarterly SMC newsletter to stay up-to-date with our work.
Ashley Giles is External Relations Manager for Seasonal Malaria Chemoprevention at Malaria Consortium