In the Sahel region of Africa, which covers a broad swathe of land south of the Sahara, malaria remains the leading cause of severe illness and death in young children. A high proportion of the malaria infections in this region take place during the rainy season, when the female Anopheles mosquito – which carries the deadliest malaria parasite – lays its eggs.
Since 2012, the World Health Organization (WHO) has recommended an additional method of malaria prevention in areas with high seasonal transmission. This strategy is known as seasonal malaria chemoprevention (SMC) and involves providing children with monthly doses of sulphadoxine-pyrimethamine and amodiaquine. By taking this drug during the 3-4 month rainy season, when malaria transmission is highest, a child can maintain continuous levels of antimalarial medicine in the blood.
In 2013 Malaria Consortium began implementing a community-based SMC project in Katsina State, Northern Nigeria, with funding from the Bill & Melinda Gates Foundation. Extra funding was provided by UKaid from the UK government through Malaria Consortium’s ongoing Support to National Malaria Programme (SuNMaP) project.
The project’s objective is to use SMC to reduce the incidence rates of both simple and severe malaria, and associated anaemia, and thus improve the overall health of children under five in this community. The project also ensures collaboration with health authorities and communities at all levels where SMC is being implemented, in order to facilitate the acceptability and future sustainability of the intervention.
Since the SMC programme’s launch at the start of the malaria season in July 2013, over 2,800 healthcare staff, trainers, and supervisors have received training to help roll out the intervention. The project in Katsina is one of the largest SMC interventions undertaken to date, resulting in around 485,000 children receiving preventive drugs for malaria. The roll-out has shown that SMC can be successfully deployed in a cost-effective and feasible way in areas where the malaria transmission season is less than four months.
Malaria Consortium is now incorporating lessons learned from Katsina into further interventions across the Sahel region and is involved in ongoing projects to implement SMC in four local government areas in Katsina State, and two in neighbouring Jigawa State.
In spite of this success in distributing SMC in Katsina, a lack of human and financial resources has meant that only three percent of the 25 million under fives who might have benefited from SMC across the Sahel region received the treatment. The treatment is not suitable in all areas of the Sahel and sub Sahel region, as WHO does not recommend the use of SMC in areas where the malaria season is longer than four months, due to questions relating to the long-term use of the drug. However, if all of the suitable areas in the Sahel region were covered by SMC treatment, approximately five million malaria cases, translating into around 20,000 deaths, could be averted.
In an attempt to maximise the benefits of the treatment, Malaria Consortium has recently been awarded a UNITAID grant to oversee the largest-yet global programme to increase SMC across the Sahel region of Africa. Working with Catholic Relief Services and other partners, Malaria Consortium will help supply an estimated 30 million treatments per year in 2015 and 2016, reaching 7.5 million children living throughout Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria and The Gambia.
The project, called ACCESS-SMC, will generate evidence on the efficacy and feasibility of preventive antimalarial drugs when rolled out at a larger scale which will, in turn, help to mobilise additional resources for SMC. As part of the project, Malaria Consortium and partners will work with communities, governments and national malaria control programmes to strengthen capacity and embed sustainability for SMC beyond the project.
Keywords: Preventive treatments