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Our SMC programme

Malaria Consortium’s SMC programme

In many parts of Africa malaria transmission is seasonal, with most malaria illness and deaths occurring during the rainy season. Seasonal malaria chemoprevention (SMC) is a highly effective intervention to prevent malaria infection during this peak transmission period among those most at risk: children under five.

SMC is defined as the community-based, intermittent administration of full courses of antimalarial medicines during the malaria season. The World Health Organization (WHO) has recommended SMC as a malaria prevention strategy for children 3–59 months since 2012. [1] A combination of two antimalarials is used in SMC: sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). SMC is typically delivered door-to-door by volunteer community distributors. It is a safe and cost-effective intervention that can be delivered safely at scale. [2] In clinical trials, it has been found to prevent up to 75 percent of malaria cases in children under five.[3] In 2019, SMC was implemented in 13 countries of the Sahel, targeting around 22 million children.[4]

Malaria Consortium has been a leading implementer of SMC since WHO issued its recommendation to scale up the intervention in 2012. Starting with an early implementation pilot in Nigeria in 2013, we then led the rapid scale-up of SMC through the Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel (ACCESS-SMC) project in 2015–2017, reaching close to seven million children in Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria and The Gambia. Since 2018, Malaria Consortium has continued to implement SMC in Burkina Faso, Chad, Nigeria and Togo. We are also conducting research exploring the feasibility, acceptability, and impact of SMC outside of the Sahel in Mozambique and Uganda. In 2021, we aim to reach 20 million children across our SMC programme.

Much of Malaria Consortium’s funding for SMC comes from philanthropic donations, primarily as a result of being awarded Top Charity status by GiveWell, a non-profit organisation dedicated to finding outstanding giving opportunities through in-depth analysis. Our program has also been supported by institutional funders such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and by UK aid from the UK government through the Support to National Malaria Programme Phase 2 (SuNMaP 2) project in Nigeria.

SMC campaigns are implemented under the leadership of national malaria programs and through countries’ existing health system structures. Malaria Consortium provides technical and logistical support on all SMC intervention components:

Malaria Consortium provides technical, logistical and financial support to SMC campaigns and works with governments and implementation partners to deliver the following SMC intervention components:

Planning and enumeration

Planning typically starts around five months before the annual SMC round. This involves determining where and when the campaign will be implemented and estimating the target population, as well as recruiting the required number of community distributors and supervisors.

Procurement and supply management

Malaria Consortium’s operations team manages the shipment of SPAQ from the manufacturers in China and India to the central warehouses in the countries where we implement SMC. From there, the medicines and other SMC commodities, such as T-shirts, bags and pens for SMC implementers, are distributed to health districts and health facilities ahead of the SMC round.

Community engagement

To ensure maximum uptake, mass campaigns such as SMC need to be well accepted by communities. Ensuring communities understand the rationale for SMC and support its implementation is therefore essential. Typically, this includes sensitisation meetings with local leaders, airing of radio spots, and town announcers disseminating relevant information during the campaign.

Training

SMC implementers are typically trained through a cascade model starting at the national level about one month before the SMC round, with each cadre of trainers subsequently training the next lower level of trainers and learners. All community distributors and supervisors attend a one- or two-day classroom training before the start of the campaign. Malaria Consortium has played a key role in developing the training materials used in the countries where we implement SMC.

SPAQ administration

Community distribution of SPAQ is at the heart of the SMC intervention. Each monthly course involves one dose of SP and three daily doses of AQ, with SP and the first dose of AQ given under the supervision of the community distributor, and the remaining two doses of AQ given by the caregiver

over the following two days. Malaria Consortium has led the development of guidance for SMC implementers, as well as tools to ensure high-quality implementation, for example job aids for community distributors.

Case management and pharmacovigilance

Children who are referred to health facilities by community distributors and who test positive for malaria infection should not receive SPAQ, but should be treated with effective antimalarial medicines according to country guidelines for the case management of malaria in children. While severe adverse events following administration of SPAQ are rare, mild side effects such as vomiting are more common. All adverse events should be reported via countries’ pharmacovigilance systems and followed up according to country guidelines.

Supervision

During SMC distribution, community distributors are assisted by field supervisors who receive more in-depth training on supervision and mentoring skills. Supervision is coordinated by salaried, facility-based health workers. Supervision is supported by district, provincial and central health authorities, as well as Malaria Consortium staff.

Monitoring and evaluation

Administrative monitoring data are collected by community distributors on tally sheets. Stock reconciliation data are collected through the national supply management systems. To identify areas that do not meet certain coverage or quality standards, Malaria Consortium routinely conducts end-of-cycle household surveys using lot quality assurance sampling methodology following all but the final SMC cycle. Following the end of the annual SMC round, Malaria Consortium commissions more comprehensive end-of-round household surveys to determine SMC coverage and quality of SMC implementation.

As an organisation, Malaria Consortium is committed to technical excellence. Within our SMC programme, much of our work is about continuous improvement of quality of SMC implementation, as well as contributing to the evidence base through M&E and research

[1] World Health Organization. WHO policy recommendation: seasonal malaria chemoprevention (SMC) for Plasmodium falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa. Geneva: WHO; 2012.

[2] WHO. World malaria report. Geneva: WHO, 2019.

[3] Meremikwu MM, et al. Intermittent preventive treatment for malaria in children living in areas with seasonal transmission. Cochrane Database of Systematic Reviews, 2012; (2).

[4] World Health Organization. World malaria report 2020: 20 years of global progress & challenges. Geneva: WHO; 2020.