Phase one of a hybrid effectiveness-implementation study to assess the feasibility, acceptability and effectiveness of implementing seasonal malaria chemoprevention in Nampula Province, Mozambique

Authors: Kevin Baker, Ivan Alejandro Pulido Tarquino, Pedro Aide, Craig Bonnington, Christian Rassi, Sol Richardson, Chuks Nnaji, Arantxa Roca-Feltrer, Maria Rodrigues, Mercia Sitoe, Sonia Enosse, Caitlin McGugan, Francisco Saute, Gloria Matambisso, Baltazar Candrinho

Results suggest that seasonal malaria chemoprevention (SMC) is effective at preventing clinical malaria in under-fives and does not significantly affect levels of drug resistance. SMC was positively accepted by the community in the study districts.

Background

Seasonal malaria chemoprevention (SMC) is a highly effective intervention for malaria prevention in high burden areas with seasonal transmission, historically implemented in the Sahel. Mozambique contributes to four percent of global malaria cases. Malaria Consortium, in partnership with the National Malaria Control Programme, conducted a two-year phased SMC study in Nampula province using sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ), or SPAQ, in children under five. Phase one results presented here highlight acceptability, feasibility and protective effect of SMC.

Methods

A pragmatic type II hybrid effectiveness-implementation study design was adopted, using mixed methods. The study was conducted in three districts, utilising: (1) non-randomised controlled trial reporting on malaria incidence; (2) drug resistance molecular marker study reporting on resistance marker changes over time; (3) coverage and quality assessment on the SMC distribution; and (4) a qualitative acceptability and feasibility assessment with stakeholders.

Results

Children who received SMC had 86 percent (hazard ratio 0.14, 95 percent CI 0.09–0.24) lower hazards of developing clinical malaria during the peak transmission season compared with children in the comparison district. Prevalence of SP molecular markers associated with resistance was high at baseline (K540E 66.1 percent). SMC achieved high coverage of eligible children over four cycles (87.7 percent, 95 percent CI 83.9–90.8 percent). Qualitative results indicate SMC was positively accepted by the targeted community.

Conclusions

Results suggest that SMC was effective at preventing clinical malaria, did not significantly impact resistance profile and was feasible and acceptable in the context. Phase two will assess SMC impact in reducing malaria incidence and if chemoprevention efficacy of SPAQ is impacted by drug resistance and drug concentrations.

Published in Malaria Journal