Two-Year Scale-Up of Seasonal Malaria Chemoprevention Reduced Malaria Morbidity among Children in the Health District of Koutiala, Mali

Int J Environ Res Public Health. 2020 Sep 11;17(18):6639. doi: 10.3390/ijerph17186639.

Abstract

Background: Previous controlled studies demonstrated seasonal malaria chemoprevention (SMC) reduces malaria morbidity by >80% in children aged 3-59 months. Here, we assessed malaria morbidity after large-scale SMC implementation during a pilot campaign in the health district of Koutiala, Mali.

Methods: Starting in August 2012, children received three rounds of SMC with sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). From July 2013 onward, children received four rounds of SMC. Prevalence of malaria infection, clinical malaria and anemia were assessed during two cross-sectional surveys conducted in August 2012 and June 2014. Investigations involved 20 randomly selected clusters in 2012 against 10 clusters in 2014.

Results: Overall, 662 children were included in 2012, and 670 in 2014. Children in 2014 versus those surveyed in 2012 showed reduced proportions of malaria infection (12.4% in 2014 versus 28.7% in 2012 (p = 0.001)), clinical malaria (0.3% versus 4.2%, respectively (p < 0.001)), and anemia (50.1% versus 67.4%, respectively (p = 0.001)). A propensity score approach that accounts for environmental differences showed that SMC conveyed a significant protective effect against malaria infection (IR = 0.01, 95% CI (0.0001; 0.09), clinical malaria (OR = 0.25, 95% CI (0.06; 0.85)), and hemoglobin concentration (β = 1.3, 95% CI (0.69; 1.96)) in 2012 and 2014, respectively.

Conclusion: SMC significantly reduced frequency of malaria infection, clinical malaria and anemia two years after SMC scale-up in Koutiala.

Keywords: Mali; malaria; morbidity; seasonal malaria chemoprevention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antimalarials* / therapeutic use
  • Chemoprevention
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Drug Combinations
  • Female
  • Humans
  • Infant
  • Malaria* / epidemiology
  • Malaria* / prevention & control
  • Mali / epidemiology
  • Morbidity
  • Pyrimethamine / therapeutic use
  • Seasons
  • Sulfadoxine / therapeutic use

Substances

  • Antimalarials
  • Drug Combinations
  • Sulfadoxine
  • Pyrimethamine