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The research, published in The Lancet, demonstrates the impact of Seasonal Malaria Chemoprevention (SMC), a combination of sulfadoxine-pyrimethamine antimalarials with amodiaquine, given as tablets once a month, during the four-month rainy season, community.
SMC has already shown that it has significantly reduced malaria cases among children, but this new study is “the first evidence of the impact on malaria deaths in children”, so the authors call for broad administration across West Africa. and Central.
The study “Achieving Catalytic Expansion of SMC in the Sahel” (ACCESS-SMC), now published, evaluated the safety and efficacy of SMC in terms of scale, cost of delivery, cost-effectiveness and effects on resistance. to drugs between 2015 and 2016 in seven countries: Burkina Faso, Chad, Gambia, Guinea, Mali, Niger and Nigeria.
Low levels of resistance to seasonal treatments have been identified, but the authors believe continuous molecular monitoring is necessary to provide an early warning of loss of efficacy.
In 2019, malaria caused 643,000 deaths worldwide and more than half (356,000) were children under the age of 5, the vast majority in West and Central Africa.
In the sub-Sahelian region of Africa (from southern Senegal and northern Guinea to Chad and northern Cameroon), SMC is given to children monthly during the rainy season.
The tablets are given over three days: two on the first day, one on the second and another on the third.
Some clinical studies have indicated a 75% reduction in malaria, including severe malaria.
For Paul Milligan, of the London School of Hygiene & Tropical Medicine (UK), one of the study authors, “this assessment of the increased implementation of SMC provides the first evidence of an impact in reducing malaria deaths in children.”
The project increased demand for SMC drugs, which in turn encouraged drug manufacturers to increase capacity and develop child-friendly formulations.
There are currently programs in 13 countries that reached around 22 million children in 2019. However, around eight million children living in areas suitable for CMS are neglected. Delivery needs to be optimized to ensure high levels of coverage in all regions, according to the publication.
During the reporting period, SMC reduced malaria deaths among children during the rainy season by 42% in Burkina Faso and 57% in Gambia.
The incidence of severe malaria was reduced in The Gambia by 55% in 2015 and 2016 and by 27% in Burkina Faso in 2015. Data for 2016 were not available.
In all seven countries, outpatient malaria cases declined, from a 25% reduction in Nigeria in 2016 to 59% in Gambia in the same year.
Each monthly treatment demonstrated a high degree of personal protection for four weeks, reducing the incidence of malaria by more than 80% during this period.
Protection then drops rapidly, with the drug reducing the incidence of malaria by 61% between days 29 and 42 after treatment.
For this reason, the authors state, treatments must have a tight interval of 28 days to maintain high levels of protection.
The study reports that in 2015, more than 12 million monthly SMC treatments were administered to a target population of over 3.6 million children and 25 million SMC treatments in 2016 to a target population of 7.6 million children.
In 2015, 86% of children received at least one treatment, while 55% received all four treatments. On average, 76% of children received treatment each month. Similar numbers received treatment in 2016. In both years, coverage varied across the seven countries.
Door-to-door delivery has proven to be the most effective method of reaching children, especially in the poorest areas.
The safety check through the national pharmacovigilance system in each country has been improved to ensure that the drug remains safe when administered on a large scale.
Serious adverse reactions were uncommon, which was in line with previous clinical studies.
In 779 single case safety reports related to MSC treatment that were available in the study, including cases of rash and gastrointestinal upset, 36 serious adverse drug reactions were recorded, but all of these children recovered and no cases of skin reactions severe was reported in the study.
Yacine Djibo, executive director of Speak Up Africa and author of the study, said: “Despite the difficulties of providing monthly door-to-door care, it is possible to achieve high coverage while reducing the unacceptable infant mortality rate associated with malaria.”
“These findings should support efforts to maintain high levels of SMC coverage and it is very encouraging to see that, since the end of ACCESS-SMC, project countries have successfully switched to other sources of funding and more countries have initiated seasonal chemoprevention programs. malaria “.
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