Impact Evaluation of Seasonal Malaria Chemoprevention under Routine Program Implementation: A Quasi-Experimental Study in Burkina Faso

Thomas Druetz,Nicolas Corneau-Tremblay,Antarou Ly,Slim Haddad,Abel Bicaba,Seni Kouanda,Tieba Millogo

doi:10.4269/ajtmh.17-0599

Abstract

.Seasonal malaria chemoprevention (SMC) for children < 5 is a strategy that is gaining popularity in West African countries. Although its efficacy to reduce malaria incidence has been demonstrated in trials, the effects of SMC implemented in routine program conditions, outside of experimental contexts, are unknown. In 2014 and 2015, a survey was conducted in 1,311 households located in Kaya District (Burkina Faso) where SMC had been recently introduced. All children < 72 months were tested for malaria and anemia. A pre–post study with control group was designed to measure SMC impact during high transmission season. A difference-in-differences approach was coupled in the analysis with propensity score weighting to control for observable and time-invariant nonobservable confounding factors. SMC reduced the parasitemia point and period prevalence by 3.3 and 24% points, respectively; this translated into protective effects of 51% and 62%. SMC also reduced the likelihood of having moderate to severe anemia by 32%, and history of recent fever by 46%. Self-reported coverage for children at the first cycle was 83%. The SMC program was successfully added to a package of interventions already in place. To our knowledge, with prevalence < 10% during the peak of the transmission season, this is the first time that malaria can be reported as hypo-endemic in a sub-Sahelian setting in Burkina Faso. SMC has great potential, and along with other interventions, it could contribute to approaching the threshold where elimination strategies will be envisioned in Burkina Faso.

Highlights

Despite encouraging signs of a recent reduction in transmission,[1,2] malaria remains one of the most important public health problems in Burkina Faso
Its efficacy to reduce malaria incidence has been demonstrated in trials, the effects of Seasonal malaria chemoprevention (SMC) implemented in routine program conditions, outside of experimental contexts, are unknown
SMC has great potential, and along with other interventions, it could contribute to approaching the threshold where elimination strategies will be envisioned in Burkina Faso

Summary

Introduction

Despite encouraging signs of a recent reduction in transmission,[1,2] malaria remains one of the most important public health problems in Burkina Faso. SMC usually consists of three or four cycles of drug administration per year, depending on Clinical trials and meta-analyses have demonstrated the efficacy of SMC to reduce malaria incidence during the intervention period and parasitemia prevalence at the end of the transmission season and suggest a positive impact on allcause mortality.[14,15] Experimental studies have found evidence of a lower prevalence of moderate to severe anemia, but this reduction was not always significant across trials.[16,17,18,19] some trials suggest that SMC is associated with greater weight gain or improvement of malnutrition indices.[16,17,20] Monthly administration of SP-3AQ was found to be the drug regimen with the highest efficacy,[21,22,23] and using community health workers (CHWs) to deliver it is more cost-effective than using facility-based nurses, immunization outreach clinics, or outreach trekking teams.[24,25]

Methods

Results

Discussion

Conclusion