Abstract
BackgroundSeasonal malaria chemoprevention is widely implemented in Sahel and sub-Sahel countries in Africa. Few studies have assessed the impact of the SMC on hospital admission and death when it is implemented in the health system. This retrospective study assessed the impact of seasonal malaria chemoprevention (SMC) on hospitalizations and deaths of children under 5 years of age during the second year of implementation of SMC in the health district of Ouelessebougou in Mali.MethodsIn February 2017, a survey was conducted to assess hospital admissions and deaths in children under 5 years of age in two health sub-districts where SMC was implemented in 2015 and two health sub-districts where SMC was not implemented. The survey reviewed deaths and hospitalizations of children under 5, in the four health sub-districts. The crude and specific incidence rates of hospitalizations and deaths were determined in both groups and expressed per 1000 children per year. A negative binomial regression model and a Cox model were used to estimate the relative risks of hospitalization and death after adjusting for confounders. The R software was used for data analysis.ResultsA total of 6638 children under 5 years of age were surveyed, 2759 children in the SMC intervention areas and 3879 children in the control areas. All causes mortality rate per 1000 person-years was 8.29 in the control areas compared to 3.63 in the intervention areas; age and gender adjusted mortality rate ratio 0.44 (95% CI 0.22–0.91), p = 0.027. The incidence rate of all causes hospital admissions was 19.60 per 1000 person-years in the intervention group compared to 33.45 per 1000 person-years in the control group, giving an incidence rate ratio (IRR) adjusted for age and gender of 0.61 (95% CI 0.44–0.84), p = 0.003.ConclusionThe implementation of SMC was associated with a substantial reduction in hospital admissions and all-cause mortality. Trial registration ClinicalTrials.gov NCT02646410.
Highlights
Seasonal malaria chemoprevention is widely implemented in Sahel and sub-Sahel countries in Africa
The incidence rate of all causes hospitalizations was 19.60 per 1000 person-years in health areas that received seasonal malaria chemoprevention (SMC) versus 33.45 per 1000 in health areas that did not receive SMC with an incidence rate ratio (IRR) of 0.58
After adjusting for age and gender using a negative binomial regression model, the incidence rate ratios (IRR) remained unchanged 0.61, corresponding to a 39% reduction in hospitalizations for all causes
Summary
Seasonal malaria chemoprevention is widely implemented in Sahel and sub-Sahel countries in Africa. In sub-Saharan Africa, over the last 15 years, the underfive mortality rate has decreased overall by 57% (95% CI 46% to 65%) [1]. 39 million children under 5 years of age live in areas of sub-Saharan Africa where SMC is deemed appropriate. In these areas, 33.7 million episodes of malaria and 152,000 deaths of children due to malaria are reported each year [4]. In Mali, the mortality rate among children under 5 was estimated at 95 per 1000 in 2014, with a higher risk of death for young children in rural areas than in urban areas (11.3% versus 6.4%) [5]
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