Abstract
ObjectiveTo investigate the effectiveness of seasonal malaria chemoprevention (SMC) and community case management with long‐acting artemisinin‐based combination therapies (ACTs) for the control of malaria in areas of extended seasonal malaria transmission.MethodIndividually randomised, placebo‐controlled trial in the Ashanti Region of Ghana. A total of 2400 children aged 3–59 months received either: (i) a short‐acting ACT for case management of malaria (artemether‐lumefantrine, AL) plus placebo SMC, or (ii) a long‐acting ACT (dihydroartemisinin‐piperaquine, DP) for case management plus placebo SMC or (iii) AL for case management plus active SMC with sulphadoxine‐pyrimethamine and amodiaquine. SMC or placebo was delivered on five occasions during the rainy season. Malaria cases were managed by community health workers, who used rapid diagnostic tests to confirm infection prior to treatment.ResultsThe incidence of malaria was lower in children given SMC during the rainy season. Compared to those given placebo SMC and AL for case management, the adjusted hazard ratio (aHR) was 0.62 (95% CI: 0.41, 0.93), P = 0.020 by intention to treat and 0.53 (95% CI: 0.29, 0.95), P = 0.033 among children given five SMC courses. There were no major differences between groups given different ACTs for case management (aHR DP vs. AL 1.18 (95% CI 0.83, 1.67), P = 0.356).Conclusion SMC may have an important public health impact in areas with a longer transmission season, but further optimisation of SMC schedules is needed to maximise its impact in such settings.
Highlights
Seasonal malaria chemoprevention (SMC) is a highly effective means to control malaria in areas with a short rainy season, where a large proportion of the annual malaria burden occurs within a few months of the year [1]
A community distribution of insecticidetreated nets had occurred within the 6 months preceding the baseline survey; most nets were new and insecticide treated, and 82.3% of children reported sleeping under an insecticide-treated net the night before the survey
We investigated an extended programme of seasonal malaria chemoprevention, and case management with a long-acting artemisinin-based combination therapies (ACTs) in an area of Ghana with a long rainy season with two peaks
Summary
Seasonal malaria chemoprevention (SMC) is a highly effective means to control malaria in areas with a short rainy season, where a large proportion of the annual malaria burden occurs within a few months of the year [1]. Most studies of SMC have taken place in areas with a short rainy season [3,4,5,6,7], and current evidence suggests that, for SMC to be appropriate, 60% of the total annual burden of malaria should occur within 4 months of the year [8]. If SMC were effective in such areas, this would substantially increase the overall population that could be protected by SMC and would help to reduce the large burden of malaria in children in West Africa.
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