Description
Introduction- Objectives: Seasonal Malaria Chemoprevention (SMC) remains a promising strategy to reduce the malaria burden in children living in malaria-endemic areas where the transmission is highly seasonal. The impact of the strategy can be reduced because of Plasmodium falciparum resistance to antimalarial drugs and full compliance to the treatment. Therefore, exploring alternative combination drugs for SMC is highly required. This study aimed to assess the effectiveness of dihydroartemisinine plus piperaquine (DHAPQ) for SMC among children under 10 years of age in Koulikoro district from 2021 to 2023.
Methodology: A total of 47 health catchments were selected within the district and randomized based on malaria prevalence, population size, net coverage, and distance to the Niger River to receive either Sulfadoxine Pyrimethamine plus Amodiaquine (SP+AQ) or DHAPQ for SMC from July to October each year. The ratio was 2 DHAPQ sites for 1 SPAQ site. The primary outcome was the incidence of clinical malaria after SMC treatment. Secondary outcomes were the prevalence of asymptomatic infection, anemia, SMC coverage, and compliance with full treatment doses.
Results and discussions: Both years, we observed significantly high coverage and compliance with treatment in the DHAPQ (p < 0.001). Incidence of clinical malaria was 45% and 27% lower in the DHAPQ arm in 2021 and 2022, respectively (IRR = 0.55, 95%CI = [0.52 - 0.59]) and IRR = 0.73, 95%CI = [0.66 - 0.82]). Age-stratified comparison shows a significant decrease in malaria incidence among children aged five and plus with approximately a reduction varying from 27% between the second and third rounds and up to 56% in the four weeks following the last round in October, corresponding to the peak of malaria in Koulikoro. In addition, treatment side effects were significantly higher in the SPAQ arm compared to the DHAPQ arm and were mainly represented by vomiting, headaches, and chills.
The prevalence of asymptomatic infection measured before the administration of SMC treatment shows a significant difference between the two study arms, with an average of 5.7% in the DHAPQ arm compared to 7.6% in the SPAQ arm (p = 0.04). A significant reduction in baseline anemia prevalence was observed in the DHAPQ at the end of the SMC season (p = 0.04).
Conclusion: Both SPAQ and DHAPQ were efficient for SMC in children under 10 years old. However, a significant reduction in clinical malaria incidence, asymptomatic infection, and anemia were observed among children treated with DHAPQ. In the absence of resistance to either SP or AQ, we can conclude that the high compliance to SMC treatment with DHAPQ due to the extremely low side effects observed in this arm compared to the SPAQ arm could explain these differences.
Keywords: malaria, SMC, DHAPQ, SPAQ, cluster RCT.
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