Seasonal malaria chemoprevention
Malaria is preventable and treatable, but many children living in African countries die from malaria before their 5th birthday. Malaria Consortium has proven the feasibility and impact of seasonal malaria chemoprevention (SMC) at scale. SMC, which consists of 4 monthly doses of sulfadoxine-pyrimethamine plus amodiaquine (SP + AQ), is recommended by the World Health Organization (WHO) as one of the most effective interventions for the prevention of malaria in areas where malaria transmission is highly seasonal and resistance to SP + AQ is low, such as the Sahel region of Africa. With areas in the Sahel having the highest incidence of malaria in the world, it is now an urgent priority to close the gap and reach all eligible children.
SMC has been shown to be highly effective and feasible for the prevention of malaria among children in areas where the malaria transmission season is no longer than 4 months. SMC involves administering up to 4 monthly doses of antimalarial drugs to children aged 3–59 months during peak malaria transmission season. Since it was approved by the WHO, SMC has been found to prevent up to 89% of malaria cases.
SMC is also highly cost effective in preventing malaria. Malaria Consortium led costing studies in 7 countries to estimate the provider cost of SMC in 2015 ($1 USD per child per month) and in 2016 ($0.85 USD per child per month), giving estimates of an average cost of $3.40 USD to protect one child from malaria during the rainy season with SMC.
What Malaria Consortium is doing
Malaria Consortium has been leading the way on SMC globally, initially through its pilot project in northern Nigeria in 2012–2014. From 2015 through 2017, Malaria Consortium led the Unitaid-funded ACCESS-SMC project to scale up SMC coverage in 7 Sahelian countries (Burkina Faso, Chad, Guinea Conakry, Mali, Niger, Nigeria, and The Gambia). As a result, SMC was shown to be safe, inexpensive, and effective. A total of 60,000 deaths and 10 million cases of malaria were estimated to have been averted.
After the end of the ACCESS-SMC project, Malaria Consortium has continued to deliver SMC to 4 million children in Nigeria, Burkina Faso, and Chad though GiveWell-directed funding. In 2019 and 2020 Malaria Consortium plans to reach over 5 million children.
Malaria Consortium works with every level of a country’s health system to deliver SMC. The organization supports each national government to develop high-level plans and policies, sharing its expertise in supply chain management, health worker training, community mobilization, safety monitoring, and impact evaluation. Malaria Consortium ensures that all stakeholders are involved in the SMC delivery and evaluation process, from the National Malaria Control Program managers and health officials who set and execute the policies and plans, to the drivers who deliver the commodities, the community health workers who administer the treatments to children, and the supervisors who ensure quality of service delivery and data capture.
As well as training and mobilizing community health workers to deliver SMC, Malaria Consortium also arranges the dissemination of public health and behaviour change communications materials to inform local people of the importance of the treatment and how they can access it. Malaria Consortium works with supply chain agencies to ensure a steady, reliable flow of the SMC drugs, from their arrival in-country to the point of distribution, and to ensure that they are monitored and kept secure.
An estimated 28–34 million children are eligible for SMC, with an estimated gap of 12–18 million eligible who are not yet receiving SMC. The potential for SMC is enormous — from saving lives and reducing illness, to preventing school absenteeism and boosting economic growth. If all children eligible for SMC had access to it, some 175,000 lives could be saved each year, and 18 million malaria cases could be prevented. It is urgent to close this gap and maximize the impact of this intervention. Malaria can be prevented, and in the Sahel and sub-Sahel regions of Africa, SMC can make an important contribution.