A Decade of Progress Accelerating Malaria Control in Mali: Evidence from the West Africa International Center of Excellence for Malaria Research

Doumbia, Seydou; Sogoba, Nafomon; Diakité, Mahamadou; Touré, Mahamoudou; Keïta, Moussa; Konaté, Drissa; Diawara, Sory Ibrahima; Diarra, Ayouba; Sanogo, Daouda; Kané, Fousseyni; Diakité, Seidina A. S.; Traoré, Karim; Thiam, Sidibé M’Baye; Traorè, Sékou F.; Cissé, Idrissa; Mihigo, Jules; Coulibaly, Mamadou B.; Dabitao, Djeneba; Alifrangis, Michael; Barry, Alyssa E.; Müller, Gunter C.; Beier, John C.; Shaffer, Jeffrey G.

doi:10.4269/ajtmh.21-1309

Cited by 7 publications

(4 citation statements)

References 34 publications

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“…Through November 2022, a total of 4556 children were enrolled during the pilot phase (2019-2020) in 9 villages across the Koulikoro Health District. In 2022, preliminary findings have been presented at the American Society of Tropical Medicine Conference [ 16 ] and published in the American Journal of Tropical Medicine and Hygiene [ 17 ]. SP-AQ and DHA-PQ were highly effective in reducing P falciparum malaria in children 5-9 years in Koulikoro, Mali, at both the pilot and district-wide study phases.…”

Section: Resultsmentioning

confidence: 99%

Seasonal Malaria Chemoprevention Therapy in Children Up To 9 Years of Age: Protocol for a Cluster-Randomized Trial Study

Toure,

Shaffer,

Sanogo

et al. 2024

JMIR Res Protoc

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Background Seasonal malaria chemoprevention (SMC) is recommended by the World Health Organization for the sub-Sahel region in sub-Saharan Africa for preventing malaria in children 3 months old to younger than 5 years. Since 2016, the Malian National Malaria Control Program has deployed SMC countrywide during its high malaria transmission season at a rate of 4 monthly cycles annually. The standard SMC regimen includes sulfadoxine-pyrimethamine (SP) plus amodiaquine (AQ). Resistance against SP is suspected to be rising across West Africa; therefore, assessing the effectiveness of an alternative antimalarial drug for SMC is needed to provide a second-line regimen when it is ultimately needed. It is not well understood whether SMC effectively prevents malaria in children aged 5 years or older. Objective The primary goal of the study is to compare 2 SMC regimens (SP-AQ and dihydroartemisinin-piperaquine [DHA-PQ]) in preventing uncomplicated Plasmodium falciparum malaria in children 3 months to 9 years old. Secondly, we will assess the possible use of DHA-PQ as an alternative SMC drug in areas where resistance to SP or AQ may increase following intensive use. Methods The study design is a 3-arm cluster-randomized design comparing the SP-AQ and DHA-PQ arms in 2 age groups (younger than 5 years and 5-9 years) and a control group for children aged 5-9 years. Standard SMC (SP-AQ) for children younger than 5 years was provided to the control arm, while SMC with SP-AQ was delivered to children aged 3 months to 9 years (arm 2), and SMC with DHA-PQ will be implemented in study arm 3 for children up to 9 years of age. The study was performed in Mali’s Koulikoro District, a rural area in southwest Mali with historically high malaria transmission rates. The study’s primary outcome is P falciparum incidence for 2 SMC regimens in children up to 9 years of age. Should DHA-PQ provide an acceptable alternative to SP-AQ, a plausible second-line prevention option would be available in the event of SP resistance or drug supply shortages. A significant byproduct of this effort included bolstering district health information systems for rapid identification of severe malaria cases. Results The study began on July 1, 2019. Through November 2022, a total of 4556 children 3 months old to younger than 5 years were enrolled. Data collection ended in spring 2023, and the findings are expected to be published later in early 2024. Conclusions Routine evaluation of antimalarial drugs is needed to establish appropriate SMC age targets. The study goals here may impact public health policy and provide alternative therapies in the event of drug shortages or resistance. Trial Registration ClinicalTrials.gov NCT04149106, https://clinicaltrials.gov/ct2/show/NCT04149106 International Registered Report Identifier (IRRID) DERR1-10.2196/51660

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Section: Resultsmentioning

confidence: 99%

Seasonal Malaria Chemoprevention Therapy in Children Up To 9 Years of Age: Protocol for a Cluster-Randomized Trial Study

Toure,

Shaffer,

Sanogo

et al. 2024

JMIR Res Protoc

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“…It is worth noting that WHO updated its recommendations on SMC in the WHO Guidelines for Malaria in June 2022, which is more flexible and different from the original 2021 version in a couple of significant ways: Areas outside the Sahel with highly seasonal malaria transmission could also benefit from SMC; SMC can be given without defining the specific number of cycles; SMC can be extended to children over six years old. The move by WHO has enabled National malaria programs (NMPs) in local countries to tailor their strategies to the settings and increase the impact of SMC when applied together with LLINs and the malaria vaccine [ 51 , 60 , 71 ].…”

Section: Resultsmentioning

confidence: 99%

Seasonal malaria chemoprevention in Africa and China’s upgraded role as a contributor: a scoping review

et al. 2023

Infect Dis Poverty

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Background Children under five are the vulnerable population most at risk of being infected with Plasmodium parasites, especially in the Sahel region. Seasonal malaria chemoprevention (SMC) recommended by World Health Organization (WHO), has proven to be a highly effective intervention to prevent malaria. Given more deaths reported during the COVID-19 pandemic than in previous years due to the disruptions to essential medical services, it is, therefore, necessary to seek a more coordinated and integrated approach to increasing the pace, coverage and resilience of SMC. Towards this end, fully leverage the resources of major players in the global fight against malaria, such as China could accelerate the SMC process in Africa. Methods We searched PubMed, MEDLINE, Web of Science, and Embase for research articles and the Institutional Repository for Information Sharing of WHO for reports on SMC. We used gap analysis to investigate the challenges and gaps of SMC since COVID-19. Through the above methods to explore China’s prospective contribution to SMC. Results A total of 68 research articles and reports were found. Through gap analysis, we found that despite the delays in the SMC campaign, 11.8 million children received SMC in 2020. However, there remained some challenges: (1) a shortage of fully covered monthly courses; (2) lack of adherence to the second and third doses of amodiaquine; (3) four courses of SMC are not sufficient to cover the entire malaria transmission season in areas where the peak transmission lasts longer; (4) additional interventions are needed to consolidate SMC efforts. China was certified malaria-free by WHO in 2021, and its experience and expertise in malaria elimination can be shared with high-burden countries. With the potential to join the multilateral cooperation in SMC, including the supply of quality-assured health commodities, know-how transfer and experience sharing, China is expected to contribute to the ongoing scale-up of SMC. Conclusions A combination of necessary preventive and curative activities may prove beneficial both for targeted populations and for health system strengthening in the long run. More actions are entailed to promote the partnership and China can be one of the main contributors with various roles.

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“…As SMC and PMC are rolled out over larger areas, monitoring for antimalarial resistance will be important. Recent studies disagree on SMC's effects on resistance, with some showing an increase in molecular resistance markers and others showing that resistance markers remained rare [22 ▪▪ ,25–27]. Also, in an area with previously documented high levels of molecular resistance markers, SMC with SP+AQ remained highly effective, so the clinical relevance of molecular resistance markers is not always clear [14 ▪ ].…”

Section: Malaria Chemopreventionmentioning

confidence: 98%

“…Although the WHO recommends SP+AQ specifically for SMC because of long-term studies that show benefit without serious adverse events, some groups have explored therapeutic alternatives to SP+AQ. A study done in Mali indicated that dihydroartemisinin-piperaquine (DHA+PQ) is potentially more efficacious than SP+AQ against clinical malaria in children 3 months to 5 years of age [22 ▪▪ ]. Another trial done in Mali reported similar performance of DHA+PQ and SP+AQ, and that DHA+PQ was better tolerated, with lower rates of abdominal pain, headache, and vomiting [23 ▪ ].…”

Section: Malaria Chemopreventionmentioning

confidence: 99%

Malaria prevention in children: an update

Friedman-Klabanoff,

Adu-Gyasi,

Asante

2024

Current Opinion in Pediatrics

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Purpose of review Malaria cases and deaths decreased from 2000 to 2015 but remain increased since 2019. Several new developments and strategies could help reverse this trend. The purpose of this review is to discuss new World Health Organization (WHO) guidelines and recent research on malaria prevention in children. Recent findings Fifteen countries have now rolled out seasonal malaria chemoprophylaxis (SMC) in children at highest risk for severe malaria, and new WHO recommendations provide more flexibility for SMC implementation in terms of target age groups, geographic region, and number of cycles. Recent studies confirm that malaria burden in school aged children, and their contribution to transmission, is high. New guidelines permit expanded chemoprevention options for these children. Two vaccines have been approved for use in malaria endemic countries, RTS,S/AS01E and R21/Matrix-M. Additionally, pyrethroid-chlorfenapyr bed nets are being deployed to combat resistant mosquitoes. Summary While challenges remain in malaria control towards elimination, new guidelines and recently approved vaccines offer hope. Monitoring for continued vaccine and chemoprevention effectiveness, and for possible epidemiologic shifts in severe malaria presentation and deaths as additional prevention efforts roll out will be paramount.

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A Decade of Progress Accelerating Malaria Control in Mali: Evidence from the West Africa International Center of Excellence for Malaria Research

Cited by 7 publications

References 34 publications

Seasonal Malaria Chemoprevention Therapy in Children Up To 9 Years of Age: Protocol for a Cluster-Randomized Trial Study

Seasonal Malaria Chemoprevention Therapy in Children Up To 9 Years of Age: Protocol for a Cluster-Randomized Trial Study

Seasonal malaria chemoprevention in Africa and China’s upgraded role as a contributor: a scoping review

Malaria prevention in children: an update

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