Developing a new approach to malaria prevention in children: seasonal malaria chemoprevention in West Africa

Children living in the Sahel region of Africa are highly vulnerable to seasonal malaria.

About 25 million children live in such areas where malaria continues to be a major cause of severe illness and death.

The School’s researchers in partnership with scientists in Senegal, Mali, The Gambia, Burkina Faso and Ghana have been at the forefront of research to combat malaria in this region which has led to the introduction of a new malaria prevention strategy known as Seasonal Malaria Chemoprevention (SMC).

Early studies undertaken by Sir Brian Greenwood, professor of clinical tropical medicine, showed how administering chemoprevention to children under the age of five during the malaria season could reduce child mortality by about 35%. However, the approach was not pursued because of concern over costs, and increasing use of insecticide-treated bed nets.

Interest in SMC revived in 2002, when a study by Badara Cisse, then a PhD student supervised by Brian Greenwood, showed that giving children under five a monthly dose of an antimalarial drug for three months reduced the incidence of malaria by 86%. A series of further studies found that the most effective drug regimen to use was a combination of sulphadoxine-pyrimethamine (SP) plus one dose of artsesunate (AQ), drugs which are slowly eliminated from the body and provide a high degree of protection for about one month after a three-day course of treatment.

Initial studies of the SP-AQ combination had been conducted in regions with low use of bed nets, so researchers then carried out a study in Mali and Burkina Faso which showed that SP-AQ gave added benefit in areas where bed nets were widely used. A 77% reduction in the incidence of uncomplicated malaria was observed in children who received this drug combination, with similar protection against severe malaria.

A large-scale effectiveness study conducted by School researchers Paul Milligan and Badara Cisse, with scientists in Senegal, showed that SMC can be delivered on a large scale by community health workers at reasonable cost, and that it is safe, acceptable to the community and highly effective.

After a review of the research in 2012, the World Health Organization recommended that children living in areas of the Sahel and sub-Sahel with highly seasonal malaria transmission should receive SMC for up to four months of the year. Regional meetings were then held with malaria control programme managers, initially led by the scientists to explain the new strategy and develop implementation plans, and subsequently organised by the West Africa regional Roll-Back Malaria network.

In 2014, SMC was implemented in Burkina Faso, Chad, Mali, Niger, Nigeria, Senegal, The Gambia and Togo, and a further five countries, Cameroon, Guinea, Guinea Bissau and Mauritania, have plans to introduce SMC. UNITAID recently announced a programme of $67million to improve access to SMC in the Sahel in 2015 and 2016.

The speed with which SMC has been implemented is seen as a model of how successful therapies and treatments should progress from research to practice.