An ambitious programme to protect children under five against malaria during the most dangerous months of the rainy season is being introduced across west Africa but funding constraints are a drag on progress.
Initial studies of the effect of seasonal malaria chemoprevention (SMC) at eight sites in Senegal, Mali, Ghana, Gambia and Burkina Faso achieved a 75 per cent reduction in malaria episodes, including severe malaria, and a possible reduction in child mortality of one in 1,000 with no reports of serious adverse affects.
These early successes led the World Health Organisation to draw up a set of implementation guidelines last November that have been adopted by 10 countries in the Sahel region of Africa. “This intervention has been shown to be effective, cost-effective, safe and feasible for the prevention of malaria among children less than five years of age,” the WHO says.
“This is now being rolled out in countrywide programmes over the forthcoming malaria transmission season starting in July and for the next four months,” says Peter Olumese, medical officer in the WHO’s global malaria programme. “We had a meeting with the 10 countries where we thought this would be a useful strategy. We wanted to plan along with them and provide support.”
More than 85 per cent of the estimated 216m annual cases of clinical malaria and 90 per cent of the 655,000 deaths occur in Africa south of Sahara. The vast majority of cases and deaths occur in young children.
“Across the Sahel subregion most childhood malaria mortality and morbidity occurs during the rainy season, which is generally short,” the WHO says. “Giving effective malaria treatment at intervals during this period has been shown to prevent illness and death from malaria in children.”
The pilot studies involved a range of antimalarial medicines administered on a monthly or bimonthly basis. This led to the WHO recommending a course of amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP) for children aged between three and 59 months at monthly intervals up to a maximum of four doses in areas of highly seasonal malaria transmission.
The areas thought most suitable for this approach were where more than 60 per cent of clinical malaria cases occurred within the four-month period of the rainy season, where the incidence of infection was greater than 10 per cent in the target age group and where the AQ+SP combination retained more than 90 per cent efficacy.
“How widely this programme is implemented depends on the resources and the money these countries have,” says Dr Olumese. “It represents good value for money because the effect is significant but most countries depend on external funding and this recommendation [from the WHO] has come midway in their funding cycle.”
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