Averting Malaria with Seasonal Malaria Chemoprophylaxis

By Dr. Dorothy Echodu, Chief Executive Officer and MPI Ambassador, Edited by Dr. Wendy Thanassi, Board Member, MPI 

Seasonal malaria chemoprophylaxis (SMC) is “the intermittent administration of a curative dose of antimalarial medicine during the malaria season, regardless of whether the child is infected with malaria.[1]” Typically, 3 to 5 monthly cycles of sulfadoxine-pyrimethamine plus amodiaquine (SP+AQ) are given to children under 5.

In the new WHO Guidelines for malaria released November 2022, country programs are given the latitude to decide where and when to use SMC, though the guidelines note that SMC is likely to be most effective where transmission is intensely seasonal[2].

SMC was first recommended in 2012 for use in the band of semi-arid countries in the Sahel region (the word “sahel” comes from the Arabic meaning “shore” and marks the littoral zone between the Sahara Desert and the savannah grasslands).

Over the last decade, SMC has been very successful, averting 80% of malaria cases in children 3-59 months old, and saving health systems and families significant amounts of money[3].

Recently, countries beyond the Sahel have begun to trial SMC. Uganda conducted a successful trial of SMC in two districts in the highly infected northeastern region of Karamoja , where monthly cycles of SP + AQ were delivered from May through September.

The results were so encouraging --90% effectiveness in preventing cases in that period, relative to control-- that Uganda is now making SMC part of national country policy, and will scale up SMC to the remaining 5 districts in the Karamoja region in the near future

[1] WHO Guidelines for malaria, 25 November 2022. Geneva: World Health Organization; 2022 (WHO/UCN/GMP/ 2022.01 Rev.3). License: CC BY-NC-SA 3.0 IGO.

[2] WHO Guidelines for malaria, 25 November 2022. Geneva: World Health Organization; 2022 (WHO/UCN/GMP/ 2022.01 Rev.3). License: CC BY-NC-SA 3.0 IGO.

[3] Gilmartin, Colin, et al. "Seasonal malaria chemoprevention in the Sahel subregion of Africa: a cost-effectiveness and cost-savings analysis." The Lancet Global Health 9.2 (2021): e199-e208.