Effectiveness, feasibility and acceptability of seasonal malaria chemoprevention in Aweil South district in Northern Bahr el Gazal, South Sudan: a type 2 hybrid effectiveness-implementation study using a convergent mixed-methods approach

To prevent malaria among those most vulnerable to the disease in areas where malaria transmission is seasonal, the World Health Organization (WHO) recommends seasonal malaria chemoprevention (SMC). SMC involves the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) [SPAQ] to children between 3 and 59 months during the rainy season. Each full course of SPAQ confers protection from malaria for approximately 28 days. This intervention has shown to be 75% effective in preventing uncomplicated and severe malaria in children under five during this high-risk period (Baba et al 2020). Because resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel region of West and Central Africa. However, it has been suggested that SP may retain its effectiveness even in areas where resistance is high (>90%), i.e. where one or more resistance markers in samples of circulating malaria parasites are present. There is therefore a need to test the feasibility and effectiveness of SMC, as well as the protective efficacy of SPAQ, in areas in Eastern and Southern Africa where malaria transmission is seasonal. In South Sudan, childhood mortality has stagnated at 96/1,000 live births since 2016. Malaria is the leading cause of mortality and morbidity, responsible for 40% of hospital consultations and admissions, 33.9% of hospital deaths and 25% of deaths in children under five. Malaria incidence is estimated at 239/1,000 hospital consultations and is estimated to have doubled in rate since 2015 due to conflict, poverty, malnutrition and climate change. Bednet use is low at just 28% due to limited distribution and challenges of maintenance during movement and displacement.

• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Prevention

ClinicalTrials.gov Identifier: NCT05471544

Project Details

Drug Resistance
Drug-based Strategies
Vulnerable Populations

Jun 2022 — Dec 2023

$150,000

South Sudan

Seasonal Malaria Chemoprevention (SMC)