SMC-NUT: Assessment of a combined strategy of seasonal malaria chemoprevention + nutrients and vitamin A-Zinc supplementation to tackle malaria and malnutrition in Burkina Faso

Objectives

• Aim 1: To assess the feasibility of combining two different strategies lead by different programmes (malaria and nutrition) which affect the same target population (children under five years). SMC is a larger community-based intervention at a national level lead by the NMCP. National Nutrition Program is trying to scale up the Community Management of Acute Malnutrition (CMAM). This project will serve as a pilot of an integrated strategy in order to mutualise resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels.
• Aim 2: To boost the impact of SMC intervention in terms of reducing malaria morbidity, mortality and reduce the burden of malnutrition and anaemia in children under five years through supplementation with micronutrients and Vitamin A-Zinc.
• Aim 3: To assess the impact of this combined strategy on the circulating parasite population. Sustainability of SMC efficacy relies on the sensitivity of the circulating parasite population to Amodiaquine and Sulfadoxine Pyrimethamine. Drug pressure, especially in wide-scale community-based intervention such as SMC and intermittent Preventive Treatment (IPT) could lead to a selection of less sensitive mutant strains that could compromise the effectiveness of the intervention in a long-term period. Therefore, the project aims to assess the impact of SMC and the combined strategy on the circulating parasite population.
• Aim 4: To reinforce the capacity of the Clinical Research Unit Nanoro. The IRSS/CRUN was established in 2008 and has been elected as Regional Division of IRSS in 2016. This is a collaborative and sustainable project. The implementation of the project will involve the creation of new platforms and the development of the existing platform. Educational opportunities will be offered to young researchers, covering the topics of nutrition, and molecular biology.

The specific objectives are:

• Primary objective 1: to assess in a randomised superiority trial whether SMC + Vitamin A-Zinc or SMC+ Plumpy’Nut® is more effective and safe in reducing uncomplicated malaria incidence, severe malaria incidence and related mortality compared to the SMC alone
• Primary objective 2: to investigate the impact of the combined strategy in reducing the burden of malnutrition through reduction of anaemia incidence, mid-upper arm circumference gain, and weight gain.
• Secondary objective 1: to assess the impact of each treatment arm on the circulation parasite population through monitoring the temporal trend of antimalarial resistance molecular markers pfcrt, pfmdr1, dhfr and dhps.
• Secondary objective 2: to assess the coverage and compliance to SMC in the study area.
• Secondary objective 3: to determine the overall risk of adverse events (AEs).