Photo : © Simon Rolin/MSF
Contact
MSF Head of mission, Mali
Tél : +223 73 29 51 56
E-mail : [email protected]
Project Summary Note
SEASONAL MALARIA CHEMOPROVENTION (SMC)
Koutiala district, Sikasso region, Mali
Implementation period: July – October 2012
DEFINITION
SMC (seasonal malaria chemoprevention) is the new nomenclature adopted by the World Health Organization (WHO) in 2011
for intermittent preventive treatment administered to infants (IPTi). It involves a combination of antimalarial drugs – in
therapeutic doses – given during the season when the risk of malaria transmission is highest. The goal of this intervention
is to reduce malaria morbidity and mortality. The drugs recommended for use with this strategy are a combination of
sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). They drugs have an active effect of approximately 28 days after they
are administered.
STRATEGY
In March 2012, the WHO recommended implementing SMC with children ages 3 – 59 months in areas where more than 60%
of cases of seasonal malaria transmission occur during a period of up to four months. The studies published on this intervention
showed a reduction of more than 80% of cases of simple malaria and of more than 70% of cases of severe malaria, even
when implemented in areas where long-lasting insecticidal mosquito nets (LLIN) are used. The distribution of LLINs in Mali
is part of the national anti-malaria strategy.
In 2012, the country’s Ministry of Health integrated the SMC into its National Malaria Control Program (NMCP). Médecins Sans
Frontières (MSF) proposed to the Ministry of Health that it become a partner in implementing the pilot SMC project.
The project was implemented in the entire Koutiala health district, which encompasses 42 health treatment centers
covering 266 villages. Coverage was estimated initially at 127,000 children from 3 to 59 months, and was revised upward to
160,000 after the first round in August 2012, which involved two drug distribution approaches: door-to-door in less-densely
populated areas and at fixed sites in higher-density areas.
This activity was carried out over three months with a distribution every four weeks. It was launched in August and ended in
October 2012.
The project evaluation was carried out through a close collaboration among teams from MSF, the NMCP and the MRTC.
PROJECT OBJECTIVES
Reduce the incidence of acute malaria
Reduce the cases of severe malaria
Reduce malaria-related mortality
Reduce anemia within the population
Reduce the total number of hospitalizations
The project’s secondary objectives included improving malaria treatment
at all health facilities and strengthening pharmacovigilance.
The SMC has a negligible impact on malaria transmission. Rather, it is
a malaria control strategy that reduces the incidence of the disease in
children 3 to 59 months of age, not an elimination strategy.
RESULTS OF THE SMC PROJECT
A household survey conducted by the Malaria Research and Training Center (MRTC) assessed the coverage. According
to parent statements, coverage totaled 89.1%. Based on the SMC patient cards that each child received during the
distribution, that distribution figure was 84.6%. The results from the door-to-door distribution coverage survey were
slightly higher than those for fixed-site distribution. The two distribution methods – which targeted coverage of more than
80% of the population – achieved their objective. Coverage in rural areas was higher than in urban areas.
Number of malaria cases/1,000 residents
admitted to five Koutiala community health centers (CHC) Koutiala
supported by MSF in a population of children ages 3 months - 5 years (2010-2012)
90
W32 : 1st SMC distribution
The malaria peak began around week 26. A comparison
of the number of cases seen at the five CHC and in the
Reference Health Center (RHC) during the four weeks of
the peak preceding the launch of the SMC (W29 to W32)
and those observed during the intervention period (W33 to
W44) reveal an average weekly reduction at those health
facilities as follows:
incidence/1000
- cases of simple pediatric malaria: from 2,426 to
802, a decline of 66.9% (primary level CHC);
- pediatric hospitalizations for cases of serious
malaria: from 248 to 77, a decline of 69.0% (secondary
and tertiary level RHC);
2011
- malaria deaths while hospitalized: from 14.5 to 4, a
decline of 72.0%;
W36 : 2nd SMC distribution
- pediatric transfusions: from 131 to 98, a decline of
25.0%; and,
2010
- pediatric hospitalizations for all causes: from
262 admissions to 95, a decline of 63.7%.
W40 : 3rd SMC distribution
2012
0
s1
s52
semaines
épidémiologiques
Epidemiological
weeks
PROJECT RENEWAL 2013
MSF continues to partner with the Ministry of Health of Mali and will implement the SMC strategy again in the Koutiala health
district. The organization hopes to carry out four rounds, rather than three, based on WHO recommendations. This will provide
coverage over the maximum number of months that fall within the period of high malaria transmission. That period generally
begins in July and ends in November or December.
PROJECT COST
The average cost of providing SMC treatment is approximately 1.123 euros/child per round. The project’s 2012 cost was
3.37 euros for three rounds. MSF estimates 2013 average costs at 4.50 euros for four rounds (2,951 CFA francs).
Distribution of expenses (euros)
Heading
Distribution of expenses
SMC 2012 - Mali, Koutiala district
Total cost
Expatriate staff
National staff
66 727
133 930
Operating costs
14 527
Medical
92 189
Logistique et sanitation
8 480
Training and local support
3 739
Transportation – Freight – Storage
120 459
Consultants, field support (MRTC)
97 097
TOTAL
637 147
Total number of children/round
159 317
SMC cost/child for three rounds
3,37
National staff
Expatriate staff 12%
25%
Consultants,
field support (MRTC)
Logistics
and sanitation
18%
2%
Medical 17%
Operating costs 3%
Transportation - Freight - Storage
Training
and local support
22%
1%
CONCLUSION
SMC is an appropriate malaria control strategy for children in seasonal transmission areas and should be
implemented along with other existing control strategies (including distribution of mosquito nets and indoor
spraying of insecticide).
MSF June 2013