Previously submitted to: JMIR Research Protocols (no longer under consideration since Jun 03, 2025)
Date Submitted: Aug 23, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Rapid assessments for the deployment of seasonal malaria chemoprevention in new geographies of east and southern Africa: protocol for a hybrid type II implementation study.
ABSTRACT
Background:
Seasonal malaria chemoprevention (SMC) is a highly effective community-based intervention to prevent malaria infections caused by Plasmodium falciparum in areas where the burden of malaria is high and malaria transmission is seasonal. SMC is commonly seen as a success story in the Sahel region, however, there are regions in east and southern Africa where malaria transmission is seasonal, and the burden is high. The same decision-making frameworks that were used in the Sahel are unlikely to be applicable to east and southern Africa due to higher pre-existing resistance to the drugs used, seasonality heterogeneity, contextual differences, and unknown cost-effectiveness, amongst others.
Objective:
This study aims to estimate the effectiveness, chemoprevention efficacy, potential deployment impact, acceptability, and feasibility of SMC with sulfadoxine-pyrimethamine and amodiaquine (SPAQ) in new geographies of east and southern Africa.
Methods:
The protocol is divided into five linked components: (1) a cluster randomized controlled trial to estimate the effectiveness of SMC with SPAQ; (2) a non-randomized controlled trial to estimate the chemoprevention efficacy of SPAQ; (3) surveillance of the prevalence of molecular markers associated with resistance to S, P and AQ drugs, (4) a dynamical modelling exercise to estimate the impact of SMC and where to prioritise future deployment and (5) a qualitative study that will evaluate the feasibility and acceptability of the intervention.
Results:
Rapid assessments in different geographies of east and southern Africa are expected to begin in 2023-2024. More geographies are currently being explored for the conduction of rapid assessments. Results are expected in 2024.
Conclusions:
These will be the first studies analysing the effectiveness, chemoprevention efficacy, feasibility, acceptability, and potential impact of SMC in new east and southern African geographies. The outcomes of these studies aim to guide future policy changes at local, national, and international levels and potentially allow for a historically successful program to expand in a sustained and cost-effective way beyond the Sahel region.
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