@article{fdi:010068864,
  title = {{E}ffectiveness of seasonal malaria chemoprevention in children under ten years of age in {S}enegal : a stepped-wedge cluster-randomised trial},
  author = {{C}iss{\'e}, {B}. and {B}a, {E}l {H}adj and {S}okhna, {C}heikh and {N}diaye, {J}. {L}. and {G}omis, {J}. {F}. and {D}ial, {Y}. and {P}itt, {C}. and {N}diaye, {M}. and {C}airns, {M}. and {F}aye, {E}. and {N}diaye, {M}. and {L}o, {A}. and {T}ine, {R}. and {F}aye, {S}. and {F}aye, {B}. and {S}y, {O}. and {K}onate, {L}. and {K}ouevijdin, {E}kou{\'e} and {F}lach, {C}. and {F}aye, {O}. and {T}rape, {J}ean-{F}ran{\c{c}}ois and {S}utherland, {C}. and {F}all, {F}. {B}. and {T}hior, {P}. {M}. and {F}aye, {O}. {K}. and {G}reenwood, {B}. and {G}aye, {O}. and {M}illigan, {P}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {S}easonal {M}alaria {C}hemoprevention ({SMC}) with sulfadoxine-pyrimethamine ({SP}) plus amodiaquine ({AQ}), given each month during the transmission season, is recommended for children living in areas of the {S}ahel where malaria transmission is highly seasonal. {T}he recommendation for {SMC} is currently limited to children under five years of age, but, in many areas of seasonal transmission, the burden in older children may justify extending this age limit. {T}his study was done to determine the effectiveness of {SMC} in {S}enegalese children up to ten years of age. {M}ethods and {F}indings {SMC} was introduced into three districts over three years in central {S}enegal using a stepped-wedge cluster-randomised design. {A} census of the population was undertaken and a surveillance system was established to record all deaths and to record all cases of malaria seen at health facilities. {A} pharmacovigilance system was put in place to detect adverse drug reactions. {F}ifty-four health posts were randomised. {N}ine started implementation of {SMC} in 2008, 18 in 2009, and a further 18 in 2010, with 9 remaining as controls. {I}n the first year of implementation, {SMC} was delivered to children aged 3-59 months; the age range was then extended for the latter two years of the study to include children up to 10 years of age. {C}luster sample surveys at the end of each transmission season were done to measure coverage of {SMC} and the prevalence of parasitaemia and anaemia, to monitor molecular markers of drug resistance, and to measure insecticide-treated net ({ITN}) use. {E}ntomological monitoring and assessment of costs of delivery in each health post and of community attitudes to {SMC} were also undertaken. {A}bout 780,000 treatments were administered over three years. {C}overage exceeded 80% each month. {M}ortality, the primary end-point, was similar in {SMC} and control areas (4.6 and 4.5 per 1000 respectively in children under 5 years and 1.3 and 1.2 per 1000 in children 5-9 years of age; the overall mortality rate ratio [{SMC}: no {SMC}] was 0.90, 95% {CI} 0.68-1.2, p = 0.496). {A} reduction of 60% (95% {CI} 54%-64%, p < 0.001) in the incidence of malaria cases confirmed by a rapid diagnostic test ({RDT}) and a reduction of 69% (95% {CI} 65%-72%, p < 0.001) in the number of treatments for malaria (confirmed and unconfirmed) was observed in children. {I}n areas where {SMC} was implemented, incidence of confirmed malaria in adults and in children too old to receive {SMC} was reduced by 26% (95% {CI} 18%-33%, p < 0.001) and the total number of treatments for malaria (confirmed and unconfirmed) in these older age groups was reduced by 29% (95% {CI} 21%-35%, p < 0.001). {O}ne hundred and twenty-three children were admitted to hospital with a diagnosis of severe malaria, with 64 in control areas and 59 in {SMC} areas, showing a reduction in the incidence rate of severe disease of 45% (95% {CI} 5%-68%, p = 0.031). {E}stimates of the reduction in the prevalence of parasitaemia at the end of the transmission season in {SMC} areas were 68% (95% {CI} 35%-85%) p = 0.002 in 2008, 84% (95% {CI} 58%-94%, p < 0.001) in 2009, and 30% (95% {CI} -130%-79%, p = 0.56) in 2010. {SMC} was well tolerated with no serious adverse reactions attributable to {SMC} drugs. {V}omiting was the most commonly reported mild adverse event but was reported in less than 1% of treatments. {T}he average cost of delivery was {US}$ 0.50 per child per month, but varied widely depending on the size of the health post. {L}imitations included the low rate of mortality, which limited our ability to detect an effect on this endpoint. {C}onclusions {SMC} substantially reduced the incidence of outpatient cases of malaria and of severe malaria in children, but no difference in all-cause mortality was observed. {I}ntroduction of {SMC} was associated with an overall reduction in malaria incidence in untreated age groups. {I}n many areas of {A}frica with seasonal malaria, there is a substantial burden in older children that could be prevented by {SMC}. {SMC} in older children is well tolerated and effective and can contribute to reducing malaria transmission.},
  keywords = {{SENEGAL}},
  booktitle = {},
  journal = {{P}los {M}edicine},
  volume = {13},
  numero = {11},
  pages = {e1002175 [18 p.]},
  ISSN = {1549-1676},
  year = {2016},
  DOI = {10.1371/journal.pmed.1002175},
  URL = {https://www.documentation.ird.fr/hor/fdi:010068864},
}