Implementation, coverage and equity of large-scale door-to-door delivery of Seasonal Malaria Chemoprevention (SMC) to children under 10 in Senegal

Abstract

SMC has been introduced widely in the Sahel since its recommendation by WHO in 2012. This study, which provided evidence of feasibility that supported the recommendation, included school-age and pre-school children. School-age children were not included in the 2012 recommendation but bear an increasing proportion of cases. In 2006, consultations with health-staff were held to choose delivery methods. The preferred approach, door-to-door with the first daily-dose supervised by a community-health-worker (CHW), was piloted and subsequently evaluated on a large-scale in under-5's in 2008 and then in under-10's 2009-2010. Coverage was higher among school-age children (96%(95%CI 94%,98%) received three treatments in 2010) than among under 5's (90%(86%,94%)). SMC was more equitable than LLINs (odds-ratio for increase in coverage for a one-level rise in socioeconomic-ranking (a 5-point scale), was 1.1 (0.95,1.2) in 2009, compared with OR 1.3 (1.2,1.5) for sleeping under an LLIN. Effective communication was important in achieving high levels of uptake. Continued training and supervision were needed to ensure CHWs adhered to treatment guidelines. SMC door-to-door can, if carefully supervised, achieve high equitable coverage and high-quality delivery. SMC programmes can be adapted to include school-age children, a neglected group that bears a substantial burden of malaria.

Figure 1

Study profile.

Figure 2

(A) Percentage of children in whom caregivers reported symptoms, 4 days after SMC distribution, in children who received SMC and in children in control areas who did not receive SMC, (B) Risk ratio for each reported symptom (SMC:No SMC);ratios above 1 indicate increased risk in children who received SMC).

Figure 3

Equity of receipt of SMC and use of bed nets by socio-economic status in 2008 and 2009 (Under-5 s in 2006 and 2008, under-10 s in 2009. LLIN: Long-lasting insecticide-treated bednet).

Figure 4

Equity of SMC coverage by mother’s education in 2008, 2009, and 2010 The figure presents the proportion of children targeted to receive SMC who received 0, 1, 2, or 3 of the 3 intended courses of treatment each year, disaggregated by whether the child’s mother had no education, some Koranic education only, or some French or French and Koranic education.