Global medium-term research priority setting for seasonal malaria chemoprevention: results from an eDelphi study

Abstract

Introduction: Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine (SPAQ) has been delivered in sub-Saharan Africa since 2014, reaching over 40 million children in 2022. New questions are emerging related to SMC's sustainability, integration with other interventions and introduction to new regions. Meanwhile, new WHO malaria guidelines have substantially increased flexibility for tailoring malaria strategies to local contexts. The SMC Alliance, bringing together researchers and implementers, commissioned a consultation to identify medium-term SMC research priorities.

Methods: The consultation was conducted online from September 2022 to September 2023 using the eDelphi methodology. An initial list of 46 research priorities was compiled during a workshop with SMC implementers. The wider expert consultation comprised three waves of online surveys available in English, French and Portuguese. Respondents rated research priorities on their importance, feasibility and degree to which they had already been addressed; responses determined elimination or retention of research priorities after each survey wave. Respondents suggested their own research priorities for rating. We also collected anonymised data on respondents' characteristics. A final ranking exercise was conducted to reach consensus on a top 10 list of research priorities.

Results: A total of 67 unique respondents residing in 20 countries provided 96 survey responses. The surveys achieved balanced representation of respondents by gender, country of residence and professional background. Of the 25 research priorities retained for ranking, the highest-ranked included 'evaluate duration of prophylactic protection offered by SPAQ and other SMC medicines' and 'evaluate the effect of integrating SMC with other malaria prevention interventions on development of antimalarial resistance'.

Conclusions: Research priorities related to sustainability, antimalarial resistance, integration with other interventions and improving quality of SMC delivery featured prominently among the highest-ranked research priorities. It is hoped the results of this consultation can encourage research uptake, guide new research and inform programme adaptation.

Keywords: Chemoprophylaxis; Health services research; Malaria.

Figure 1. World map summarising countries of residence of eDelphi respondents. Dark blue: respondents in both Wave 1 and/or Wave 2, and Wave 3. Mid blue: respondents in Wave 3 but not Wave 1 or 2. Light blue: respondents in Wave 1 and Wave 2, but not Wave 3. Grey: any survey wave included respondents born in these countries, but currently residing elsewhere. Light green: respondents in initial priority-setting workshop but not eDelphi surveys.