Nigeria: Expanding seasonal malaria chemoprevention and overcoming challenges posed by COVID-19

Dr Chibuzo Oguoma, Programme Director, Philanthropic Funding SMC Project, Malaria Consortium/Nigeria

1. How effective has seasonal malaria chemoprevention (SMC) been in reducing child morbidity and mortality from malaria in Nigeria?

No formal impact assessment has been done in the country. However, a case-control study in five countries, including Nigeria,1 looked at the reduction in clinical malaria during the 4 weeks after receiving SMC with SPAQ. The protective effect2 reported from the Nigerian study arm was 83.1%. However, a landmark publication in The Lancet puts the reduction in confirmed malaria cases at outpatient clinics during the high transmission period at 55.2% in Nigeria.

2. Can you talk us through Nigeria’s expansion of the SMC programme?

In 2020, the nationally-led ‘high burden to high impact’ approach recommended by WHO to jump-start progress against malaria3 led to an expansion of SMC-eligible states; from nine states within the Sahelian region to 20, plus the Abuja Federal Capital Territory. In addition, in some of the new states, the cycles were increased from four to five due to extended annual rains.

3. What key challenges did you face in 2021 with regard to SMC implementation? 

The COVID-19 pandemic posed new challenges affecting how we implemented SMC; personal protective equipment was required as well as specific training, which increased the unit cost of implementation.

4. How did you overcome these challenges?

We have mainstreamed COVID-19 preventive measures into the SMC training modules. Caregivers were asked to administer SPAQ with community distributors observing the process; supervisors also ensured physical distancing was respected, as well as adherence to precautionary actions by people and communities to help slow down the spread of COVID-19.

5. What has it been like to work with MMV on SMC?

The cooperation with MMV has been rewarding. Regular calls provide the opportunity for cross learning amongst SMC countries and this has provided information about new developments within the malaria sector. 

1. Effectiveness of seasonal malaria chemoprevention (SMC) treatments when SMC is implemented at scale: Case–control studies in 5 countries:

2. Of the 100 children exposed to malaria and receiving SMC, 83 may avoid contracting the disease.

3. High burden to high impact: a targeted malaria response: