Protecting children when they are most vulnerable

Dr Djermakoye Hadiza Jackou, Coordinator of the National Malaria Control Programme in Niger

Seasonal malaria chemoprevention (SMC) was recommended by the World Health Organization (WHO) in 2012 to protect children from being infected in areas of high seasonal malaria in the Sahel region of Africa.1 However, in 2014, fewer than 5% (~3 million) of all eligible children benefitted from SMC.2

Working closely with national malaria control and elimination programmes across the Sahel region, MMV is part of the SMC working group created to coordinate countries’ efforts to adopt and implement SMC policy. It has also developed a multi-country forecasting tool to improve stock management of SMC drugs, tracking key data by year, country, number of eligible children and drug volumes required.

Dr Djermakoye Hadiza Jackou, Coordinator of the National Malaria Control Programme (PNLP) in Niger talks about the progress and challenges of SMC roll-out in Niger.

1. What has been the impact of SMC in Niger so far?

Since the implementation in 2013, based on testimonials from health workers and mothers, we have seen a decrease in the number of severe malaria cases and deaths, as well as a reduction in attendance at health facilities during hightransmission periods. However, we cannot say definitively that this is due to SMC – we will have to do an impact study in 2018 to validate this.

2. What were the main challenges you faced in implementing SMC? How did you overcome them?

In previous years, the main challenges were the coordination and harmonization between various partners, each with their own procedures and requirements, as well as variance in epidemiological data obtained using multiple data-collection tools. Before the introduction of the dispersible formulation, we also observed enormous problems in treatment compliance from patients, difficulty in administration (due to a sugar shortage), as well as limited availability of the drug. These challenges resulted in significant additional costs. 

The Ministry of Public Health has since set up an SMC-coordinating committee to plan, supervise and oversee the project. It will standardize data collection tools and disease awareness materials, synchronize campaigns with neighbouring countries, as well as manage stock levels.

3. What has been the impact of the dispersible formulation in Niger?

With the ease of administration of the dispersible formulation, we have seen better acceptance by children, with less vomiting and rejection. There are also significant reductions in cost and logistics associated with removing the need for a pestle and mortar, and consumable items such as sugar.

4. With the ACCESS-SMC project now complete, what are the next steps in implementing SMC in Niger?

SMC started in Niger in 2013 with the support of Médecins Sans Frontières, and subsequently received support from UNICEF, The Global Fund, Islamic Relief Niger, the ACCESS-SMC project, and the P/MTN5 malaria project until 2016. In 2018, with the support of The Global Fund, President's Malaria Initiative, UNICEF and other partners, we plan to increase access to SMC in the 61 eligible districts in Niger.

Important next steps include continued effort to scale-up SMC, advocacy for strong resource mobilization, and a strategy for cross-border distribution of treatment.

5. What characteristics should a future SMC drug possess?

An ideal SMC product should be a single-dose dispersible formulation that does not have a bitter taste for children. This would allow a more efficient, directly-observed administration compared with the current schedule of three doses over 3 days.

6. What are your hopes for the future of SMC in Niger and in the Sahel region?

SMC in children of all ages is key if we are to move closer to malaria elimination in the Sahel region. It is my hope that the implementation of SMC through cross-border activities and synchronization with other countries will make it possible for SMC to prevent malaria in the maximum number of children.

1. World Health Organization. WHO policy recommendation: Seasonal malaria chemoprevention (SMC) for Plasmodium falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa (2012).

2. Malaria Consortium website. SMC at scale – saving lives (2017)