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
At this time, there was no child-friendly formulation available either, making administration a challenge. Infants and very young children are generally unable to swallow pills; as such, tablets needed to be crushed and mixed with water before administration, leading to possible under-dosing. Some tablets also had an unpleasant bitter taste, causing children to spit them out.
MMV’s partner Guilin Pharmaceutical has developed a child-friendly dispersible formulation for the oral administration of sulfadoxine–pyrimethamine and amodiaquine (SPAQ). SPAQ is a cost-effective drug combination shown in clinical trials to prevent approximately 75% of malaria episodes during the transmission season.1 Currently, MMV's partner Guilin Pharmaceutical is the sole prequalified supplier of SPAQ. In 2016, Guilin’s child-friendly formulation became the first paediatric SPAQ product to be validated by The Global Fund Expert Review Panel for purchase by international donors. To ensure a sustainable supply of dispersible SPAQ, MMV is supporting a second manufacturer, S Kant HEALTHCARE Ltd. (India), to obtain WHO prequalification of its product. In parallel, MMV is leading the collection of scientific and stakeholder input on the desired attributes of next-generation SMC drugs as alternatives to SPAQ.
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.
To date, 12 countries3 have integrated SMC into the package of interventions provided by community health workers and volunteers. Based on data from studies in five ACCESS-SMC countries, SMC was associated with an 89% reduction in malaria incidence for 4 weeks after treatment (62% from 5 to 6 weeks after treatment), compared with children who had not received SMC or whose last dose was more than 6 weeks earlier.2 Furthermore, 180 million courses of monthly treatment have been delivered to children in over 12 countries in the Sahel region since the 2014 scale-up, to the end of 2017, of which 68 million were delivered in 2017, enough to protect 17 million children.
Updated July 2018
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)
3. Burkina Faso, Cameroon, Chad, Gambia, Ghana, Guinea, Guinea Bissau, Mali, Niger, Nigeria, Senegal and Togo.