Aim: While recommended by World Health Organisation, seasonal malaria chemoprevention (SMC) was not yet a policy recommendation in Nigeria in 2013. There was a need to explore the feasibility, effectiveness, acceptability and cost of a community based system for SMC delivery in Northern Nigeria to inform policy and scale up.
Method: SMC commenced in two LGAs in Katsina state in 2013 and scaled up to four LGAs in 2014 targeting about 91,225 children between 3-59 months. The approach included formative research to inform design including engagement of stakeholders; development of tools, implementation and monitoring and evaluation. Baseline household survey with malariometric component was carried out in 2014 and an endline and cost analysis in 2015. Trends in malaria cases were used to assess the impact of the intervention comparing data from sentinel sites between intervention and non-intervention LGAs.
Result: At endline, 91% of caregivers had heard of SMC and 89.3% children received at least one SMC treatment course while 61.8% received at least three courses. There was a decline in children that tested positive with malaria rapid diagnostic tests from 76.9% at baseline to 47.8% (p=0.000023); children with temp ≥37.5oC from 21.9% to 6.8% (P=0.01); and children with anaemia from 25.4% to 18.0% (P>0.05). Sentinel data demonstrated 27% and 69% decline in malaria incidence in the intervention LGAs in 2013 and 2014 respectively. The economic cost per child who received all four courses of SMC in 2014 was estimated at $3.77, excluding design, start up and research related costs.
Conclusion: This project demonstrated feasibility of SMC implementation in Nigeria and affirmed its effectiveness in reducing malaria morbidity. The tools and capacity building materials developed from this project were further adapted to inform larger roll-out of SMC in six additional countries. SMC is now a policy recommendation in northern Nigeria.