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Diadier Diallo TEG symposium, 29 th March 2012

SEASONAL MALARIA CHEMOPREVENTION (SMC) FOR MALARIA CONTROL IN SUB-SAHARAN AFRICA: FROM RESEARCH TO POLICY. Diadier Diallo TEG symposium, 29 th March 2012. From IPT to SMC.

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Diadier Diallo TEG symposium, 29 th March 2012

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  1. SEASONAL MALARIA CHEMOPREVENTION (SMC) FOR MALARIA CONTROL IN SUB-SAHARAN AFRICA: FROM RESEARCH TO POLICY DiadierDiallo TEG symposium, 29th March 2012

  2. From IPT to SMC Intermittent preventive treatment of malaria initially recommended for prevention of malaria in pregnancy (IPTp) and then in infants (IPTi) using SP Intermittent preventive treatment of malaria tried in older children (IPTc) (Cisse et al; 2006) 367;659-667 IPTc renamed Seasonal Malaria Chemoprevention (SMC)

  3. What is Seasonal Malaria Chemoprevention (SMC)? Intermittent administration of full treatment courses of an antimalarial medicine during the malaria transmission season to prevent malarial illness with the objective of maintaining therapeutic antimalarialdrug concentrations in the blood throughout the period of greatest malarial risk (WHO TEG, 2011)

  4. Seasonal malaria chemoprevention • Several studies using different drug regimens were carried out between 2002-2011 • A Task Force was set up in 2008 to gather evidence on • Efficacy, Safety, Delivery mechanisms of SMC • The Task Force commissioned a review of SMC study results

  5. Meta-Analysis endpoint definitions • Clinical malaria with any parasitaemia • Severe malaria (WHO definition) • Moderate anaemia prevalence (Hb < 8g/dLor PCV< 25%) • Serious adverse events / adverse events • Parasite prevalence • Drug resistance including resistance to SP 14 studies identified and 8 met inclusion criteria

  6. Impact of monthly SMC (any drug regimen) on clinical malaria during the intervention period No protection Protective efficacy against uncomplicated clinical malaria = 83% (95% CI: 78% , 87%)

  7. Impact of SMC on severe malaria, anaemia and all-cause mortality

  8. Efficacy of SMC in context of high ITN coverage Konaté et al, 2011 and Dicko et al, 2011

  9. Safety: Adverse Events (AEs) • More than 900, 000 courses administered to more than 190, 000 children • Most common AEs was vomiting, associated with SP+PQ, DHA+PQ and SP+AQ • No drug-related serious adverse events identified • No evidence of severe skin reactions or blood dyscrasias

  10. Effect of SMC on clinical malaria in the high transmission season post intervention Pooled analyses from 7 studies IRRs = 1.08 (95%CI: 1.03 – 1.12) In the context of high coverage with ITNs IRRs = 1.10 (95%CI: 1.03 – 1.17) No increase in severe malaria, all-cause hospital admissions or deaths

  11. Delivery of SMC, Basse, The Gambia (Bojang et al. PloS Med 2011)8:e1000408)

  12. Coverage - large scale SMC study in Senegal

  13. Total financial cost in 2010, in Senegal • Total Financial Cost: US$ 233,713 • Courses of treatment administered: 471,282 • Children under 10: 175,000 • Coverage: >90% • Cost per course $0.5 Breakdown excluding research incentives Drug administration (CHWs) Supervision SMC Drugs Research participation incentives

  14. Studies in The Gambia and Ghana (Greenwood et al., Trends Parasitol 2011, 27, 477-480)

  15. Areas potentially suitable for SMC Sahel 25millions children under 5 Low SP resistance East/Southern Africa 14 millions children under 5 High SP resistance Alternative drugs needed

  16. Potential impact of SMC on the burden of malaria Cases averted (millions) Malaria deaths averted (1000s) Sahel and sub-Sahel S & E Africa

  17. Policy process • Meeting in Dakar in October 2008 • Meeting with the WHO policy group in July 2010 • Presentation SMC data to the WHO Technical Expert Group (TEG) in May 2011. • Further information needed, but this should delay implementation • TEG recommended implementation of SMC

  18. Policy process • The WHO MPAC reviewed recommendation in Feb 2012 • WHO likely to formulate policy recommendation on SMC • A working group meeting convened to review and finalise implementation field guide • Countries are preparing implementation plan, anticipating a policy recommendation

  19. Conclusions • Substantial protective effect against clinical malaria • SMC is safe and generally well tolerated • SMC delivery is feasible with high coverage • SMC likely to be cost effective in areas where it is suited • Millions of episodes can be averted a year • Strong evidence to support the adoption of SMC for malaria control in areas of seasonal malaria transmission WHO is likely to recommend SMC for areas of seasonal malaria transmission

  20. Acknowledgements IPTc Taskforce Oumar Gaye (Chair) KalifaBojang BadaraCissé LesongConteh DiadierDiallo (Secretary) OgobaraDoumbo Malang Fofana BocarKouyaté Laurent Moyenga Seth Owusu-Agyei KlénonTraore LSHTM Brian Greenwood Paul Milligan Anne Wilson Daniel Chandramohan Simon Cousens Geoff Targett Matt Cairns AzraGhani AmitBhasin All the investigators The SMC working group Bill & Melinda Gates Foundation

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