RTI International, Washington, District of Columbia, USA.
RTI International, Conakry, Guinea.
BMJ Glob Health. 2024 Feb 26;9(2):e013898. doi: 10.1136/bmjgh-2023-013898.
Seasonal malaria chemoprevention (SMC) is a main intervention to prevent and reduce childhood malaria. Since 2015, Guinea has implemented SMC targeting children aged 3-59 months (CU5) in districts with high and seasonal malaria transmission.
We assessed the programmatic impact of SMC in Guinea's context of scaled up malaria intervention programming by comparing malaria-related outcomes in 14 districts that had or had not been targeted for SMC.
Using routine health management information system data, we compared the district-level monthly test positivity rate (TPR) and monthly uncomplicated and severe malaria incidence for the whole population and disaggregated age groups (<5 years and ≥5 years of age). Changes in malaria indicators through time were analysed by calculating the district-level compound annual growth rate (CAGR) from 2014 to 2021; we used statistical analyses to describe trends in tested clinical cases, TPR, uncomplicated malaria incidence and severe malaria incidence.
The CAGR of TPR of all age groups was statistically lower in SMC (median=-7.8%) compared with non-SMC (median=-3.0%) districts. Similarly, the CAGR in uncomplicated malaria incidence was significantly lower in SMC (median=1.8%) compared with non-SMC (median=11.5%) districts. For both TPR and uncomplicated malaria incidence, the observed difference was also significant when age disaggregated. The CAGR of severe malaria incidence showed that all age groups experienced a decline in severe malaria in both SMC and non-SMC districts. However, this decline was significantly higher in SMC (median=-22.3%) than in non-SMC (median=-5.1%) districts for the entire population, as well as both CU5 and people over 5 years of age.
Even in an operational programming context, adding SMC to the malaria intervention package yields a positive epidemiological impact and results in a greater reduction in TPR, as well as the incidence of uncomplicated and severe malaria in CU5.
季节性疟疾化学预防（SMC）是预防和减少儿童疟疾的主要干预措施。自 2015 年以来，几内亚在疟疾传播高和季节性的地区为 3-59 月龄儿童（CU5）实施了 SMC。
通过比较已实施和未实施 SMC 的 14 个区疟疾相关结局，评估 SMC 在几内亚扩大疟疾干预规划背景下的规划影响。
利用常规卫生管理信息系统数据，我们比较了全人群和年龄分组（<5 岁和≥5 岁）的区月阳性率（TPR）和月单纯性和重症疟疾发病率。通过计算 2014 年至 2021 年的区年度复合增长率（CAGR），分析疟疾指标随时间的变化；我们使用统计分析来描述检测病例、TPR、单纯性疟疾发病率和重症疟疾发病率的趋势。
所有年龄组的 TPR 的 CAGR 在 SMC 区（中位数=-7.8%）显著低于非 SMC 区（中位数=-3.0%）。同样，SMC 区的单纯性疟疾发病率 CAGR（中位数=1.8%）也显著低于非 SMC 区（中位数=11.5%）。TPR 和单纯性疟疾发病率均按年龄分层，观察到的差异也有统计学意义。重症疟疾发病率的 CAGR 表明，所有年龄组在 SMC 和非 SMC 区的重症疟疾均有所下降。然而，在整个人群、CU5 和 5 岁以上人群中，SMC 区（中位数=-22.3%）的下降幅度显著高于非 SMC 区（中位数=-5.1%）。
即使在运营规划背景下，将 SMC 纳入疟疾干预方案也会产生积极的流行病学影响，并导致 TPR 以及 CU5 单纯性和重症疟疾发病率的更大降幅。
