Djedanem Medard, Salé Noura Mamane, Aminou Elhadji Yacoudima Yacoubou Mahaman, Testa Jean, Jambou Ronan
CERMES, Niamey, Niger.
EPICENTRE, Niamey, Niger.
PLOS Glob Public Health. 2025 Sep 12;5(9):e0005124. doi: 10.1371/journal.pgph.0005124. eCollection 2025.
In areas with seasonal malaria transmission, seasonal malaria chemoprevention (SMC) involves giving children a three-day course of sulfadoxine-pyrimethamine and amodiaquine once a month during the transmission season. This strategy has been used for ten years for children under five years of age. The logistical cost is affordable in malaria-endemic countries and varies slightly depending on accessibility. This systematic review and meta-analysis aims to better assess the effectiveness of seasonal malaria chemoprevention in reducing malaria incidence and prevalence in Sahelian countries, ten years after its introduction. This review followed the Preferred Reporting Items for Systematic Reviews (PRISMA) 2020 guidelines, and was based on Google scholar, MEDLINE (PubMed), the Cochrane library, African Journal Online, and Index Medicus African to compile its data. The combination of keywords such as "malaria", "Plasmodium", "malaria chemoprevention", "Sahel", "Efficacy", "Resistance", as well as Boolean operators (AND, OR) were used to inventory studies published between 2013 and 2023. Eligible studies included randomized clinical trials (RCTs), non-randomized trials, prospective cohort studies, intervention studies and observational studies. For randomized trials (RCTs), Cochrane's Risk of Bias 2 (RoB 2) tool was used to specifically assess the risk of bias in randomized controlled trials. And for non-randomized trials and observational studies, we applied the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool, which included a meta-analysis of the studies. The study protocol was registered under the number (PROSPERO registry CRD42023413920), and R software was used for the meta-analysis. The meta-analysis shows that SMC is effective in reducing the incidence of uncomplicated malaria, severe malaria and mortality in children under five. Compared with control groups a reduction in the burden of malaria was observed in children receiving SMC. SMC appears to effectively reduce the incidence of malaria in children under five. However, it should be noted that SMC is always used alongside other prevention strategies, such as indoor residual spraying and long-lasting insecticide-treated nets. However, the epidemiological context of the Sahelian region is changing, and the strategy must be adapted to address the persistence of transmission during the dry season and the increase in malaria cases among older children.
在有季节性疟疾传播的地区，季节性疟疾化学预防（SMC）是指在传播季节每月为儿童提供一个为期三天的磺胺多辛-乙胺嘧啶和阿莫地喹疗程。该策略已在五岁以下儿童中使用了十年。在疟疾流行国家，后勤成本是可以承受的，并且会因可及性略有不同。这项系统评价和荟萃分析旨在更好地评估季节性疟疾化学预防在引入十年后对降低萨赫勒国家疟疾发病率和流行率的有效性。本评价遵循《系统评价优先报告条目》（PRISMA）2020指南，并基于谷歌学术、MEDLINE（PubMed）、考克兰图书馆、《非洲期刊在线》和《非洲医学索引》来收集数据。使用“疟疾”“疟原虫”“疟疾化学预防”“萨赫勒”“疗效”“耐药性”等关键词以及布尔运算符（AND、OR）的组合来检索2013年至2023年发表的研究。符合条件的研究包括随机临床试验（RCT）、非随机试验、前瞻性队列研究、干预研究和观察性研究。对于随机试验（RCT），使用考克兰偏倚风险2（RoB 2）工具专门评估随机对照试验中的偏倚风险。对于非随机试验和观察性研究，我们应用了ROBINS-I（干预非随机研究中的偏倚风险）工具，其中包括对这些研究的荟萃分析。该研究方案已在编号（PROSPERO注册库CRD42023413920）下注册，并使用R软件进行荟萃分析。荟萃分析表明，SMC在降低五岁以下儿童非复杂性疟疾、重症疟疾的发病率和死亡率方面是有效的。与对照组相比，接受SMC的儿童疟疾负担有所减轻。SMC似乎能有效降低五岁以下儿童的疟疾发病率。然而，应当指出，SMC总是与其他预防策略一起使用，如室内滞留喷洒和长效驱虫蚊帐。然而，萨赫勒地区的流行病学情况正在发生变化，必须调整该策略以应对旱季传播的持续存在以及大龄儿童中疟疾病例的增加。
