Background Paper: Seasonal Malaria Chemoprevention, WHO Technical Consultation on Universal Access to Core Malaria Interventions

Malaria is preventable and treatable, but many children living in Africa die from malaria before their fifth birthday. Seasonal malaria chemoprevention (SMC) was recommended by WHO in 2012 as a malaria prevention intervention in areas with highly seasonal malaria transmission in the Sahel sub-region of Sub-Saharan Africa. As of 2014, fewer than 5% (2.99 million) of all eligible children were benefiting from SMC. ACCESS-SMC was initiated in 2015 to overcome barriers to SMC scale up, supporting National Malaria Control Programs in Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria and The Gambia to treat over 6.3 million children by 2016. As of 2017, most eligible countries (Burkina Faso, Cameroon, Chad, Gambia, Ghana, Guinea, Guinea-Bissau, Mali, Niger, Nigeria, Senegal and Togo) now have SMC programs. There have been a number of barriers that prevented or impacted on access to SMC. Most of these barriers have to do with market bottlenecks due to limited production capacity of quality-assured SMC drugs, and with operational and technical choices around delivery models and quality assurance. As highlighted in the document, gaps in human resources (both in numbers and sometimes in skills), absence of systematic planning, weaknesses in training and supervisions processes, uncertainties around population estimates, are just some of the factors affecting access to SMC in some contexts. Despite these issues, the experience of the ACCESS-SMC project has shown that high coverage of a large number of eligible children is possible, and can have a significant impact on the malaria burden. As shown below, trends in national malaria HMIS data are consistent with a substantial reduction in malaria cases and malaria deaths in SMC implementation areas. Also, based on molecular markers surveys, prevalence of markers of resistance to SMC drugs at baseline was found to be low, consistent with high level of efficacy of monthly treatments observed in case-control studies. SMC was found to be highly effective and safe at scale, and costing studies revealed a weighted average cost of 3.6$ in 2016. SMC has been rapidly introduced in the Sahel, but there are concerns around sustainability, as well as questions as to the long-term efficacy of SMC drugs. More importantly, there is still an estimated gap of 12 to 18 million children who could benefit from SMC, but who are not currently included in SMC programmes. SMC is inexpensive, safe and effective, and with areas in the Sahel having the highest incidence of malaria in the world, it is now an urgent priority to close the gap and reach all eligible children.