Assessment of the impact of ACCESS-SMC on malaria cases and deaths in 2015 and 2016. ACCESS-SMC evaluation.

The impact of the ACCESS-SMC programme in reducing the number of cases of malaria treated at health facilities was assessed using reports of confirmed cases in the national health management information systems (HMIS) or from data on confirmed outpatient cases tested or treated for malaria collected from selected sentinel health facilities, in areas which implemented SMC from 2015, areas which implemented from 2016, and control areas that had not introduced SMC by the end of 2016. DHIS2 (District Health Information System 2) databases had been established in two of the seven ACCESS-SMC countries prior to the introduction of SMC (The Gambia and Burkina Faso). In these countries the percentage reduction in the number of malaria deaths in hospital, and the percentage reduction in the number of confirmed malaria cases at health facilities, was estimated from DHIS2 data. In Chad, Guinea, Mali, Niger, Nigeria, the percentage reduction in the number of confirmed outpatient cases was estimated using data extracted from clinic records in selected health facilities which had complete data during the transmission seasons of 2015 and 2016 and for at least one transmission season prior to SMC. To adjust for year-to-year trends in the transmission of malaria and in the use of parasitological testing to confirm cases, the change in the number of confirmed cases (or malaria deaths in hospital) in children under 5 before and after SMC introduction was compared with the corresponding change in older age groups who did not receive SMC, and with control areas. To understand the potential impact of ACCESS-SMC in terms of the absolute number of cases and deaths that may have been averted, taking into account cases that may not present to health facilities, predictions were then made based on the number of treatments estimated to have been administered to children under 5 years of age, the efficacy of monthly treatments from case control studies, and using modelled predictions of malaria incidence rates in children under 5 years of age in ACCESS-SMC areas prior to SMC.