Since July 2012, Doctors Without Borders/Médecins Sans Frontières (MSF) has been employing seasonal malaria chemoprevention (SMC) for the first time in Mali and Chad. This strategy involves intermittent prophylactic distributions of anti-malaria medicines, and the initial results are encouraging, notably for the number of cases avoided.
In this interview, MSF Tropical Medicine Adviser Dr. Estrella Lasry reflects on the different aspects and future prospects of this strategy.
What are the main considerations when employing SMC?
It's the first intervention of this type we've ever run, so we had to delve into a number of medical and operational issues and read up on studies covering the subject and the World Health Organization's (WHO) recommendation issued last March.
As a first step, we had to select which anti-malarial treatment to use. The combination of amodiaquine and sulphadoxine/pyrimethamine is known to be one of the most effective, as it causes fewer side effects in children and guarantees relatively long coverage, averaging 28 days.
Then we decided to target children between three months and five years old. Immunity to malaria is less developed at this age, so young children are particularly vulnerable to the disease.
Finally, we identified the most heavily indicated areas to get our work underway. The WHO recommends SMC as a malaria prevention strategy in countries with seasonal malaria—where more than 60 percent of annual cases occur within four months or less. This is the case for the area roughly stretching between Senegal and the Central African Republic.
So, we decided on Mali and Chad, where malaria is the first cause of consultation and infant mortality.