Effect of Seasonal Malaria Chemoprevention on Incidence of Uncomplicated Malaria among Children under 5 Years in Kotido and Moroto Districts, Uganda, 2021: An Interrupted Time Series Analysis
- Vector-borne
Background
Seasonal malaria chemoprevention (SMC) refers to monthly administration of full treatment courses of antimalarial medicine to children <5 years during high malaria transmission season. SMC has demonstrated effectiveness in Sahel and sub-Sahel countries in Africa but had never been implemented in Uganda until April 2021, when Uganda began SMC in Kotido and Moroto Districts. We assessed the effect of SMC on malaria incidence among children <5 years of age in Kotido and Moroto Districts.
Methods
We conducted an interrupted time-series analysis using the single group approach and adjusted for seasonality of malaria. We extracted aggregated monthly data of outpatient (uncomplicated) malaria among children <5 years from the District Health Information System 2 (DHIS2), 52 months before SMC (Jan 2017-Apr 2021), and 8 months during SMC (May-Dec 2021). We evaluated the incidence of uncomplicated malaria among children <5 years before and during SMC implementation. We computed monthly incidence per 1,000 children <5 years.
Results
In Kotido District, malaria incidence was 693/1,000 during SMC implementation period, compare to an expected 1216/1,000 if SMC had not been implemented. The mean monthly malaria incidence was 87/1,000, compared to an expected mean of 152/1,000 if SMC had not been implemented. This represents a statistically significant mean monthly change of -65.4 [-104.6, -26.2] malaria cases/1,000 during SMC implementation. In Moroto District, malaria incidence was 713/1,000 during SMC implementation period, compared to an expected 905/1,000 if SMC had not been implemented. The mean monthly malaria incidence was 89/1,000, compared to an expected 113/1,000 if SMC had not been deployed. This represents a statistically significant mean monthly change of -24.0 [-41.1, -6.8] malaria cases/1,000 during SMC implementation.
Conclusion
Implementation of SMC substantially reduced incidence of uncomplicated malaria among children <5 years in Moroto and Kotido district. The government should consider scaling up SMC in other districts.
Seasonal malaria chemoprevention (SMC) refers to monthly administration of full treatment courses of antimalarial medicine to children <5 years during high malaria transmission season. SMC has demonstrated effectiveness in Sahel and sub-Sahel countries in Africa but had never been implemented in Uganda until April 2021, when Uganda began SMC in Kotido and Moroto Districts. We assessed the effect of SMC on malaria incidence among children <5 years of age in Kotido and Moroto Districts.
Methods
We conducted an interrupted time-series analysis using the single group approach and adjusted for seasonality of malaria. We extracted aggregated monthly data of outpatient (uncomplicated) malaria among children <5 years from the District Health Information System 2 (DHIS2), 52 months before SMC (Jan 2017-Apr 2021), and 8 months during SMC (May-Dec 2021). We evaluated the incidence of uncomplicated malaria among children <5 years before and during SMC implementation. We computed monthly incidence per 1,000 children <5 years.
Results
In Kotido District, malaria incidence was 693/1,000 during SMC implementation period, compare to an expected 1216/1,000 if SMC had not been implemented. The mean monthly malaria incidence was 87/1,000, compared to an expected mean of 152/1,000 if SMC had not been implemented. This represents a statistically significant mean monthly change of -65.4 [-104.6, -26.2] malaria cases/1,000 during SMC implementation. In Moroto District, malaria incidence was 713/1,000 during SMC implementation period, compared to an expected 905/1,000 if SMC had not been implemented. The mean monthly malaria incidence was 89/1,000, compared to an expected 113/1,000 if SMC had not been deployed. This represents a statistically significant mean monthly change of -24.0 [-41.1, -6.8] malaria cases/1,000 during SMC implementation.
Conclusion
Implementation of SMC substantially reduced incidence of uncomplicated malaria among children <5 years in Moroto and Kotido district. The government should consider scaling up SMC in other districts.