"Investigating the rebound effects of seasonal malaria chemoprevention (SMC) in Mali"

摘要 季节性疟疾化学预防(SMC)已被世卫组织推荐用于#年疟疾流行国家。 自2012年以来，撒哈拉以南非洲的疟疾季节性传播很强。干预措施包括 以下儿童给予完全治疗剂量的磺胺多辛-乙胺嘧啶(SP)加阿莫地喹 5岁儿童在疟疾传播季节期间每4周进行一次，每年3至4次。自2016年以来， 马里在全国范围内实施了这一战略。虽然目标中疟疾病例的显著减少 年龄组观察到，疟疾在5岁及以上儿童中的增加趋势也报告在 正在实施SMC的许多设置。拟议的研究考虑了以前的研究和试点数据 显示大约每8名儿童中(12.5%)在历史上没有接受过任何剂量或 治疗方案所需的四剂中的一剂。这项研究试图招募一大群人 允许在以前遵守SMC的儿童与有效对照之间进行大规模比较 小组(以前不遵守SMC的儿童)阐明逐步取消SMC计划的影响 使不符合资格的人老化。本R01提案的主要目的是调查SMC的退出效果 由于年龄要求，通过以下三个具体目标：1)确定疟疾反弹 在加入SMC后发生的情况，包括与严重疟疾和贫血的关联；2)评估 特定年龄恶性疟原虫流行率、有性寄生虫和无性寄生虫以及感染多样性的变化 在部署SMC之后；以及3)评估在 遵循SMC资格及其与疾病的关系。这项研究将提供有关 SMC在五岁时停止的影响可大大有助于改善疟疾监测 其他低收入和中等收入国家的总体成果。

Summary Seasonal Malaria Chemoprevention (SMC) has been recommended by WHO for malaria endemic countries in sub-Saharan Africa with strong seasonal malaria transmission since 2012. The intervention consists of the administration of full treatment doses of Sulfadoxine-Pyrimethamine (SP) plus Amodiaquine to children less than 5 years of age every 4 weeks during the malaria transmission season for 3 to 4 rounds per year. Since 2016, Mali has implemented the strategy countrywide. While significant decreases in malaria cases among the target age group was observed, increasing trends in malaria among children 5 years and above is also reported in the many settings where SMC is being implemented. The proposed study considers previous studies and pilot data showing that approximately out of every eight children (12.5%) have historically received either no doses or a single dose out of a the required four doses for the treatment regimen. This study seeks to enroll a large cohort of children to permit a large-scale comparison between children previously compliant to SMC with a valid control group (children not previously compliant to SMC) to elucidate the effects of phasing out of the SMC program due to age ineligibility. The primary objective of this R01 proposal is to investigate the withdrawal effects of SMC due to age eligibility requirements through the following three specific aims: 1) Determine malaria rebound occurrence following SMC enrollment including its association with severe malaria and anemia; 2) Assess changes in the age-specific P. falciparum prevalence, sexual and asexual parasites, and multiplicity of infection following SMC deployment; and 3) Assess the change in immune response to malaria antigens during and following SMC eligibility and the relationship with disease. The study will provide valuable information on the impact of SMC stoppage at five years of age which can significant contribute improving monitoring malaria outcomes in other low- and middle-income countries overall.