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Seasonal malaria chemoprevention: successes and missed opportunities

الوقاية الكيميائية الموسمية من الملاريا: النجاحات والفرص الضائعة
Authors: Matthew E. Coldiron; Lorenz von Seidlein; Rebecca F. Grais;

Seasonal malaria chemoprevention: successes and missed opportunities

Abstract

La chimioprévention saisonnière du paludisme (CPS) a été recommandée en 2012 pour les jeunes enfants du Sahel pendant la haute saison de transmission du paludisme. Les enfants reçoivent une dose unique de sulfadoxine/pyriméthamine combinée à un traitement de 3 jours d'amodiaquine, une fois par mois pendant 4 mois maximum. Le déploiement et la mise à l'échelle de la CPS ont été impressionnants, 12 millions d'enfants ayant bénéficié de l'intervention en 2016. Il existe des preuves de son bénéfice global dans les contextes de mise en œuvre de routine, et une méta-analyse des données des essais cliniques a montré une diminution de 75 % du paludisme clinique par rapport au placebo. SMC n'est pas exempt de lacunes. Sa zone cible comprend de nombreuses zones difficiles d'accès, à la fois en raison de la médiocrité des infrastructures et de l'instabilité politique. L'adhésion au traitement préventif de 3 jours n'a pas été entièrement documentée et pourrait s'avérer difficile. À mesure que la CPS est mise à l'échelle, l'intégration dans un paradigme communautaire plus large qui comprend d'autres activités préventives et curatives peut s'avérer bénéfique, à la fois pour les systèmes de santé et pour les bénéficiaires.

La quimioprevención estacional de la malaria (SMC) se recomendó en 2012 para niños pequeños en el Sahel durante la temporada pico de transmisión de la malaria. Los niños reciben una dosis única de sulfadoxina/pirimetamina combinada con un ciclo de 3 días de amodiaquina, una vez al mes durante un máximo de 4 meses. El despliegue y la ampliación de SMC ha sido impresionante, con 12 millones de niños que recibieron la intervención en 2016. Existe evidencia de su beneficio general en entornos de implementación de rutina, y un metanálisis de datos de ensayos clínicos mostró una disminución del 75% en la malaria clínica en comparación con el placebo. SMC no está exento de deficiencias. Su zona objetivo incluye muchas áreas de difícil acceso, tanto por la mala infraestructura como por la inestabilidad política. El cumplimiento del tratamiento a un curso de 3 días de tratamiento preventivo no se ha documentado completamente y podría resultar difícil. A medida que se amplía el SMC, la integración en un paradigma más amplio basado en la comunidad que incluya otras actividades preventivas y curativas puede resultar beneficiosa, tanto para los sistemas de salud como para los receptores.

Seasonal malaria chemoprevention (SMC) was recommended in 2012 for young children in the Sahel during the peak malaria transmission season. Children are given a single dose of sulfadoxine/pyrimethamine combined with a 3-day course of amodiaquine, once a month for up to 4 months. Roll-out and scale-up of SMC has been impressive, with 12 million children receiving the intervention in 2016. There is evidence of its overall benefit in routine implementation settings, and a meta-analysis of clinical trial data showed a 75% decrease in clinical malaria compared to placebo. SMC is not free of shortcomings. Its target zone includes many hard-to-reach areas, both because of poor infrastructure and because of political instability. Treatment adherence to a 3-day course of preventive treatment has not been fully documented, and could prove challenging. As SMC is scaled up, integration into a broader, community-based paradigm which includes other preventive and curative activities may prove beneficial, both for health systems and for recipients.

تمت التوصية بالوقاية الكيميائية الموسمية من الملاريا (SMC) في عام 2012 للأطفال الصغار في منطقة الساحل خلال موسم ذروة انتقال الملاريا. يتم إعطاء الأطفال جرعة واحدة من السلفادوكسين/البيريميثامين مع دورة لمدة 3 أيام من الأمودياكين، مرة واحدة في الشهر لمدة تصل إلى 4 أشهر. كان نشر وتوسيع نطاق SMC مثيرًا للإعجاب، حيث تلقى 12 مليون طفل التدخل في عام 2016. هناك أدلة على فائدتها الإجمالية في إعدادات التنفيذ الروتيني، وأظهر التحليل التلوي لبيانات التجارب السريرية انخفاضًا بنسبة 75 ٪ في الملاريا السريرية مقارنة بالدواء الوهمي. SMC ليست خالية من أوجه القصور. وتشمل المنطقة المستهدفة العديد من المناطق التي يصعب الوصول إليها، سواء بسبب ضعف البنية التحتية أو بسبب عدم الاستقرار السياسي. لم يتم توثيق الالتزام بالعلاج بدورة العلاج الوقائي لمدة 3 أيام بشكل كامل، ويمكن أن يكون صعبًا. مع توسيع نطاق SMC، قد يكون الاندماج في نموذج مجتمعي أوسع يشمل أنشطة وقائية وعلاجية أخرى مفيدًا لكل من الأنظمة الصحية والمستفيدين.

Country
United Kingdom
Keywords

FOS: Political science, RC955-962, Infectious and parasitic diseases, RC109-216, FOS: Health sciences, Pediatrics, Engineering, Tropical medicine, Arctic medicine. Tropical medicine, Pathology, Internal medicine, Political science, Immunology and Microbiology, Public health, Politics, Life Sciences, Chloroquine, Clinical trial, Drug Combinations, Environmental health, Pyrimethamine, Child, Preschool, Medicine, Seasons, Sulfadoxine/pyrimethamine, Opinion, Antimalarial Drugs, Immunology, FOS: Law, Nursing, Chemoprevention, Global Impact of Helminth Infections and Control Strategies, Antimalarials, Health Sciences, Sulfadoxine, Humans, Global Impact of Arboviral Diseases, Africa South of the Sahara, FOS: Clinical medicine, Public Health, Environmental and Occupational Health, Infant, Amodiaquine, Political instability, Transmission (telecommunications), Malaria, Electrical engineering, Parasitology, Law

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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
45
Top 10%
Top 10%
Top 10%
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gold