Understanding and Maximizing the Community Impact of Antimalarial Treatment (INDIE-SMC)

Seasonal Malaria Chemoprophylaxis (SMC) is a fundamental component of malaria control. The SMC program involves that sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) is given to children below the age of 5 years during the peak transmission season in areas of seasonal malaria transmission. Yet, its efficacy is increasingly below expectations. This study involves an Operational evaluation of a modified existing intervention and its implementation are prepared in direct interaction with the Ministry of Health (MoH) to tailor data collection to local needs. The main questions it aims to answer are: 1. what are the reasons for the continued high infection rates in the SMC-targeted population; 2. what are the implications for transmission of sub-optimal SMC in children less than 5 years old; 3. can the impact of SMC be improved by including older age groups that would both expand the population that experiences direct chemoprophylactic benefits and concurrently reduce transmission to the wider community Researchers will: i) Compare SMC effectiveness as implemented by the national malaria control program and SMC implemented in a research context where all doses are directly observed. ii) Quantify the infectious reservoir and the contribution of different age groups to transmission with conventional SMC (\<5 years) and extended SMC (\<10 years) iii) Determine the impact of drug resistance and drug absorption on SMC efficacy iv) Understand social barriers and enablers interfering with SMC efficacy and how SMC uptake is related to health equity with special attention to gender inequalities. v) Quantify SMC efficacy decay under programmatic conditions and key drivers of this decay.