Effectiveness and Chemoprevention Efficacy of Implementing Seasonal Malaria Chemoprevention in Karamoja Region, Uganda

Summary

To-date, seasonal malaria chemoprevention (SMC) has only been scaled up across the Sahel region of west and central Africa, primarily because of concerns over widespread resistance to sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) in east and southern Africa. There are increasing calls for this successful intervention to be used more widely and aggressively, including in areas of east and southern Africa where malaria transmission is seasonal. To test the feasibility, acceptability and impact of SMC with SPAQ in new geographies outside of the Sahel, Malaria Consortium, together with the malaria programmes in Mozambique and Uganda, is conducting implementation studies in both countries. The studies comprise two phases, with the first phase focusing on acceptability and feasibility, followed by more rigorous assessments of the effectiveness of the intervention and chemoprevention efficacy of the medicines used in SMC. Phase 1 of the studies has been successfully completed. The studies showed that SMC with SPAQ was safe, acceptable and feasible, with very high coverage achieved among the target population.Phase 2 of the SMC implementation study in Uganda will include study components exploring the effectiveness of SMC with SPAQ and dihydroartemisinin-piperaquine (DP), as well as the chemoprevention efficacy of DP when used in SMC. The study will be conducted in five districts of Karamoja region. It will involve SMC delivery to around 142,000 children. The majority of the target population will receive SPAQ, but around 15,000 children will receive DP. Five monthly SMC cycles will be implemented between May and September 2022. As the protective period of SPAQ and DP are comparable, monthly administration cycles will be implemented irrespective of the drug regimen used.

Timeline

Start

2022-06-01

Primary completion

2022-11-01

Completion

2023-12-01

Publications

• Nuwa A, Baker K, Kajubi R, Nnaji CA, Theiss-Nyland K, Odongo M, Kyagulanyi T, Nabakooza J, Salandini D, Asua V, Nakirunda M, Rassi C, Rutazaana D, Achuma R, Sagaki P, Bwanika JB, Magumba G, Yeka A, Nsobya S, Kamya MR, Tibenderana J, Opigo J. Effectiveness of sulfadoxine-pyrimethamine plus amodiaquine and dihydroartemisinin-piperaquine for seasonal malaria chemoprevention in Uganda: a three-arm, open-label, non-inferiority and superiority, cluster-randomised, controlled trial. Lancet Infect Dis. 2025 Jul;25(7):726-736. doi: 10.1016/S1473-3099(24)00746-1. Epub 2025 Jan 15.
• Kajubi R, Ainsworth J, Baker K, Richardson S, Bonnington C, Rassi C, Achan J, Magumba G, Rubahika D, Nabakooza J, Tibenderana J, Nuwa A, Opigo J. A hybrid effectiveness-implementation study protocol to assess the effectiveness and chemoprevention efficacy of implementing seasonal malaria chemoprevention in five districts in Karamoja region, Uganda. Gates Open Res. 2023 Dec 18;7:14. doi: 10.12688/gatesopenres.14287.2. eCollection 2023.

Drugs

Indications