Assessment of a Combined Strategy of Seasonal Malaria Chemoprevention + Supplementation With PlumpyDoz and Vitamin A-Zinc to Prevent Malaria and Malnutrition in Burkina Faso

Malaria is hyper-endemic in Burkina Faso and many sub-Saharan Africa countries. According to the National Malaria Control Program (NMCP) approximately 11 915 816 malaria cases and 4 144 malaria-related deaths were reported in 2017 in Burkina Faso. Numerous malaria control interventions have been implemented in Burkina Faso in order to achieve the 2030 Sustainable Development Goal (SDG) 3. Seasonal malaria chemo-prevention (SMC) ranks among the largest and reliable interventions for malaria control in countries with marked seasonality of malaria transmission. This preventive measures involves administering antimalarial drugs (Amodiaquine-Sulfadoxine-Pyrimethamine) to children aged 6- 59 months on a monthly basis during the high transmission peak. In Burkina Faso, SMC is implemented from July/August to October/November each year. SMC is recommended by the World Health Organization (WHO) and is known to reduce malaria morbidity by 30 to 80%. Despite the implementation of this strategy, the burden of malaria and associated mortality is still very high in this population in Burkina Faso. This raises questions about other hidden factors that can negatively affect the effectiveness of SMC intervention.

At the same time, malnutrition is a major cause of childhood morbidity and mortality in low- and middle-income countries such as Burkina Faso. Malnutrition can lower immune system leading to increased severity of malaria in the population. The National Nutrition Program (NPP), which is the agency established to address malnutrition problems in Burkina Faso, currently aims to scale-up Community Management of Acute Malnutrition (CMAM). Both malaria and malnutrition are highly prevalent in rural settings. Furthermore, malaria seasonal peak coincides with period of food crisis in the country suggesting that malnutrition may influence malaria incidence during that period. Children under five years again represent the most vulnerable group. Importantly, treating micronutrient deficiencies is known to reduce malaria morbidity and mortality. Plumpy'Doz is specifically formulated for prevention of malnutrition in children from 6 months of age and adults. It has been recommended since 2007 by the WHO, UN Children's Fund (UNICEF), World Food Program (WFP), and the UN Standing Committee on Nutrition in the joint declaration on community-based management of severe acute malnutrition. Evidence also shows that Vitamin A-Zinc supplementation reduce malaria morbidity. A reduction by 20-30% of malaria incidence through micronutrient supplementation such as Vitamin A-Zinc has also been reported.

These aspects underlie the idea of the SMC-Nutrition project. This combined strategy could enhance the immune response and therefore decrease the severity of malaria in this population and at the same time reduce the burden of malnutrition in children under SMC coverage. This project will serve as a pilot integrated strategy in order to mutualize resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels. If the pilot produces promising results, a large-scale multi-centric assessment of the strategy will be performed in several SMC countries (i.e. Niger, Mali and Burkina Faso).

Purpose and objective(s) Aim 1: To assess the feasibility of combining two different strategies led by different programs (malaria and nutrition) which affect the same target population (children under five years). SMC is a larger community-based intervention at a national level led by the NMCP. National Nutrition Program is trying to scale up the Community Management of Acute Malnutrition (CMAM). This project will serve as a pilot of integrated strategy in order to mutualize resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels.

Aim 2: To boost the impact of SMC intervention in terms of reducing malaria morbidity, mortality and reduce the burden of malnutrition and anaemia in children under five years through supplementation with micronutrients and Vitamin A-Zinc.