Superiority of Three Directly Observed Treatment Compared to One Directly Observed Treatment in the Seasonal Malaria Chemoprevention in Children Aged Under Five in Burkina Faso: A Quasi-Experimental Trial

The implementation of seasonal malaria chemoprevention (SMC) in Burkina Faso has not achieved its objective of reducing by at least 60% the morbidity associated with malaria in children under 5 years of age. We assessed a new approach of delivery consisting for the community health workers to directly supervise the three doses of the treatment compared to the standard of delivery (only the first dose directly observed treatment). The objective of the study was to compare the superiority of three doses supervised intake of SMC (3DOT) to the supervised intake of the first dose only. Three centers for health and social promotion were randomly selected in the Gaoua health district (3DOT) and 4 in the Boromo health district (1DOT) to receive a monthly four rounds of SMC with Sulfadoxine-pyrimethamine plus Amodiaquine (SP+AQ) in a quasi-experimental cluster randomized trial, before-after with a control group design which included in total 2440 children. The primary endpoint was the reduction in prevalence between each SMC round. The Khi-2 test was used to assess the superiority of 3DOT versus 1DOT. The reduction of malaria prevalence was significantly higher in 3DOT compared to the 1DOT, 68.60% vs 53.00% (p<.0001). The coverage in the 3DOT was significantly lower than that in the 1DOT, 81.39% versus 95.72%; p<0.0001 for optimal coverage. The 3DOT delivery approach of SMC provides better reduction of malaria prevalence than the 1DOT. However, the lower coverage obtained with the 3DOT compared to the 1DOT is a concerning issue to overcome in the perspective of the scale-up of this strategy at large scale.