Examining the Long-Term Impact of Malaria Chemoprophylaxis in Everyday Life in Rural Gambian Adolescents

Children in sub-Saharan Africa remain vulnerable to contracting malaria. While chemoprophylaxis is effective in preventing disease, its impact on social well-being is less understood. In this cross-sectional follow-up study conducted in 2001, we examined the role of chemoprophylaxis on social well-being in rural Gambia. Participants were 141 adolescents (age: 14.8–19.5; 40% male) from five villages, drawn from a longitudinal cohort in which one group received chemoprophylaxis in infancy, while the other received a placebo and began prophylaxis 1–2 years post-trial. Using a walking interview methodology, participants guided researchers through five village locations. Their narrations were coded for emotional content and social themes, followed by network analyses examining the relationships between these themes across treatment groups and gender. Emotional response analysis revealed significant gender differences in valence, with females exhibiting higher positive emotional tone than males (X2 = 5.85, p = 0.016). Treatment effects showed gender-specific patterns: among males, the placebo group exhibited higher positive valence compared to the chemoprophylaxis group (X2 = 8.34, p = 0.004), while females showed no treatment differences (X2 = 1.11, p = 0.291). Affect analysis revealed high positive responses across all groups with no significant differences. Network analysis revealed significant gender differences in how adolescents organize social themes within their communities. Females demonstrated higher centrality in eigenvector (global influence; p = 0.039) and degree centrality (number of direct edges; p < 0.001), indicating greater interconnectedness and influence within the networks. No significant treatment group differences were observed in the network structure across any centrality indicators (all p > 0.05). This study provides an example of how the social–ecological framework and ecologically valid assessment methods, such as the walking interview, can be applied to investigate the interplay between early childhood health interventions, social dynamics, and individual development in a rural African context. The findings revealed that gender exerts a stronger influence than early treatment on adolescent social–emotional development.