Effective Seasonal Malaria Chemoprevention Strategies in Benin

Introduction to Seasonal Malaria Chemoprevention in Benin

Benin, located in West Africa, is one of the countries profoundly affected by malaria, a disease caused by Plasmodium parasites and transmitted through the bites of infected female Anopheles mosquitoes. In recent years, the implementation of Seasonal Malaria Chemoprevention (SMC) has emerged as a strategic intervention aimed at reducing the malaria burden among vulnerable populations, particularly children under five years of age. SMC involves the administration of antimalarial medications during peak transmission seasons to prevent malaria infections and associated complications. With the World Health Organization’s (WHO) endorsement, SMC has been recognized for its potential to significantly decrease malaria incidence and mortality rates, particularly in regions with seasonal malaria transmission patterns.

The introduction of SMC in Benin began in 2019, specifically targeting the northern regions with high malaria transmission rates. As of 2022, the program has progressively expanded, and the government, along with the National Malaria Control Program (NMCP), is exploring geographical and demographic extensions of SMC to enhance its impact. The two proposed strategies are: extending SMC coverage to older children aged 5–10 years in the currently targeted departments or geographically expanding the program to include new departments where malaria remains a threat.

Importance of Geographic and Demographic Extensions of SMC

Understanding the geographic and demographic extensions of SMC is crucial for maximizing its effectiveness. The current focus on children under five has been justified given that this age group bears the highest burden of malaria-related morbidity and mortality. However, there is a growing recognition that older children also contribute significantly to the malaria reservoir, especially in high-transmission settings. Expanding SMC to include children aged 5–10 years could potentially prevent a substantial number of malaria cases and reduce the overall transmission rates in the community.

Additionally, the geographic extension of SMC to new areas, particularly in southern Benin, represents an important opportunity to protect more children at high risk of severe malaria. Communities in these areas might experience a high burden of malaria due to climatic factors and increased vector populations, necessitating targeted interventions that can effectively reduce transmission. Mathematical modeling has been utilized to simulate the potential impact of these extensions, highlighting that the geographic extension could avert significantly more severe malaria cases and deaths compared to solely demographic expansions (Lemant et al., 2025).

Table 1: Projected Impact of SMC Extensions on Malaria Cases in Benin

Impact of SMC on Malaria Burden in Children Under Five

The implementation of SMC has shown promising results in reducing malaria incidence among children under five in Benin. Studies indicate a significant decrease in malaria hospitalization rates and mortality associated with the SMC campaigns. For instance, a review of SMC programs in similar epidemiological contexts demonstrated that SMC effectively halved the number of malaria cases in children receiving the intervention compared to those who did not (Cissé et al., 2016).

The NMCP’s decision to implement SMC in Benin was based on successful pilot programs demonstrating substantial reductions in malaria morbidity. By administering antimalarial drugs during the peak transmission months, the program aims to disrupt the malaria cycle, providing children with critical protection against severe illness. Reports from the 2021 SMC campaigns indicated coverage rates exceeding 90%, suggesting high community acceptance and participation (Lemant et al., 2025).

Comparative Analysis of SMC Effectiveness in Different Regions

The effectiveness of SMC varies across regions, influenced by factors such as local transmission dynamics, healthcare access, and community engagement. A comparative analysis of SMC programs in different Beninese departments reveals that the northern regions, where malaria transmission is primarily seasonal, have experienced the greatest impact. In contrast, southern regions, characterized by perennial transmission patterns, present unique challenges that require tailored approaches to SMC implementation.

A study conducted in the Atacora and Alibori departments indicated that children under five receiving SMC experienced 57% fewer malaria infections compared to controls (Cissé et al., 2016). In regions where SMC was not implemented, the burden of disease remained high, underscoring the intervention’s critical role in malaria prevention.

Table 2: SMC Effectiveness by Region

Recommendations for Future Malaria Control Policies in Benin

To strengthen malaria control efforts in Benin, several recommendations can be made based on the findings of SMC programs:

1. Geographic Expansion: Prioritize the geographic extension of SMC to high-burden areas, particularly in southern Benin, where malaria remains a significant threat to children under five.

2. Demographic Targeting: Expand the coverage of SMC to include children aged 5-10 years, as they represent a substantial reservoir for malaria transmission and can significantly benefit from preventive measures.

3. Community Engagement: Enhance community education and engagement to ensure high participation rates in SMC campaigns, fostering local ownership of malaria prevention strategies.

4. Integrated Approaches: Combine SMC with other malaria control measures, such as insecticide-treated nets (ITNs) and indoor residual spraying (IRS), to maximize the overall impact on malaria transmission.

5. Ongoing Monitoring and Evaluation: Implement robust monitoring and evaluation systems to assess the effectiveness of SMC and adapt strategies based on emerging data and malaria trends.

FAQ Section

What is Seasonal Malaria Chemoprevention (SMC)?

SMC is a preventive intervention involving the administration of antimalarial drugs to children during the peak malaria transmission season to reduce infection rates and associated morbidity.

Why is SMC important in Benin?

SMC is vital in Benin due to the high incidence of malaria among children under five, which poses significant health risks and contributes to high mortality rates.

How does SMC work?

SMC works by providing prophylactic treatment that clears existing malaria infections and prevents new ones for a defined period, effectively reducing the overall malaria burden in targeted populations.

What are the challenges in implementing SMC?

Challenges include ensuring high coverage, managing drug resistance, and addressing community perceptions and acceptance of the intervention.

How can SMC be expanded in Benin?

SMC can be expanded geographically to include more areas and demographically to cover older children, based on modeling studies indicating higher potential impact.

References

1. Lemant, J., Champagne, C., Houndjo, W., Aïssan, J., Aïkpon, R., Houetohossou, C., Kpanou, S., Goers, R., & Pothin, E. (2025). Supporting evidence-based decisions about the geographic and demographic extensions of seasonal malaria chemoprevention in Benin: A modelling study. PLOS Global Public Health, 10.1371/journal.pgph.0004509. Retrieved from https://doi.org/10.1371/journal.pgph.0004509

2. Cissé, B., Ba, E. H., Sokhna, C., Ndiaye, J. L., Gomis, J. F., Diallo, Y., et al. (2016). Effectiveness of seasonal malaria chemoprevention in children under ten years of age in Senegal: A stepped-wedge cluster-randomised trial. PLOS Medicine, 13(11), e1002175. Retrieved from https://doi.org/10.1371/journal.pmed.1002175

3. World Health Organization. (2023). Seasonal Malaria Chemoprevention with Sulfadoxine-Pyrimethamine Plus Amodiaquine in Children: A Field Guide. 2nd ed

4. Baba, E., Hamade, P., Kivumbi, H., Marasciulo, M., Maxwell, K., Moroso, D., et al. (2020). Effectiveness of seasonal malaria chemoprevention at scale in west and central Africa: An observational study. Lancet, 396(10265), 1829–1840 20)32227-3

5. Pitt, C., Dial, Y., Faye, S. L., Cairns, M., Faye, E., et al. (2018). Implementation, coverage and equity of large-scale door-to-door delivery of Seasonal Malaria Chemoprevention (SMC) to children under 10 in Senegal. Scientific Reports, 8(1), 5489. Retrieved from https://doi.org/10.1038/s41598-018-23878-2