Despite impressive progress in recent years, malaria continues to impose a heavy
morbidity and mortality burden. Ninety-five percent of the estimated 247 million malaria
cases and 619,000 deaths worldwide in 2021 occurred in the World Health Organization
(WHO) Africa Region [1]. The expansion of SP-IPTi to include children up to two years of
age and additional entry points, referred to now as PMC, offers the potential to increase
the impact of the intervention by delivering more protective doses of SP to an age group
with a higher malaria burden. However, to support the development of national policies
and international guidelines on the adoption and implementation of PMC at scale, more
evidence is needed on where, when, how and under what circumstances PMC can be effective,
cost-effective, acceptable, equitable and feasible.
The aim of the impact evaluation is to inform decision-making by policy makers and
programme managers involved in national malaria control programmes by evaluating the
protective efficacy of PMC with five doses versus zero doses as standard of care in Côte
d'Ivoire. The design is a multi-site quantitative study of the implementation of PMC in
Côte d'Ivoire. The health districts of Seguela and Kani were identified as the
intervention and control districts, respectively, based on population size, number of
Extended Programme of Immunisation (EPI) facilities, malaria incidence, EPI coverage and
availability of an appropriate control population receiving standard care.
All children up to 36 months of age with parental consent will be recruited into a
passive cohort. The investigators will also extract data on malaria and anaemia cases
among children receiving PMC from health facility records.
The investigators will form and follow an active arm of the cohort in which a randomly
selected subset of children in the passive cohort will be visited every three months
during the study period in their homes to obtain detailed information, including details
of the household, malaria risk factors, history of malaria and anaemia, health-seeking
behaviour, and past EPI vaccinations. Blood will be collected for microscopy measures of
parasitaemia, anaemia diagnosis by haemoglobin levels, and retrospective analysis of
malaria infection (not for clinical management) by polymerase chain reaction methods.
Rapid diagnostic tests will be used amongst symptomatic children to identify cases. First
line antimalarial treatment will be provided to all confirmed cases. Children will be
screened for malnutrition by measuring their mid-upper arm circumference (MUAC). If they
are determined to have either moderate (MAM) or severe acute malnutrition (SAM),
treatment will consist of standard of care which can include referral to the nearest
health facility with clinical management capacity or treatment on site.
