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Cycle 1

Principal Investigator: Alassane Dicko, University of Bamako
NIH-Supported Collaborator: Patrick Duffy, National Institute of Allergy and Infectious Disease (NIAID)
Title of NIH Award: Malaria Immunology and Pathogenesis in Pregnant Women and Young Children

Project Overview
Malaria is the leading cause of morbidity and mortality in Mali. Despite effective implementation of usual control measures such as insecticide treated nets (ITN) and artemisinin combination therapy (ACT) malaria remains the number one killer in Mali. We recently showed that Seasonal Malaria Chemoprevention (SMC), previously known as Intermittent Preventive Treatment of Malaria in children, reduces malaria infection and disease by more 80% in Malian children, prompting the WHO to approve SMC as policy for countries with seasonal malaria transmission, such as Mali, in March 2012. The strategy is a highly cost-effective approach to reduce childhood mortality in these areas. Despite the huge benefit of the SMC on malaria infection and disease, the optimal approach to deliver SMC remains to be determined and there is no data on the long term effect of this strategy on the development of immunity to malaria. An optimal SMC delivery approach will make a substantial contribution toward the achievement of the goals of the US President’s Malaria Initiative (PMI) and the Millenium Development Goals. The objectives of the study are to identify the most effective method to deliver SMC, and to obtain information on the long term impact of SMC on malaria immunity. The design is a cluster-randomized trial over three years. By using a step-wedge design, the investigators aim to i) determine the optimal mode (fixed-point (FPD) vs door-to-door delivery (DDD); directly observed treatment (DOT) vs. non-DOT (NDOT)) and frequency (3 vs. 4 doses per season) of SMC delivery; ii) to compare quantitative measures of immunity in children who do and do not receive SMC over a three year period. The anticipated outcome of the study will be a qualified optimal approach to deliver SMC in Mali, and an expanded understanding of its impact on health outcomes and antimalarial immunity. The results will be shared with stakeholders, and will be used at the end of each year to guide the implementation of SMC in Mali.
PH 1-85 Mali photo 2PH 1-85 Mali photo 1

Summary of Recent Activities:

Activities during this reporting period include: i) the analysis of the samples for drug resistance and immunology , ii) collection of the data on malaria morbidity in SMC and post SMC children to further assess the impact of the strategy on malaria immunity; iii) the data entry and cleaning and analysis. Preliminary results of the analysis of the immunology data indicate that the 4th year of the SMC was not associated with a decrease the IgG levels to AMA1, MSP1 and CSP. The analysis of the drug resistance by PCR was just completed. The preliminary results will be reported in the next quarter. The PI also presented the impact of the SMC implementation on hospital admission and death was presented during the Multilateral Initiative on Malaria (MIM) conference in Dakar in April 2018. The results indicate that SMC implementation was associated with 40% reduction in hospital admissions and 60% reduction in mortality. Children in Mali will continue to receive SMC using the door to door distribution method based on the results from the project. This change in distribution has led to a substantial increase in the coverage of the SMC in 2017 compared to when the strategy was given using a point fixed distribution method.

Health Cycle 1 Recipients