Seasonal Malaria Chemoprevention Implementation: Effect on Malaria Incidence and Immunity in a Context of Expansion of P. falciparum Resistant Genotypes with Potential Reduction of the Effectiveness in Sub-Saharan Africa

Séni Nikiema,1,2 Issiaka Soulama,1,3 Salif Sombié,1 André-Marie Tchouatieu,4 Samuel Sindie Sermé,5 Noëlie Béré Henry,5 Nicolas Ouedraogo,1 Nathalie Ouaré,1,6 Raissa Ily,1,6 Oumarou Ouédraogo,3 Dramane Zongo,3 Florencia Wendkuuni Djigma,2 Alfred B Tiono,1 Sodiomon B Sirima,5 Jacques Simporé2,7 1Research Department, Centre National de Recherche et de Formation sur le Paludisme (CNRFP)/Institut National de Santé Publique (INSP), Ouagadougou, Burkina Faso; 2Laboratoire de Biologie Moléculaire et de Génétique (LABIOGENE), Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso; 3Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé (IRSS)/Centre National de Recherche Scientifiques et Technologiques (CNRST), Ouagadougou, Burkina Faso; 4Access and Product Management – Chemoprevention Department, Medicines for Malaria Venture (MMV), Geneva, Switzerland; 5Direction Scientifique, Groupe de Recherche Action en Santé, Ouagadougou, Burkina Faso; 6Institut Supérieur des Sciences de la santé (IN.S.SA), Université Nazi Boni, Bobo Dioulasso, Burkina Faso; 7Centre de recherche biomoléculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina FasoCorrespondence: Issiaka Soulama, Institut de Recherche en Sciences de la Santé /CNRST, 06 BP 9067, Ouagadougou, Burkina Faso, Tel +22670757190, Email iss.soulama@gmail.comAbstract: Seasonal Malaria Chemoprevention (SMC), which combines amodiaquine (AQ) with sulfadoxine-pyrimethamine (SP), is an effective and promising strategy, recommended by WHO, for controlling malaria morbidity and mortality in areas of intense seasonal transmission. Despite the effectiveness of this strategy, a number of controversies regarding the impact of the development of malaria-specific immunity and challenges of the strategy in the context of increasing and expanding antimalarial drugs resistance but also the limited coverage of the SMC in children make the relevance of the SMC questionable, especially in view of the financial and logistical investments. Indeed, the number of malaria cases in the target group, children under 5 years old, has increased while the implementation of SMC is been extended in several African countries. This ambivalence of the SMC strategy, the increase in the prevalence of malaria cases suggests the need to evaluate the SMC and understand some of the factors that may hinder the success of this strategy in the implementation areas. The present review discusses the impact of the SMC on malaria morbidity, parasite resistance to antimalarial drugs, molecular and the immunity affecting the incidence of malaria in children. This approach will contribute to improving the malaria control strategy in highly seasonal transmission areas where the SMC is implemented.Keywords: seasonal malaria chemoprevention, immunity, resistance, sulfadoxine-pyrimethamine, amodiaquine