Factors Associated with Malaria in Children Aged 3 to 59 Months Under Seasonal Malaria Chemoprevention with Direct Observation Therapy in Two Districts in Burkina Faso, 2020: A Quasi-Experimental Trial

The seasonal malaria chemoprevention (SMC) represents one of the key interventions for malaria elimination in seasonal malaria transmission settings. However, though the SMC was implemented in Burkina Faso since the last ten years, the incidence of malaria in children of 3 to 59 months under seasonal malaria chemoprevention (SMC) remains high in the country. To enhance the intervention's effectiveness in its routine system, strategies are being explored, including a new delivery approach in which community health workers directly supervise the administration of the three doses of SMC therapy (3DOT), compared to the standard delivery approach in which only the first dose is directly observed therapy (1DOT) and the remaining two doses are given to the child's guardians or parents, who must administer them to the child over the following two days. While the search for the most effective delivery strategy for SMC continues, our study aimed to identify factors associated with malaria under the 3DOT and 1DOT delivery of SMC in children aged 3 to 59 months in 2 districts in Burkina Faso. We identified factors associated with malaria in 2440 children included in a quasi-experimental cluster randomized trial, before-after with a control group design. Four health and social promotion centers were randomly selected in the Boromo health district (1DOT) and 3 in the Gaoua health district (3DOT) to receive a monthly four rounds of SMC with Sulfadoxine-pyrimethamine plus Amodiaquine. A survey logistic regression calculated the odds ratios of association between variables and malaria with significance threshold ɑ= 0.05. The results revealed, lack of optimal supervision (aOR = 2.466 [1.650–3.686], p < 0.0001), lack of optimal coverage (aOR = 4.881 [2.454–9.708], p < 0.0001), total vomiting/rejection (aOR = 14.016 [2.169–90.552], p = 0.0055), residence in the health district of Gaoua (3DOT) (aOR = 2.057 [1.425–2.970], p = 0.0001) and past history of fever (aOR = 3.045 [1.630–5.686], p = 0.0005) were significantly associated with malaria in children under five years of age under SMC. The factors associated with malaria under SMC identified in this study support the conclusion of the superiority of 3DOT compared to 1DOT to reduce the prevalence of malaria. Addressing these factors would make the strategy more relevant for the elimination of malaria by 2030.