Meta-analysis statistics.

In areas with seasonal malaria transmission, seasonal malaria chemoprevention (SMC) involves giving children a three-day course of sulfadoxine-pyrimethamine and amodiaquine once a month during the transmission season. This strategy has been used for ten years for children under five years of age. The logistical cost is affordable in malaria-endemic countries and varies slightly depending on accessibility. This systematic review and meta-analysis aims to better assess the effectiveness of seasonal malaria chemoprevention in reducing malaria incidence and prevalence in Sahelian countries, ten years after its introduction. This review followed the Preferred Reporting Items for Systematic Reviews (PRISMA) 2020 guidelines, and was based on Google scholar, MEDLINE (PubMed), the Cochrane library, African Journal Online, and Index Medicus African to compile its data. The combination of keywords such as “malaria”, “Plasmodium”, “malaria chemoprevention”, “Sahel”, “Efficacy”, “Resistance”, as well as Boolean operators (AND, OR) were used to inventory studies published between 2013 and 2023. Eligible studies included randomized clinical trials (RCTs), non-randomized trials, prospective cohort studies, intervention studies and observational studies. For randomized trials (RCTs), Cochrane’s Risk of Bias 2 (RoB 2) tool was used to specifically assess the risk of bias in randomized controlled trials. And for non-randomized trials and observational studies, we applied the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool, which included a meta-analysis of the studies. The study protocol was registered under the number (PROSPERO registry CRD42023413920), and R software was used for the meta-analysis. The meta-analysis shows that SMC is effective in reducing the incidence of uncomplicated malaria, severe malaria and mortality in children under five. Compared with control groups a reduction in the burden of malaria was observed in children receiving SMC. SMC appears to effectively reduce the incidence of malaria in children under five. However, it should be noted that SMC is always used alongside other prevention strategies, such as indoor residual spraying and long-lasting insecticide-treated nets. However, the epidemiological context of the Sahelian region is changing, and the strategy must be adapted to address the persistence of transmission during the dry season and the increase in malaria cases among older children.

在季节性疟疾传播地区，季节性疟疾化学预防（seasonal malaria chemoprevention, SMC）指在疟疾传播季每月为儿童提供为期三天的磺胺多辛-乙胺嘧啶（sulfadoxine-pyrimethamine）联合阿莫地喹（amodiaquine）疗程。该策略已在5岁以下儿童中应用十年。在疟疾流行国家，其后勤成本可负担，且会因可及性差异略有波动。本系统评价与荟萃分析旨在评估季节性疟疾化学预防在萨赫勒地区国家推广十年后，对疟疾发病率与患病率的降低效果。本评价遵循《系统评价首选报告条目（Preferred Reporting Items for Systematic Reviews, PRISMA）》2020版指南，数据来源于谷歌学术、MEDLINE（PubMed）、Cochrane图书馆、非洲在线期刊及非洲医学索引。本研究通过组合"malaria（疟疾）"、"Plasmodium（疟原虫）"、"malaria chemoprevention（疟疾化学预防）"、"Sahel（萨赫勒）"、"Efficacy（疗效）"、"Resistance（耐药性）"等关键词，并结合布尔运算符（AND、OR），对2013至2023年发表的相关研究进行了检索筛选。符合纳入标准的研究包括随机对照试验（randomized clinical trials, RCTs）、非随机试验、前瞻性队列研究、干预性研究及观察性研究。针对随机对照试验，采用Cochrane偏倚风险2（Cochrane’s Risk of Bias 2, RoB 2）工具对其偏倚风险进行专门评估；对于非随机试验与观察性研究，则采用ROBINS-I（非随机干预研究偏倚风险，Risk of Bias in Non-randomized Studies of Interventions）工具进行评估，并对纳入研究开展荟萃分析。本研究方案已在PROSPERO注册平台注册（编号CRD42023413920），荟萃分析采用R软件完成。荟萃分析结果显示，季节性疟疾化学预防可有效降低5岁以下儿童的无并发症疟疾发病率、重症疟疾发病率及死亡率。与对照组相比，接受季节性疟疾化学预防的儿童疟疾疾病负担显著降低。季节性疟疾化学预防可有效降低5岁以下儿童的疟疾发病率。但需注意，季节性疟疾化学预防通常需与其他疟疾防控策略联合应用，例如室内滞留喷洒及长效经杀虫剂处理蚊帐。然而，萨赫勒地区的流行病学背景正发生变化，该策略需进行调整，以应对旱季疟疾传播持续存在及大龄儿童疟疾病例增多的问题。