Impact of seasonal malaria chemoprevention timing on clinical malaria incidence dynamics in the Kedougou region, Senegal.

Seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine and amodiaquine is recommended by the World Health Organization since 2012 for clinical malaria prevention in children in the Sahelian region of Africa. In Senegal, SMC implementation began in 2013 and is given to children under 10 years old. This study aimed to describe clinical malaria incidence in the general population during routine SMC implementation and to analyse how SMC timing impacted clinical malaria dynamics in eligible children. We conducted an ecological study in the Kedougou region of Senegal in 27 villages included in the Bandafassi Health and Demographic Surveillance System (HDSS). We calculated weekly Plasmodium falciparum malaria incidence by age group using malaria case data recorded by community health workers and health-posts, and population denominators obtained from Bandafassi Health and Demographic Surveillance System. We used negative binomial generalized additive multilevel models to analyse the incidence of clinical episodes in children under 10 years during the expected SMC prophylactic period and at the end of the transmission period. Malaria incidence was strongly seasonal with a high transmission period starting in June. Children under SMC presented an overall lower incidence compared to older children and young adults. Among children eligible for SMC, the incidence was lowest for approximately 3 weeks after treatment administration and increased subsequently, suggesting a gradual loss of protection. At the end of the high transmission period, a higher malaria incidence was recorded from the 3rd to 6th week after the week of administration of the fourth (final) SMC round. While protecting children under 10 years, SMC warrants adjustment to reduce exposure before the next round, to increase protection of 5-9 years, and to cover the high transmission period completely. The addition of a 5th round of SMC in 2023 was necessary to cover the end of the transmission season, but individual-level studies are required to ensure that drug efficacy and adequate dosing are maintained.