The intermittent administration of seasonal malaria chemoprevention (SMC) is recommended to prevent malaria among children aged 3–59 months in areas of the Sahel subregion in Africa. However, the cost-effectiveness and cost savings of SMC have not previously been evaluated in large-scale studies. We did a cost-effectiveness and cost-savings analysis of a large-scale, multi-country SMC campaign with sulfadoxine–pyrimethamine plus amodiaquine for children younger than 5 years in seven countries in the Sahel subregion (Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, and The Gambia) in 2016. The total cost of SMC for all seven countries was $22·8 million, and the weighted average economic cost of administering four monthly SMC cycles was $3·63 per child (ranging from $2·71 in Niger to $8·20 in The Gambia). Based on 80% modelled effectiveness of SMC, the incremental economic cost per malaria case averted ranged from $2·91 in Niger to $30·73 in The Gambia. The estimated total economic cost savings to the health systems in all seven countries were US$66·0 million and the total net economic cost savings were US$43·2 million. Our interpretation is that SMC is a low-cost and highly cost-effective intervention that contributes to substantial cost savings by reducing malaria diagnostic and treatment costs among children.

The world is facing an unprecedented crisis related to the COVID-19 pandemic with many unknowns, which has led to much confusion and anxiety. Public health measures have for centuries been the cornerstone of the response to epidemics. Among them, physical distancing measures aim to reduce contact between infected and uninfected people. As part of the global COVID-19 response, they have been widely used to slow down the spread of the virus in several countries. Despite their overall acceptance, they have been poorly documented, particularly in Africa, and debates persist on their appropriateness and practicality in the context of low-income countries. This article describes the implementation of these measures in four West-African countries—Mali, Burkina Faso, Senegal and Guinea—and discusses people’s willingness to comply with them. We describe these measures and discuss the importance of considering the socio-cultural, economic and political context to choose the most appropriate and effective measures and propose ways to explore strategies that are potentially better adapted to the African context.

In 2013, the Guinean health authority had to reorganise and run a national response against malaria as a priority. The review of the National Strategic Plan to fight malaria in Guinea was carried out and one of its critical components was the prevention and rapid management of fever (RMF) attributable to malaria in children. The study reports on the demographic and health determinants of this rapid management in children under 5. The participants were 4786 children from 2874 representative households. RMF was defined in terms of recourse to primary care. The recourse was defined by child's reference for the treatment of fever which led or not to treatment of malaria. We found that 1491 children (31.2%) had a bout of fever within the 2 weeks that preceded the survey. The prevalence of malaria was 45.4% among those children who have a bout of fever. The recourse to traditional healers was estimated at 9.6% and the use of health facilities was estimated at 71.5%. Overall, 74.9% of children with fever received treatment within the recommended timeliness (24 h), with regional disparity in this rapid response. The high proportion of recourse to traditional healers is still a matter of concern. New control and prevention strategies should be extended to traditional healers for their training and involvement in directing febrile children to health facilities.

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