Protecting Those Most at Risk of Malaria: Child Health and the COVID-19 Response

The piece below originally appeared on PMI Impact Malaria‘s blog.

Every two minutes, a child dies of malaria. In 2018, of the estimated 405,000 malaria deaths worldwide, more than 67% were children under the age of five. Fortunately, there are proven methods to prevent malaria among this group, and the last decade has seen considerable progress in reducing the incidence of malaria. However, health service disruptions and drug shortages due to COVID-19 threaten to undermine recent gains.

One method for reducing childhood malaria is seasonal malaria chemoprevention (SMC), a campaign-style public health intervention that involves administering doses of antimalarial medicine to children at monthly intervals during the malaria transmission season. PMI Impact Malaria (IM) supports SMC campaigns in Cameroon, Mali, and Niger and provides technical assistance to Ghana’s campaign.

Training, supervising, and paying thousands of health workers to administer antimalarials to millions of children is no small feat, especially in the context of COVID-19. Through a series of creative country-driven adaptations, PMI Impact Malaria is continuing the delivery of SMC campaigns while also minimizing COVID-19 exposure among beneficiaries and health workers.

Door-to-Door Distribution Only

Last year, Mali and Niger distributed antimalarials to children through a combination of fixed site and door-to-door distribution for each cycle of their SMC campaigns. This year, both countries implemented 100% door-to-door distribution to avoid large crowds from gathering around a fixed site.


Crowd gathers at a fixed site SMC distribution in Konodimini, Segou Region, Mali during the second cycle of Mali’s SMC campaign in August 2019. Photo credit: Kathryn Malhotra, PMI Impact Malaria

Remote Microplanning

Niger conducted remote SMC microplanning. Central level health officials provided provisional health authorities with templates pre-filled with 2019 data and updates to certain parameters. The districts then held meetings with the health center directors in groups of no more than five to complete and correct the template. A team of national-level supervisors provided remote technical assistance throughout the whole process.

Safe Supervision

SMC supervisors travel in a car that is washed and disinfected before and during the supervision period. Each car is equipped with a handwashing or gel kit and no more than three people are allowed in each car, including the driver. Supervisors wear obligatory face masks inside and outside the car.

COVID-Secure Trainings

In Cameroon, health workers received SMC training in limited group sizes while wearing face masks and maintaining proper social distance. Classrooms were disinfected and equipped with a handwashing station and the windows were opened for increased ventilation. Trainers briefed participants on barrier measures and incorporated a COVID-19 module into their curriculum.

Clear and Concise Communications

During the SMC campaigns this year, caregivers administer the first treatment dose of antimalarial medicine to the child, rather than community health workers (CHWs) doing so. Mali created a communications aid demonstrating how the CHW should wear a face mask and stand back at a safe distance while supervising the caregiver administering the first dose using the household’s own utensils. After visiting a compound, the CHW washes their hands before visiting the next compound.

In an ideal world, communications under COVID-19 would mean increasing mass media and decreasing face-to-face communications as much as possible. However, some of these zones have very low mass media/radio coverage and so village criers remain an important communications tool and are able to maintain a safe distance with their megaphones.

Mali’s SMC guidance demonstrating COVID-19 measures.


Results from the first cycle of the 2020 campaigns show that the vast majority of families are continuing to accept SMC during the COVID-19 pandemic.

For more information, view the presentation of the July 16, 2020 webinar hosted by the Child Health Task Force on delivering SMC in the context of COVID-19.

For more examples of PMI Impact Malaria’s country-driven COVID-19 adaptations, read this recent blog post: Advancing Global Malaria Service Delivery in the Face of COVID-19

Written by Katherine Kemp, PMI Impact Malaria Communications Coordinator. Contributions from Charlotte Eddis, PMI Impact Malaria Senior Technical Advisor, and Anne Bulchis, PMI Impact Malaria Communications Manager.

Source: World Health Organization—World Malaria Report 2019

Header photo caption: Community health worker Boubacar Traore explains SMC doses to Mariam Diakite, mother of 8-month old twins Awa and Adama, in Niono, Mali during the first cycle of Mali’s 2020 SMC campaign. Photo Credit: PMI Impact Malaria

PMI Impact Malaria is led by  Population Services International (PSI)  in partnership with  Jhpiego,  Medical Care Development International (MCDI), and  UCSF

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