Discussion
malaria, infection
MALARIA, INFECTION
Currently, there is a growing interest of combining health interventions for efficient management of resources to ensure sustainability while improving health outcomes [Though previous studies reported the protective effect of AZc supplementation [Interestingly, a synergetic action was observed with the MQ-LNS Plumpy’Doz™ enhancing the protective effect of SMC against clinical malaria while no effect on asymptomatic carriage was observed. This would mean that the addition of nutritional supplements would not protect the infection but would contribute to preventing the evolution of asymptomatic cases to clinical forms. Two plausible reasons initially evoked which could justify this result resides on the one hand in the reinforcement of the immune system by the nutritional supplements and on the other hand in the improvement of the absorption of the drug AQSP given during SMC campaign. The latter case seems less likely due to the lack of difference in asymptomatic carriage because increased drug absorption in children who received supplementation would necessarily lead to a difference not only in clinical cases but also in asymptomatic carriage. The persistence of the HRP2 protein in the absence of the parasite [Beyond investigating the mechanisms underlying this synergistic effect, the most important relies in the extend of the reduction of the incidence of malaria as well as all cause morbidity by this combined strategy. In view of the level of reduction in the incidence of clinical malaria, especially severe malaria, this study demonstrates the need for this combined strategy in malaria control in endemic settings. Similarly, previous study conducted in Nigeria reported lower odds of clinical malaria in children who received a MQ-LNS in addition to SMC compared to children receiving SMC alone [In terms of implementation, the door-to-door strategy for SMC offered an excellent opportunity for nutritional supplementation, which effectively reduces costs for implementation at scale. Acceptability of this combined strategy was not assessed, which represents a limitation for this study, but MQ-LNS are usually liked by children and their addition could also contribute to improving adherence to SMC. Another limit of this study relies in the duration of the supplementation, which was 3 months (delay in the acquisition of the Plumpy’Doz™ due to the closing of the borders during the Covid 19 pandemic) not covering the entire period of the SMC, which may reduce the expected effect.Finally, the cross-sectional home visits during the follow-up allowed smooth characterization of the high transmission peak which was stretched towards the end of the year suggesting the need for an extension of SMC during this period in the area.