Conclusion
malaria
MALARIA
Even in areas with features indicative of high SP and AQ resistance, seasonal malaria chemoprevention with SPAQ provides excellent protective effect against malaria in the eligible targeted population, in this case children aged 3–59 months. These findings are very promising and could have policy implications. However, SP and AQ resistance remains a viable concern; hence, future studies should consider evaluating alternative SMC regimens in terms of effectiveness, feasibility, acceptability, and cost effectiveness. Alternative drug regimens could act as back up in case the chemoprevention efficacy SP and AQ declines over time, or they could be used in rotation with SPAQ to delay the development of resistance. Continuous and regular resistance marker monitoring is highly recommended track changes in these markers as SMC is being implemented in similar geographies especially at scale.It is also likely that SP confers protection against clinical malaria episodes in combination with the partner drug AQ, even in areas with high prevalence of SP resistance markers. Further research may be needed in this context to investigate the chemoprevention efficacy and the long-term protective effect of SMC using SPAQ, over a defined period.