Study of the coverage and the impact of the chemoprevention of seasonal malaria in Niger from 2013 to 2022: systematic review

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Lamine" }, { "@type": "Person", "name": "Ibrahim Alkassoum" }, { "@type": "Person", "name": "Léon Blaise Gwendé Savadogo" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Purpose Malaria remains a public health problem in Niger, especially among children under the age of five. To combat this scourge, since 2012, the World Health Organization (WHO) has recommended seasonal malaria chemoprevention (SMC), a strategy based on the administration of sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) during the period of high transmission. This systematic review assesses the coverage, efficacy, and challenges of SMC in Niger between 2013 and 2022, analyzing its impact on malaria morbidity and mortality. Materials and methods The PRISMA guidelines were used to ensure a rigorous and comprehensive recording of the systematic review process. Through searches in five different databases, articles were imported into Zotero software, then transferred to the Covidence application, where data processing was carried out. The selected articles were independently evaluated by two reviewers. These included studies that assessed coverage, malaria incidence, and the impact of SMC. Studies published in French and English were included. Data extraction from the included studies was performed, and a quality assessment was conducted, including an evaluation of the risk of bias. Results Among the six studies, three assessed SMC coverage in all eight regions of Niger while also evaluating side effects. They showed high overall coverage but low coverage in some areas. Another study examined the impact in terms of the incidence of complicated malaria, malaria-related hospitalization, and mortality. Another publication revealed that antibody responses against the blood and pre-erythrocytic stages of P. falciparum were higher in the area where SMC was implemented. Conclusions This study demonstrates that SMC has a significant impact on reducing malaria incidence. Although there is high overall coverage, variations exist, particularly in hard-to-reach areas. Few adverse events were reported. However, very few studies are available, highlighting the need for additional research in Niger to better understand this strategy. 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F1000Research 2025, 14 :539 ( https://doi.org/10.12688/f1000research.165268.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Systematic Review Study of the coverage and the impact of the chemoprevention of seasonal malaria in Niger from 2013 to 2022: systematic review [version 1; peer review: awaiting peer review] Almoustapha Mahamane Wazodan https://orcid.org/0009-0008-8782-3419 1 , Moustapha M. Lamine 2 , Ibrahim Alkassoum 3 , Léon Blaise Gwendé Savadogo https://orcid.org/0000-0002-7861-8607 4 Almoustapha Mahamane Wazodan https://orcid.org/0009-0008-8782-3419 1 , Moustapha M. Lamine 2 , Ibrahim Alkassoum 3 , Léon Blaise Gwendé Savadogo https://orcid.org/0000-0002-7861-8607 4 PUBLISHED 30 May 2025 Author details Author details 1 Doctoral School of Health Sciences at Nazi Boni University, Bobo-Dioulasso, Burkina Faso 2 Department of Biological Science Lab-EGB2S, Université André Salifou, Zinder, Niger 3 Faculty of Health Sciences of Abdou Moumouni University, Niamey, Niger 4 Public Health Department of the Higher Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso Almoustapha Mahamane Wazodan Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Moustapha M. Lamine Roles: Data Curation, Formal Analysis, Methodology, Supervision, Validation, Writing – Review & Editing Ibrahim Alkassoum Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Léon Blaise Gwendé Savadogo Roles: Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Visualization, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW This article is included in the Neglected Tropical Diseases collection. Abstract Purpose Malaria remains a public health problem in Niger, especially among children under the age of five. To combat this scourge, since 2012, the World Health Organization (WHO) has recommended seasonal malaria chemoprevention (SMC), a strategy based on the administration of sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) during the period of high transmission. This systematic review assesses the coverage, efficacy, and challenges of SMC in Niger between 2013 and 2022, analyzing its impact on malaria morbidity and mortality. Materials and methods The PRISMA guidelines were used to ensure a rigorous and comprehensive recording of the systematic review process. Through searches in five different databases, articles were imported into Zotero software, then transferred to the Covidence application, where data processing was carried out. The selected articles were independently evaluated by two reviewers. These included studies that assessed coverage, malaria incidence, and the impact of SMC. Studies published in French and English were included. Data extraction from the included studies was performed, and a quality assessment was conducted, including an evaluation of the risk of bias. Results Among the six studies, three assessed SMC coverage in all eight regions of Niger while also evaluating side effects. They showed high overall coverage but low coverage in some areas. Another study examined the impact in terms of the incidence of complicated malaria, malaria-related hospitalization, and mortality. Another publication revealed that antibody responses against the blood and pre-erythrocytic stages of P. falciparum were higher in the area where SMC was implemented. Conclusions This study demonstrates that SMC has a significant impact on reducing malaria incidence. Although there is high overall coverage, variations exist, particularly in hard-to-reach areas. Few adverse events were reported. However, very few studies are available, highlighting the need for additional research in Niger to better understand this strategy. READ ALL READ LESS Keywords Malaria, sulfadoxine-pyrimethamine and amodiaquine, SMC, Coverage, incidence, Niger Corresponding Author(s) Almoustapha Mahamane Wazodan ( [email protected] ) Close Corresponding author: Almoustapha Mahamane Wazodan Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Mahamane Wazodan A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Mahamane Wazodan A, Lamine MM, Alkassoum I and Gwendé Savadogo LB. Study of the coverage and the impact of the chemoprevention of seasonal malaria in Niger from 2013 to 2022: systematic review [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :539 ( https://doi.org/10.12688/f1000research.165268.1 ) First published: 30 May 2025, 14 :539 ( https://doi.org/10.12688/f1000research.165268.1 ) Latest published: 18 May 2026, 14 :539 ( https://doi.org/10.12688/f1000research.165268.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction Malaria remains one of the most significant public health challenges globally, especially in sub-Saharan Africa, where the burden of the disease is disproportionately high. 1 It is transmitted to humans by the bite of an infected female Anopheles mosquito and occurs mainly in tropical regions. 2 Although preventable and treatable, malaria remains a major challenge in Niger, where it is endemic and exposes the entire population to a high risk. 3 The disease represents a considerable financial burden for households and constitutes an obstacle to the country’s development. According to the latest Global Malaria Report, there were 263 million cases of malaria in 2023, compared to 252 million in 2022. The estimated number of deaths due to malaria was 597,000 in 2023, down slightly from 600,000 in 2022. The WHO African Region continues to bear a large and disproportionate share of the global malaria burden. In 2023, approximately 94% of malaria cases and 95% of malaria-related deaths occurred in this region. Children under five accounted for about 76% of these deaths. More than half of them took place in four countries: Nigeria (30.9%), the Democratic Republic of the Congo (11.3%), Niger (5.9%), and the United Republic of Tanzania (4.3%). 4 In fact, in 2021, 58% of the 4,182 malaria-related deaths in Niger occurred among children in this age group. Despite efforts to combat the disease, the situation remains concerning. In 2023, the population at risk in Niger was 26,207,976, with 4,461 recorded deaths, 35,381 estimated deaths, and 3,937,742 suspected and confirmed cases. 4 In response to this crisis, the WHO launched a strategy in 2016 based on three pillars: (a) universal access to prevention, diagnosis, and treatment; (b) elimination of transmission; and (c) epidemiological surveillance 5 . This approach emphasizes innovation, research, and multidisciplinary collaboration. In Niger, seasonal malaria chemoprevention (SMC) was introduced in 2013, in line with WHO recommendations. 6 This intervention involves administering sulfadoxine-pyrimethamine and amodiaquine over three days, one month apart, to children aged 3 to 59 months during the transmission season. 7 In regard to these recommendations, studies were conducted in several, including Burkina Faso, Mali, Niger, and The Gambia, have shown a significant reduction in malaria-related deaths, with a protective efficacy of 88.2% over 28 days. 8 However, effective implementation of SMC requires rigorous monitoring to assess its impact and community acceptance. Moreover, the evolving epidemiology of malaria has led to the adoption of targeted strategies tailored to the specific characteristics of different areas and populations. In Niger, the 2022 campaign covered 67 health districts and introduced a fifth treatment cycle in certain districts based on their epidemiological profile. In this context, we conducted a systematic literature review to assess the coverage and impact of SMC in Niger between 2013 and 2022. The objective of this review is to evaluate the effectiveness of SMC in preventing malaria episodes, as measured by adherence to the treatment regimen. Secondary outcomes include the occurrence of adverse events and the measurement of incidence and prevalence. Identifying implementation gaps is essential to inform future strategies and strengthen malaria control efforts in Niger. Understanding the successes and challenges of SMC in this context is critical for guiding policy decisions. Methods Type of study This is a systematic literature review covering the period from January 1, 2013, to December 2022. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), and the protocol was assigned the registration number CRD42023495767. We will include randomized and non-randomized clinical trials, prospective cohort studies, and intervention studies that report on the coverage and impact of seasonal malaria chemoprevention (SMC) in malaria prevention in Niger. Experimental animal studies will be excluded. Data source The review includes online-accessible literature such as reports, dissertations, and theses available in Niger. Technique and data collection The search strategy will involve a comprehensive search of databases including MEDLINE (via PubMed), EMBASE, Web of Science, African Index Medicus, and African Journals Online (AJOL). A combination of keywords and Medical Subject Headings (MeSH) will be used such as ‘malaria’, ‘Plasmodium’, ‘malaria chemoprevention’, ‘Niger’, ‘impact’, and ‘coverage’ in conjunction with appropriate Boolean operators (AND, OR). Additional relevant search terms and reference will also be included to facilitate research ( Table 1 ). We use Pico Framework to describe the participant, population and outcome for this study ( Table 2 ). Table 1. Databases consulted and search terms. Databases Addresses Keywords/MeSH terms used Boolean operators Date range African Journal https://www.ajol.info/index.php/ajol 'malaria', 'Plasmodium' AND, OR 2013-2022 Google scholar https://scholar.google.com/ 'malaria', 'Plasmodium', 'malaria chemoprevention', 'Niger', 'impact', and 'incidence' AND, OR 2013-2022 Science direct https://www.sciencedirect.com/ 'malaria', 'Plasmodium', 'malaria chemoprevention', 'Niger', 'impact', and 'coverage' AND, OR 2013-2022 Med online https://pubmed.ncbi.nlm.nih.gov/ 'malaria', 'Plasmodium', 'malaria chemoprevention', 'Niger', 'SMC', and 'coverage' AND, OR 2013-2022 World Heath Global Organizations Index Medicus https://www.globalindexmedicus.net/en/ 'Season Malaria Niger', 'impact', and 'coverage' AND, OR 2013-2022 Table 2. Pico framework for this study. Component Description P Participants will be children under five years of age and of both sexes. They will reside in Niger and have benefited from the SMC for the prevention of malaria in times of high transmission I Intervention studies using sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) tablet combinations will be included. All must have received all three doses of SMC at least once during the four months of distribution C Children or region not receiving SMC, or before SMC implementation Children O Malaria incidence, prevalence, mortality, adverse events, coverage rate, hospitalization Data organizations All original studies and reports that analyzed data on seasonal malaria chemoprevention in Niger were considered. Studies published in either French or English between January 1, 2013, and December 31, 2022, were eligible for inclusion. The strategy for selecting bibliographic sources is presented in ( Table 1 ). Duplicate articles were removed, and two independent investigators screened the titles, abstracts, and subsequently the full texts of eligible articles. Relevant studies were selected based on the following criteria: peer-reviewed status, full-text availability, and inclusion of at least one of the following indicators: incidence, effectiveness, prevalence, or coverage of seasonal malaria chemoprevention. Data processing and analysis All articles identified through the search were imported into Zotero software and then copied to the Covidence application 9 where data processing was performed. The extraction plan was developed or two members of the systematic review team extracted data focusing on the following variables: general characteristics of the study (author, year of publication, study design); characteristics of the participants; characteristics of the intervention; main outcomes. As outcome measures vary across studies, heterogeneity, variability; reporting issues, and methodological limitations (including effect sizes, standard errors, p-values , sample sizes per group) of the available set of studies, we were unable to perform a meta-analysis; a narrative synthesis was conducted instead. Each study was described, followed by a comparative analysis and synthesis. We followed the PRISMA guidelines to ensure a rigorous and comprehensive account of the systematic review process. 10 Results Through searches across various databases, 198 publications were identified, of which 6 met the eligibility criteria for inclusion in the final review ( Figure 1 ). These articles were published between 2013 and 2022. Among them, one was a case-control study, one was a survey synthesis report, and the remaining four were evaluation studies ( Table 3 ). Figure 1. Flow diagram of study selection process. Table 3. Basic characteristics of studies included in the review. 1st author, year Site, type of study Type of documents Population, size Title Issa et al., 2017 6 Magaria/Niger case witnesses Article 482 children Estimation of the public health impact of seasonal malaria chemoprevention in Niger Issa et al., 2017 11 MAGARIA, cross-sectional survey Article 240 mothers of children due to 40 children per CSI Perception of seasonal malaria chemoprevention in Niger Souley et al., 2020 12 Niger study Evaluative Article 39 health districts 2016 Scaling up seasonal malaria chemoprevention in Niger: Description of the 2016 champagne Lamine et al. , 2021 13 Dosso and Zinder, cross-sectional survey Article Children aged 3 to 59 months, 2016 Evidence that seasonal malaria chemoprevention with SPAQ influences blood and pre-erythrocytic stage antibody responses of Plasmodium falciparum infections in Niger Alkassoum et al., 2016 14 Madarounfa, evaluative studies Article 141 mothers or child care workers, 12 community relays and 7 health workers from the CSI campaign sites Evaluation of the effectiveness of chemoprevention of seasonal malaria in children aged 3 to 59 months in the Madarounfa health district in Niger in 2013 Koscalova et al., 2014 15 Five health districts (DS) (Magaria, Madaoua, Bouza, Madaraounfa and Guidam-Roumdji), summary report of several surveys Summary report Children targeted by CPS 206,000 Capitalization of the implementation of chemoprevention of seasonal malaria in Niger Coverage The studies were conducted to assess the coverage of SMC. The first studies were conducted in 2013 as a pilot phase, targeted five health districts (HDs) spread across three regions of Niger: Magaria, Madaoua, Bouza, Madarounfa and Guidan Roumdji (Zinder, Tahaoua and Maradi). 11 Initially, the number of children targeted was 139,000. After exhaustive censuses in these districts, this figure was revised upwards by 50%, bringing the total number of eligible children to 206,000. Surveys conducted by the epicenter in the five HDs made it possible to estimate the coverage of the SMC program. The results, presented in ( Table 4 ), show the coverage rates obtained after the fourth round of SMC. The second study, conducted in 2016, revealed high coverage during the second round of the CPS ( Table 4 ). Out of the 39 targeted health areas, 23 were fully covered, 4 partially covered and 12 had not benefited from the CPS. 12 Table 4. Coverage rate (%, 95% CI, cluster effect) in Niger. Authors Years Targets Coverage SMC % Goals Souley et al., 2020 12 2016 Niger 39 health districts (8 regions) National 85.75 Tahoua 85 Zinder 99 Dosso 75 Diffa 73 Maradi 84 Tillabery 79 Niamey 59 This study is to describe the 2016 campaign of seasonal malaria chemoprevention in Niger Alkassoum et al., 2016 14 2013 Madaraounfa 141 mothers or child care workers, 12 community relays and 7 health workers from the CSI campaign sites SMC 86.6 The objective of the study is to assess the effectiveness of seasonal malaria chemoprevention (SMC) in children aged from 3 to 59 months in the health areas of Safo and Moullé in HD of Madarounfa in 2013 Koscalova et al., 2014 15 2014 Five health districts Magaria, Madaoua, Bouza, Madaraounfa and Guidam-Roumdji Children targeted by SMC 206,000 Magaria SMC1 89.3 SMC2 93.7 SMC3 90.7 SMC4 89.7 Madaoua and Bouza SMC1 92.6 SMC296.2 SMC3 94.5 SMC4 88.0 Madarounfa SMC1 95.6 SMC2 96.8 SMC3 92.8 SMC4 85.6 Guidan Roumdji SMC1 99.2 SMC2 98.9 SMC3 99.3 SMC4 99.1 The general objective of this work is to document the implementation of SMC in Niger Impact of seasonal malaria chemoprevention A single case study was conducted to estimate the public health impact of seasonal malaria chemoprevention (SMC). The study aimed to compare the incidence of malaria in six Integrated Health Centres (IHCs) where SMC was implemented with that in six other IHCs not benefiting from the intervention. 6 It focused on several indicators, including malaria incidence, number of cases averted, reduction in parasitaemia, number of hospitalisations, and malaria-related deaths following the introduction of SMC. The results showed that SMC significantly reduces parasite carriage and load. It decreased the incidence of uncomplicated malaria by 73% and showed a strong correlation with the reduction in malaria episodes (R = 0.59). Additionally, SMC reduced the incidence of severe malaria by 26.5%, convulsions by 19.9%, and hospitalisations by 23%. It also had a notable impact on reducing coma (13.2%) and mortality (48.3%) ( Figure 2 ). However, no significant reduction in anaemia was observed. Figure 2. Summary of the impact of the SMC on the different indicators studied. The effect of CPS on immunity A 2016 study conducted in Dosso and Zinder analyzed 229 children aged 3 to 59 months, distributed as follows: 71 in Zinder, 77 in Dosso, and 81 in Gaya. The results showed that median antibody concentrations were significantly higher in Zinder than in Gaya. This study suggests that seasonal malaria chemoprevention (SMC) with SPAQ influences immune responses at both the bloodstream and pre-erythrocytic stages of P. falciparum infections in Niger. It should also be noted that antibody titers increased with the number of CPS/SPAQ cycles administered. These findings contradict the hypothesis that CPS/SPAQ may weaken immunity against erythrocytic and hepatic antigens. 13 Further studies are needed to better understand the effects of CPS on antimalarial immunity. Adverse reactions (ARs) In the 2016 study on the implementation of SMC, we found that during the four cycles of SMC, 224 cases of non-serious adverse events (AEs) were reported by the national pharmacovigilance system. Prior to the start of the SMC cycles, all health workers and communities were sensitized to the possibility of AEs. The incidence rate was 0.82 per 10,000. The most commonly reported AEs were digestive disorders such as nausea, vomiting, abdominal pain, and diarrhea. Other symptoms were fever, anorexia, and pruritus. The regional distribution of AEs is presented in ( Figure 3 ). 12 Figure 3. Distribution of adverse events (AEs) by region. In a second study some minor side effects have been observed dominated by vomiting (54%) Some minor side effects have been observed dominated by vomiting (54%). 14 Risk of bias assessment Six studies were analyzed, carried out between 2013 and 2022, in different regions of Niger (Magaria, Dosso, Zinder, Madarounfa, etc.). These studies were of various types: cross-sectional surveys, evaluative studies and summary reports. The target populations were children aged 3 to 59 months, mothers, health workers and community relays. The studies assessed the impact, effectiveness and coverage of SMC, often in conjunction with the SPAQ (Sulfadoxine-Pyrimethamine and Amodiaquine) distribution campaign. The Newcastle Ottawa Scale (NOS) will be used ranges from modelled to high ( Table 5 ). This study stands out with a high score (8/9) reflecting good sample representativeness and bias control. 12 It should also be noted that the following studies obtain intermediate scores (6/9) with a satisfactory methodology. 6 , 13 The other three studies show methodological limitations with a score of 4 to 5/9, especially in terms of comparability and measurement of results. 11 , 14 , 15 Table 5. The Newcastle Ottawa Scale (NOS). Study Selection (*/4) Comparability (*/2) Outcome/Exposure (*/3) Total score (*/9) Issa et al., 2017 6 *** * ** 6/9 Issa et al., 2017 11 ** * * 4/9 Souley et al., 2020 12 **** ** ** 8/9 Lamine et al., 2021 12 *** * ** 6/9 Alkassoum et al., 2016 14 ** * ** 5/9 Koscolova et al., 2014 15 ** * ** 4/9 Discussions This study reviewed and synthesized six studies in the context of the chemoprevention of seasonal malaria in children aged 3 to 59 months. SMC significantly reduced malaria incidence rates and moderately reduced severe malaria. It also led to reductions in moderate anemia and all-cause hospitalization rates in high and moderate transmission zones, along with a decrease in mortality rates. To better contextualize these results, it is important to compare them with those from other countries that have implemented SMC. In Niger, we observed a 48.3% reduction in mortality rates. These results are comparable to a study in Burkina Faso, which found a 42.3% reduction in hospital deaths during the high transmission season, while in The Gambia, this reduction reached up to 56.6%. 8 As for simple and severe malaria, the rates observed were 73% and 48.3%, respectively. These results are lower than those found in Nigeria, where malaria incidence was reduced by 35% to 45%. 16 These results may be explained by the effective implementation of complementary control strategies in Niger, such as the use of insecticide-treated mosquito nets and indoor residual spraying. Additionally in Mali, SMC was associated with a 55% reduction in severe malaria and a 40% reduction in hospitalizations. These results are higher than those found in Niger, which reported reductions of 26.5% and 23%, respectively. This difference could be attributed to higher SMC coverage and better population adherence within the country. 17 Moreover, when comparing our results with those from Chad, which implemented SMC in 2014, a 35% reduction in malaria incidence was observed, with a coverage rate of 50%. These results are similar to those found in remote and insecure areas of Niger, 18 where low coverage may be due to logistical challenges and limited community buy-in. Furthermore, our results on incidence are also higher than those found in Uganda, which reported a 43% reduction in confirmed cases. 19 This difference could be explained by the broader SMC coverage in Niger (74.4% in 2015) and its earlier implementation in 2013, which may have led to greater community adherence to the strategy. 11 SMC has shown substantial reductions in uncomplicated malaria incidence, with rate ratios indicating a 73% decrease in malaria cases among children under five. 20 In Nigeria, SMC significantly reduced the malaria burden among under-five children, with a 2% decrease in case numbers and a 3.5% reduction in deaths between 2020 and 2021. In 2023, 53 million children were covered, primarily through door-to-door distribution and community-based interventions. 21 When comparing this study with a 2021 review that included twelve randomized studies, the results were stratified by age (<5 years and ≥5 years), number of cycles (three or four versus five or six), and, where possible, by drug type. The drug regimens examined included sulfadoxine-pyrimethamine combined with amodiaquine, amodiaquine-sulfadoxine, and sulfadoxine-pyrimethamine combined with artesunate. All included studies were conducted in Sahelian countries, where high-grade resistance to sulfadoxine-pyrimethamine was lower, and in areas where parasite prevalence ranged from 1% to 79%. The study demonstrated a significant reduction in the incidence of uncomplicated malaria during the transmission season. Additionally, there was a notable decrease in the prevalence of malaria parasitemia. 20 What is more research entitled ACCESS-SMC reveals some evidence that seasonal malaria chemoprevention with SPAQ is well tolerated. During the four SMC cycles, 224 cases of non-serious adverse events (AEs) were reported by the national pharmacovigilance system. In comparison, other countries reported 36 serious adverse events through the ACCESS-SMC partnership in 2015 and 2016, including one rash, two fevers, one extrapyramidal syndrome, one angioedema, and 31 gastrointestinal disorders. 22 Regarding the coverage of SMC, it should be noted that, at the national level, coverage in 2016 was 85.75%. The regions of Tahoua, Zinder, Dosso, Diffa, Maradi, Tillabéri, and Niamey had coverage rates of 85%, 99%, 75%, 73%, 73%, 84%, 79%, and 59%, respectively. 12 While the overall coverage is high, the results show regional variation. It is also important to note that, in the absence of reliable data on the target population, administrative coverage may not reflect the actual coverage of the SMC program. This justifies the need for cross-sectional surveys to measure program coverage at least once, at the end of the four SMC distributions. Improving health system performance and data availability is crucial for enhancing SMC coverage and ensuring equitable access to preventive measures. 23 Though there were no comparisons between children who received three or four rounds of SMC in Niger. The results are lower than those found in a study in Ghana, which had 90% coverage and showed similar risk reductions in the three- and four-round trials. Other studies have also compared delivery methods and dosing regimens, reporting innovations such as door-to-door distribution and direct observation of the first dose by the distributor. Even though coverage is high in Niger, the incidence rate is lower than that found in the Ugandan study, which showed that SMC using sulfadoxine-pyrimethamine and amodiaquine (SPAQ) resulted in a 92% reduction in malaria incidence among children aged 3–59 months during peak transmission seasons (“A non-randomised controlled trial to assess the protective effect of SMC in the context of high parasite resistance in Uganda,” 2022). 24 In intervention areas, 90% of children did not experience malaria episodes, compared to only 15% in control areas, indicating the substantial impact of SMC on public health. This difference could be explained by the quality of the implementation of the intervention or by epidemiological conditions. In terms of resistance, Niger is in the Sahel zone, where SP resistance is relatively low. One study found some evidence that seasonal malaria chemoprevention with SPAQ affects antibody responses to blood-stage and pre-erythrocytic stages of P. falciparum infections in Niger. 13 Unlike Burkina Faso, where similar studies have been conducted, these studies have shown that SMC with SPAQ provides strong immune protection without negatively impacting the development of natural immunity. 25 In Nigeria, however, resistance to SP has been reported in some regions. 16 Although resistance remains low in Niger, there is a need to implement a monitoring system to better adapt the strategy. This review provided an overview of the studies conducted in Niger regarding seasonal malaria chemoprevention, focusing specifically on coverage and its impact. Some key factors for the successful implementation of SMC include high coverage, community adherence, and the integration of SMC with other complementary strategies. These factors are often associated with a positive impact on reducing malaria-related morbidity and mortality. It is important to note that community engagement and the participation of local leaders are crucial to ensuring acceptance of SMC. Despite its performance, challenges persist in the implementation of SMC. These include variations in coverage between rural and urban areas, logistical and financial constraints, and drug resistance in some regions. To improve the implementation of SMC in Niger, particular attention must be paid to increasing coverage in rural and remote areas. Community participation should also be strengthened through awareness-raising and the integration of other malaria control strategies, such as insecticide-treated mosquito nets and epidemiological surveillance. These findings also highlight that very few studies have been conducted to assess the coverage and impact of SMC since its implementation in Niger in 2013. While district-level results show satisfactory coverage of over 80%, they do not reflect national-level coverage. This underscores the need to conduct further research to generate comprehensive data for improving the strategy. Limit of the study It should be noted that in this study, we were unable to perform a meta-analysis. During our research, we found a limited number of studies on the coverage and impact of SMC in Niger. It should also be noted that the studies identified were mostly conducted at the district level. The study period was relatively short, and very few studies included a control group. All these factors limit the ability to draw robust conclusions. Conclusion Seasonal malaria chemoprevention (SMC) has proven to be highly effective, with an acceptable coverage rate that is well accepted by the population in Niger. The results are comparable to those observed in other countries where the SMC program is implemented. This review highlights that several studies have addressed various aspects of malaria chemoprevention, including its effectiveness, public health impact, coverage, and adverse effects. These studies have produced satisfactory results, underscoring the importance of SMC as a key strategy in the fight against malaria. However, there are still very few studies specifically focusing on the coverage and impact of SMC in Niger, which highlights the need for further research to strengthen and improve the strategy. Ethics and consent Ethical approval and consent were not required. Data availability Underlying data No data are associated with this article. Extended data Figshare: Mahamane Wazodan, Almoustapha (2025). PRISMA: Study Of The Coverage And The Impact Of The Chemoprevention Of Seasonal Malaria In Niger From 2013 To 2022: Systematic Review. figshare. Dataset. https://doi.org/10.6084/m9.figshare.29087414.v1 26 This project contains the following underlying data: PRISMA_2020_checklist Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 Public domain dedication). References 1. WHO: World Health Organisation.2024 [Cited 23 July 2024]. Reference Source 2. WHO Guidelines for malaria. Geneva: World Health Organization; 2022 [Cited 3 July 2024]. Reference Source 3. INSTITUT NATIONAL DE LA STATISTIQUE: Annuaire Statistique 2018-2022. NATIONAL HEALTH INFORMATION SYSTEM. 2024 [Cited 3 March 2025]. 4. WHO: World malaria report.2024; 10 : 2025. 5. WHO: WHO/GMP technical expert group meeting on preventive chemotherapy: Report of the technical consultation on seasonal malaria chemoprevention (SMC), chimio-prévention saisonnière du paludisme (CSP), Geneva 4-6 May 2011.2011. [Cited 3 March 2025]. 6. 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Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 30 May 2025 ADD YOUR COMMENT Comment Author details Author details 1 Doctoral School of Health Sciences at Nazi Boni University, Bobo-Dioulasso, Burkina Faso 2 Department of Biological Science Lab-EGB2S, Université André Salifou, Zinder, Niger 3 Faculty of Health Sciences of Abdou Moumouni University, Niamey, Niger 4 Public Health Department of the Higher Institute of Health Sciences, Nazi Boni University, Bobo-Dioulasso, Burkina Faso Almoustapha Mahamane Wazodan Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Moustapha M. Lamine Roles: Data Curation, Formal Analysis, Methodology, Supervision, Validation, Writing – Review & Editing Ibrahim Alkassoum Roles: Conceptualization, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing Léon Blaise Gwendé Savadogo Roles: Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 18 May 2026, 14:539 https://doi.org/10.12688/f1000research.165268.2 version 1 Published: 30 May 2025, 14:539 https://doi.org/10.12688/f1000research.165268.1 Copyright © 2025 Mahamane Wazodan A et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Mahamane Wazodan A, Lamine MM, Alkassoum I and Gwendé Savadogo LB. Study of the coverage and the impact of the chemoprevention of seasonal malaria in Niger from 2013 to 2022: systematic review [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :539 ( https://doi.org/10.12688/f1000research.165268.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. 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