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SCHOOL OFrUBUC HEAl.TH 
COl.u:GF.OrKEAL.TH SCI):NCLS 
lMP"cr o r SE"SON"L """LARlA l -HEMOrRLV[NTIOl'l (SMC)ON 
M"L"R1AMORBID1TVA.!'o'D .\lOMTALITY Au'llONCCHILDR£N <SYEAJlS 
OLD 1!'1 ( iPPERWE5T REG ION 
THIS DlSSERTATIQN IS !)l"B) UTfED TO THE USIV[RSITY Of GHAl'iIA. 
LEGOS IN PARTIAL F\!LnL.\IL"~T or TIn R.f.QUlRDI['''n FOR THE 
AWARD m ' MSC/IotO/lo' iTORl1l:G ,\.'I{) EVAJ.UATION DEGRE[ 
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University of Ghana http://ugspace.ug.edu.gh
University of Ghana http://ugspace.ug.edu.gh
F;", ly. Iu..nkmy >uperv; ,.,r.D,SelhK. Aflibedli,fo.u.esupf>Ot1andad>'ieegi'·enlO 
mc. h""'YlHllhanbt.;ncask,fOfme\O~ ... ;th.I.,.,indecd~fuI.Also.DrD><,"",o 
l)uah.fQ,'helimehededic.le<l..,du.e«<lmiul"'PPOr1~~o\Ome1hroughoulmythesj. 
lomc. l w illoJso1lw\kmyIlkndsChriS\Op/lnT......roMldEmmanucIAwiabforIhcJUpport 
and pny. ... off.rN 10 me Ihroughool thc program. m.yu.eoJmi&htyGod bc:wi!hllSall 
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U.<k j!.' .... nd sc..,.,...,lm.lariachemoprnention(SMC)i• • pn:vention l t. .I C&)'lhatWllS 
rmpl.m.ntcdinth.UppcrWest~gionin20 I Stargc1inKclul<lrarhctwccnW&&e51.S9 
monthsolddurinllpc. .. malari.lr1ImI"Iliwonpcriod. Childm! ..= :dosed ....i th 
Amodioquine{AQ) +SulfadoxincpyrirnclhamiM(SPJfOltltrtweriloysevcrymonthfOffour 
monthspori<>d. Theobjwiv.ofthi' JludyillOe. ..J ua1Cth<'itn~ofSMConmaJ";. 
m<><bidityandll'lOlUlity.."ongchi!dml < }oldiDth<' UppeTW~tf<'&lOO';ncc ,t 
Method" or<condarydata wasc.trKtcd from NMCP {OHIM S2) to NIAI~ the itn~of 
SMCinthrUpj)CfWr:s'Kjionusinlth.Nonhmtas.controllPOllP·Kuotl ....t chinll 
" ... uscdtonutchfOfcommonsuppontoc',aJ..atothcitnpAClofSMCiDIhcUppallo'cst 
I'Cgioninchikmn<SyconoJd 
'T'hocov. ... ofSMCwasbc1. .. ..,n'14%to97%fOffouryoarspcriodiDthcUppt'rWCSI 
I'Cgioo , 'T'homc""diff<"l'mOCfofchildrcnpositi'~iDUppet W~ondNonhmtre:giOflil· 
lS9ll64at (9S". -4215S,11 ·29671 .91). MllIwdca!hstr<fldswuhi&h(ndeaths)in 
lhcNonhemI'Cgioo compamilOUppcr W~rtiion. ~signifiCllllir..,.aorSMCorr 
Childrtn dyina d""tonulariawumillCedlO23.6%iDUppa We:s.re:gioQ.'·vaJ"",--4I,OOI 
C<NI' l u.i<t~ : IIH: .tudy", ••• lsthatSMCin1CfVftlriOClhas.sijptificantimPKtinmillCing 
~:..rnorbid;lyondmottaliIYin<hildn:n < 5YeartOldinIbcUppetWcstrtgl<wrof 
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A.'ct-scI/'U(m. ... ~fT«IOOlIhrIttU«l 
ikNI~ ..... chan,. __~  
LnitpaledCOlJltn..ol1 cuolluo ltWllljltmctll 
l_rminalptn~~U'QCmftII 
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1.4Lnlerv<:ntionsformalaria prevcntionandcontmLlIInOI\gchikiml < 5YEARS. .. LL 
University of Ghana http://ugspace.ug.edu.gh
2.6 I nl"~ral"dcM\l11unilyc_mamoK.m(nl(lCCM) 
University of Ghana http://ugspace.ug.edu.gh
University of Ghana http://ugspace.ug.edu.gh
TobI.2 : T"lIdNumboto(Ctlildron3.59n>1)nlhs"'~i~IO~lIIddooed(.-om201~·201 8 32 
T"'I.7: lmpaotofSMCon~hildrond)'inlofmal.nainUppel'W ... ~,. 
T"'I.8:M""oflh.;ndqM:ndenLvari.blcsror~wpponbetWCCIIILMlWOrqioas 
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FOil" I : C....:~pluai f..,.... ... ork 
F;'. ..... 2M.pofU~r\lo'HlR~&ion 
F;8U~ l : SMC ~~p«t.d and dosed 10 ~hild"", ~Io ... five ye .... ;n u""". W. .. Rtsinn 
F;&un:S : TMlrt'rldofunderfi.·.dellthsd~IO ....l lril;ntheUpperWCSlondNoN>ern 
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Malaria~main$ 1 publi. ~alththall(1l&. gLobally, espc<:ially in JUb·SaharanAfrienn 
wuntri. .. ThrW",ldH. ..l thOrgonlzation(WHO),rporuf",2017cmmated216mil1ion 
malaril oase'lIlobo.llyand""t"'hith200millionorth.~ ... ...,f1omAfrieatq>reSl<nling 
92% OU10flll. 216. Maiariad ••l h$globoilyslOOd 001 4JSOOO and clilldren aged 5)unand 
belowdcath."'as266000~p~$Cnlin892%1I1oba1ly(WHO.20 1 .). fi&htingmaJariaal""" 
has 0011 WHO and DIh ... donon billion of US dollars usinII differnll 
opproaobeslinl."'cntioninthc ....' o'ld.SpeciallyAfricancoumries".=moI. ... i.e:okmic 
maJari.approe.ch.i"ttgra~communil)'casebas<:dmanag.cm""lofm.olaria{lCCM)and 
Ghanoswis!i.ealscrviccd.mog"'phioandh.a1Ih....,.."Y~poru(GbanlSt.aIi$licalServi« 
(GSS),Ohano. Health Servi •• (G HS). &. ICF Int .....t ional. 2015). SMC intel'o'Ullion 
Ipproaohaill\SlIdotinlithildrene\lcrymonlhbqjiMingthcpukofthcnainYKa.sonsiDc:e 
iMvcclo'foriMlrulsminionof nlllorili""reosesi. . bil ......p cciallychildren<S),un 
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.... "".r.moOlvulrl<ruki""lpv.irh vUYlo"'immuniry (Ndiay.cr aL.2018a). WHO 
rrcomm.ndcdlh<drugSOr.hoieefo'SMCmonlhly inler. ..n rion u. fulllh=doy.ou...., 
Ove,wpasrdc..&.."""rcounrries miniSlryof hcaJlhandWnationaimalariaCOnlro] 
P"'i"'"'hujnl~n.;r,.ddrortsincombl.tingmalwi"malari.md ..... kcounrriesU5in& 
...ariou!inrervenrion.s.."'ilh.upponfrominremationalpannenanclfundilliogeno:ies. 
malwrnorbidilyarnongchild",n5l.ill ",mai""........,..ptably higll in AfricI (H...-sb.y.r o.l . 
2017). TheUPpe'WflI. ·egioni• • Sah<lian7.0rI<wtKttmo.laria·~ · ;'PlOIrly 
snsonaI.v.irhmosrofthcmalari.lburUenoe<:urineduringlhcnoiny..-.Lowrainy 
>ea>on.rh.rempe'B,,,,,,, ondlhcborecding,,,,asCfcatc.goodm";ronmemrortbevcctorro 
muhiply""drhi,'cad.roinc",aseinmalariamorbidiryandmoraliry""""'llch.iIdm:t < 5 
)· ..... inrhe"'Cion. TheintroducriooofSMCinrh.upper"'gionbyrb.n..llioDllrnalaria 
oonb"l)l ptOl:ram and its donors p.mn.rs is . p",v ...t ivc inlm'otionapproac:b ...... hea!rhy 
"""'Iuiwesbitesduriqthi'periodofhigllmo.lari. lfaSrni$$ion. TheSMCmodieine,stays 
;n,hobloodforlOdoysr.omaM,howm"ytime.rhe""binenbytbevcctorcanyinarlw: 
malari.parui'. .. thcyunDOIboinf""red,inttrhemcdicine.mnaininrhebloodforrlw: 
rl<Xt lOdays 10 proleet rh.m I"rom gettirog malaria. n.emai".imofSMCinraven!ioni,ro 
en.u"'Optjm""1m&imail\lflo:eofrheanri.malari.mcdieinesCOll~ntraliortin""b]oodor 
.,·erychilddroring rhi,periodof malario hiBhrr.mmission. Thisi, toensun:tharr.omane, 
howmanv rimesthuochildrenvebint1lbymG!lquirocsd...u. rhehightnn...uswnperiod, 
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IIwyfnI"'OIK.cdflOJnmal. .. 'nfcc.oon6\M:lOtheSMC ......' C'ntlintheir bloodlillho. 
Childmon.oli ry "'mai nsu"""~pU.blyhi&hinMrie&..-.peciallyJ\lb.SahanMric.a. ... ith 
mal.". ""inti. m.jo< ~onlnbulOl' 10 Ibis burd .... Th.- pn!'ValnIU ofmalaN mnains ...... 
_1O-eC~hurdm""thelllho"_yandthor_Id .. Iatp. M&l. ... "'Il .......... 
thelfN""t.llLKoI:dealhs'n(hilo1rc-n <Syean .. IUb-S .... Afna~1huo4h 
""'....nuoblr •• llcdi_mnalns.publoche&Jththtal'ntheUppn ....' estRtgioaofGhina. 
10 im""",. the cc:ooomi<: ul\I&tioninw"";""' .,..:Ilbrirpmiouolinwia Ihcho$p!lal 
l&kinscucof lh.o.icLchild,Th.-NMCpov. ..l lOAIis.orcduadlM/&riamorbidiryand 
mon&I,ry bIwdm by 7S%bythc yur 202O(NMCP 2(16). Ia ••f fon lOoombu mal .... in 
Ghano.thet-lMCPwiUllhodonotI*tnerlMsinlroduccdUlirM<r.uotioncalkd-.J 
aWi.m.mo"n"urtionintheupprr...p.itlJ .... 201S.4uctolhc:bip ........ 
~intbildml<S~<On'nthM ... IlIOft.ThilinlnvaMion_rccornmcnded~. 
10 12 by WHO to Iho Swl CDUn.riU with tht';mofreduci"ll mal .... tnnsmiqion. 
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eSjl«i.llych;kl~n < S )'<'arJold. Accordini!y.lhe inle",emion hassho"'n 10 bt cost-
dTecl,,·e.$IIfeandf.a$ibl. fOl'u..I'"'~.nlionofmalari.incltild~n < Syeanofogein&r. . 
of~i&hIY"'lISOnaJlnIn<mls5;OfI . Ap05lin!e~lion.'udywudon • .Il'heendpoinland 
come to sIIow thol SMC ....u  S*fcand "",.dfcc.ive(Nonv''''''''.ct oJ 2016). Howc"ef. 
pItIj«limpaclevoJuationlwnotYelbeer>doneco,·"';ngtheprojectperiod.lbisSludy. 
th<n'fo~.!oeekslo e,·oJuatelhc:impa<lofsusonalmalariachcmoc:tt'~DIiOfli.alCf"""'iOfl 
on malaria morbidily ...d  mortoJily""",ngchildmo < 'ycanold since il lmpl.menuolion in 
201S.20IBintMupp<rwest~gionwere;tWlSpl1otedbytbeNMCPincollabotstiOflwl'" 
Seasonal maJ.nacMmoprtw:ntion ill ""w;nttrveDUon lhaI wa$pilolCdbymc naIioooJ 
malariaconltOlprogram(NMCP)inponnm.hipwilhtheinlern8lioMldoooninmcUpper 
Wffi Rtgion. whi<h aims II l'edu";ng ",aIaria burden (mort>idily and monality) in children 
Wel!n'gion.Thisstudyuscd~aryd"taftomtheNMCP(DHIMS2)1O..w)'ZClhe 
dreclcfSMComon,chi1drenbctweentheogesl-S9monthsllSingpropms.i!y~ 
the Northe", Re&ion .. 1M control ifOuP. DItII e~tno<:tion done from DHIMS2 wftv,1Ift 
I'rom the Nation.J malariatolllflll pf'OJPWITl lO_tbe"",-...ge. moroidily and mortality 
inchildn:n<Syeandu.lOmalW6...nna lMinl..-.entionperi06. ThiI"'"'OrqlOIt$Iw 
'imil.".cl\aracttriStic.""h .. ...".V.B.Uluon.l.mpenl1uresandnoiOiroJll"'n.rnslhi.i. 
uKinKI.ctinlllmalChln&oJSorithmthatwillbtUSGdlOrnalChthebcne/ici";"'",ithlhc 
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UCut. ... I ObJ«'Ii>·tI 
Toevailolllelhoimpenof_nalmaloriIchemoprC"..  mlionon..w.i.olDOlbidllyand 
-Wityinchi!dn:n<SyunoldinlhoUpPCfWnlRqi<a 
USpeciIl<Objc<'iv. . 
2. TOa5SC'ALheco""rqeofSMC~II"~elOthe"",wFlovrrthepmodinth'upper 
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£XTERNAL ~..---, 
"::~~" =Jj,:~-:= 1= 
r "pol ,,:1} 
UMHS "I "1\t['1 
~ ~ I 
University of Ghana http://ugspace.ug.edu.gh
«O/IOIftoc:fOO:lOr$tpom""".i"I ,)~I""'andPOv<ff)' .,l"',,'ny_<tUI •• JOOdbnledinl 
... """_"'fot"' ••· ..  \OII ......m  ... inB""'I ..; . ......"  .. IOIIl~kiply;.,""lIlbcnond"' ... i~ 
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This dl. pt.ri,'evi. ...o dallulanllileTalllte . i&JtificanllOlhcltudy. llis rompriliedofthe 
concop<uaI~view,lh.lhcomicaI~viewondlhcempiric&l~.w. Tb:concepruaJ~1<W 
di$Clw. . lhcdefinllionltondconc.plSwhilclhcempiri,*,~l/Wrocusaonu .." ng 
dLlrin&lhcmalari.seasonlOp=enlmalarialUlnes$wilhlhe~veoflJl.lilltaining 
\II ....p t"u'i.""'imaJarialdtujjCO~ODSilltbcblood~lhcperiodorpul<:Sl 
COIIr.ieSOf.p·IIq . ,monlhlyinlcrval.,ochildrmaiOdJ-S9monthsill .... ofhicItJr 
S....".,.. malariadw:moprtvcnlion i'.Cunnll imervcuIiOll~I3'Ipr<>gnm 
recornmenlkdbyWHOinllfHSkno",nwithhiPtlyXtiGnallnnSmissionofmalari.fur 
.hildrcn .gubc_3-S9monlhsoldills.Mllqionsof~~inAmc..1n 
MiKh 2012. the World Health Orpnizalion (WHO)Cl<MOVl ",ilh. poUcydoe_ 
~mcndation rOf.n.winl""entionpurposivclyqainslIllcP.(a1ciparommalari.in 
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Ch'kWn < !~. . oIcI _ ThI,""""-au!\IlalWk,p.sllc.~IOrlhotaUlyseuonwlor", 
mallNuwu.ni. ...... lln.c>UbIyhl&h'n_hSahclb<-IIVrlholmlpm"COrA~ 11 
IfIvohulhedillribuOOrloflhorap<uocdoonofanu·oruoIari.jAmodiaq ...... IAQ)· 
COIICtftlfMionsinlhoblood~lhisptriodolbi"'lrUUmissioltorrnat..n. ......... 
ItIis'""IMftblcpoup. O. ...... lil"Slp,lotrdlhisinIn"o"alUon(SMC}inlbouppcr_rqion 
inluly20 ISin lbon<>Mcmpu1olIhoCO<lftuy .." bm:malaria_' _· _hiP ........ 
child""'<5ycaniaIboCQlll:lUY,~lotbcGhmltdmooiraPbyltld'-ldt-,. 
I<iIwIISuristicalSeniCC\OSS} .. "'. • lOU).Sludiablts ....... dIoIlDCIIlIItoIy.~ 
....· coloownlhll_lbIy.m.jnistraeionolscatonlllaWlrUlc~(SM(') 
modic ....J (onc-d.ltydoaeorsuJfodo.~pl""OMd&Ydo«of~) 
IOdlildto:nb<-N.~IbtA&c·sl.'9monlhsreal!cdia~ll<I.protK:tionwi ... 
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IfSMCis ....... ., ....d1..wmi •. n'ncom.,.NII'On .... ," be ",. .. ~~d ('" clio' treaUn<III of .uct 
....... cue ""' .. ~", M.JcIof.'tOC .... IIl;,.,~.201.'AIIoChnONdoes"-'.., 
1J\oIO'o'I !I.- " fric.chlJdrao c ... bc"""",tcdlfom lNl"'.d. ." " cMl"gh~of 
A.-.I;".CO"~_· Ir)' WUO Myo chM I>CIIIIOlriaionpletnalliq SMCobouId 
......~ .c III ci""" o".;t.b!licy ofmaiaN R.pid Di...-;c Tau (lI\RDT.j ... lIliawcopy 
for ctillieaJ di.~. ac ~I ""'~I.;" \he uansmission pniod. In \bi.o _ . 1M NMCP in 
ofchc~ww ..p on. chc,,",ionoJ matari'COIIcrol propam"""ouppofUIdcM..p,c. 
widlavailabililyormROT. .c .Jlr. . ,lici ... frolll\he,...;o....t~l co cbrCHPS~ 
S.. .... l mat.n..chcmop...."nllon_. ... for childrao oaal>etwcm,·S9rno.nlrs 
otd ;,. _knoWll\uha~hiahmalari.morbidityondmoct.hl)'C$pl'CUoIl)'chiIdrao < S 
)'eatlold..AOIIIdytcnd...:cedln ScnogoJf()j lowinl implcmc:M&cioaofStotC, SUI\'Cil10n00 
concIuctcdco"""'"""a:I\<UXevc ... I'otlowUIa~AQ'SP ""'wdllllSMC_ 
..t.onddfccti~irlltduciq..w.;.lIIOfbIly ond-'icy inSaqol(Ba"'al..20I6) . ... 
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Gkan~mal.ri . ... nll;n.theleadinIlCIU5tmor\.llilye,p"d.llychild,enundtrfi""l"'arsold, 
thi,promp<the.,udyonCOl,. .I Tcc,ivcne .. onSMCfoliowinll.year.-lmini.;ltationof 
SMCin1heUpp<.Wu1 Relion.theJiudyfoundlhallhc:cOSlofdo.ingpefehildisS9.66 
ondthj.<anbcr<:d,",.wMnlClhnSllplOm<:l<¢child"",.noihff rc&ions(Non,'ignDn.C1IJ, 
2.4Inf.r.·cnllon.rorm.l.ri.p ...... n!loGoad«>dl .... l .muB child~n <5YEARS 
Lonll lutinllinse<:IieidnnC1{lLlN)isITNd."sncdlGrcmaineffecfi""formvJtiplc)'ears 
witholll",,,,,alrnroLil'.oncIheNalionalM.olariaConItOIProrpaminltr.'C11tioo$1J'ategY 
,0 LLlNnTN usage in Ibe mWlicipa/i,y{Konlan C1a1 .. 2019). UlNilnI IWSillltOdU<:edby 
WHOlOmosl malariloC1l\le:microl.llltriulOr<:<IU<:edmaiwiamorbidil)'lnIimortality 
Thi'''I'I,eIYWU inln>d,",edlO reduced physic.ol OOOIKIS by Ihc """tor II n;,;hlwcn:':lhe 
bitc:lohhcmosquitonincrus.-iondlhe .. byinltOducinglhcpwas.ilelOthcvietim.lont 
University of Ghana http://ugspace.ug.edu.gh
1_linginsccliddenflil "onB;ntheroomSandchiklren <SycarSGldand~gn3JII"vmen 
.1..,pins;dcilal .. i8hI.Tk;."",.'cnli"em.IlSUJ.C .nprQte<lm~lhMO""childin . f. .... ily 
fromlh. bile>ofmosquiloes . lnighlltld lhi ' Bi~"" a rrwcimumprotcctionnealcdbYmost 
flmili ...s pecially . ,rtighl.Studi •• hI" ....o wnlh.ollonKIas,ing~cidesU'eltedncu 
canremain.IT""'ives.~.fI.,nv.ral"'lShinilforuplOa'In.slthreeyean(WH02(1I9) 
O"...er$hipItldUI;liuli""oflonKllLStln8insccticid• • lJeatedncu(LLINIITN)~U«$ 
AiplUlGfdfortto,cd""cdmalarillburdcninAfrica.especiallywSabclilocltwben: 
malari ••• cnd<micondtuU11y aITeclchildren <5yearsold. ThtNatiooaIMaiarioComroI 
Prognmin . .. effontGoombatmlliaria.intrOduoedindoorl'1!$idualspnoyingwhicbmain 
o. ceilinp diu afterwards. Thi. inlm'ention does not Pf"_tbe: biles of the mosquilO 
frombitinihumMbulonly ...s un:sildoc$not~oatb·SJnyai .., ""oroeiJiDp ..1 Ieft 
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the mosquitoes diu up<>n ",.tlog on 1M spJa)'N ....1 1' and c~ilinS" in the roo(ltll. (""PM I 
2(14). Studi~ I.,,,,~ .~gg~ ..C <!!luI1 the combination ofLLlN and IRS on ind<.>orsurflCel 
togell1erC.lima'edha\"CIOl\'cnC<!517millil>nc ..... from2000in2015(Shem.rd.SmilIIet 
aI,.2(11), Ir>door",sidu.alop ..y inHpllYIVCry imponant role in comblnin& malaril 
csptdlUy ""Il<'" the", il ICtW u. .s c of LUN. Onu I hokl$C;s opnlYcd. night slcq>ing in 
the room. be<:omc clISicr si...., mot! mot/'.enIcare gi~.rs complains1h:1'c is hcal.lccping 
commWliticsI. .. ht",timclyinitjalionoflrCatin8fcl·n;l mOSlJyllleduelOclistance.TCCM 
"""t",.pproprialct";n<:dCHW.tteaIWlcomplicate<!mllaria.pncwnoniaand diarrhelohas 
... l.rainedtoHknlifyondtimclyprovid.tn:atmentlOclIildm'l<.,5~oldp...,.nting 
",illlfc"trondwaltringSlOOI.ThcyoretnlinedandproYidodwithRDTs.,lIItimolariai 
d!'lliJ. oral antibiotic .. zinc labl.l IIId orat ",hyw.uonsah (ORS). Thcy_uained on ho .... 
todilposcmalarilb)'1eslingwithRDTl.diseasehislOIyandrapirawryrmU$injbealS 
University of Ghana http://ugspace.ug.edu.gh
Timdyinte"'~nt;onOllld"'f~""IOfc_.h. .' edccreased hasrcdu<cddLildren<5ycars 
<Io.thsfo • .,.s<dcCll(\e'''''OfId",;dc 
Anystudic.thathulho"'Tlt/ultlhcinu"ducLionof SMCha$reduccdM&lariain~hildn:n 
Iicl_S9moothst/ult llcn.ratedinfonnationmustbcappn:>prillClybc;ruormcdandiu 
.ubseq .... ntimpro"'"mC1ltinwbe.llh ..r vi« pe1iormancc. SoolI!srudi~havcbttft 
conductcdande""IWI(edlhatSMChasredU«dmalatiae:plsodcinch~dtcn <5>,""oId 
A 51wly cond""ted in B..rnNiFaso in 2014 and 201j by Thomas Drualllal(Drurtl.eI 
aI •• 201.)w.hownlhaISMCcover.gc ... .sll%inchildrm<72monthsinthofirstf'O@ll 
of SMC and il hM redutoi the parasitmlil point and perlodprevoJcncc b)' ].]%and 24% 
poinu.respecti1lcly. ThisilutransIBtcdlOaprolKti1l• • lTectofS I%and62%. Tbo:.ructics 
di.tria.parultaemi.pre.'oJenccn:duccdb)· II% andthecompar;sondiscricLpfWSiUlCmil 
iDC"'tiO!$ 10 46%. The study al50 iodicalcdlhat m.aioria ilincu feU 10 I (llUter dcgre. in 
theinte"cnliondistriclcompami lo\hecomparisondittriCl(DDOR- 0.20;9S%CIO.04-
O.94).thcll1ud)'''''DC]udedthal l'O\lti ... SMCimpl. ....n lationhasn:dllCCdm&larilond 
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2.7S'-..... 1 m • •• rI. <h.mopr.vonlion (S.\lC) 
s". ......l m.lari.chcm<>preV<ntion; f OMO(\h<m;oOmrncrKk<!inlel'o'cnlionprogramby 
WllO J;f\Cc2012.lhal in."I.'c~ \h< IIdmlninraliono(.,rumWari&! drug ;nlennillCnlly to 
child ... n < 5)-ear$oldduringthcpc.kpcric:.fDfmalari.tr;1rISmiSlion~n. Acc:o.dinglC 
World Heallh O'l!...ulJltion (WHO), SMC i. dcf,ned as "th. inlennittcnl odrninimabon of 
fulluutmrnlfO<ll'$Cofanllll;m.allrialmcdicin.J lCchildlcndW"ingth<maJariaJ !USO<\;n 
....... ofhlgh.lyseuonalmalari. ~ ..i on·'. n..;ntOf'o'cnlion ai""atnw:jmwn 
mon,hforf"LL1consecut;v.motIlhtochildtcnbct ..u nlh• • gcl·S9monlhs;nmosttnaiariB 
cndemiccOWItric •.••p c<:i. llylhcSahcl.llldSub.Sahcl. Afric.anOO\UlQ"iQ. AsrudY .." N 
donc;nStncsal"'inll·cluslerrandomiudde. ignwi!hIltn.(9j illten·. ..t ioadisa"io;taJld 
f'eCOI"dod"1060.IO))""d590rupeclivdy. ThiSprnmIN.totaI~..,;tionof40.9% 
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o~""llnurnbe,ofdn!hs;n2015GIwlaH(allhScrvjC(AM .... I I"P"IU.Thcrtponsi.ho"'n 
lbl the Uppo' W""t Rcg,on",cOtdcdthclo_ot numbe,ofmalaria cuesinth.alyeot 
A stud)' on lIIe impoool ofSMConchlld",nbnwemtheag• • J.59 months old in M.lH in 
201 4, to ev.lIUlll< theeffe<:"vellt$$of SMC on malaria pn-valence. C<tverage and anaemi. 
""""'I ,hescage.non.randomiwlpre·pwtdesill"_usedforlheitm"...,tionaroup 
andlhcconU'Olgroup.n..inl<",entionll""'P~iv""'SMCtnedi<:innforfourrounds 
andthefO\tlin.LlINdistriblllion ...." "Sthesamcif'O'lP0(cltildrtn,wbiletbecoolJ'Oldid 
notr"".i,·.anySMCmcdici""s e~c.ptlhc LUNdi.aibutionwhm:lhedilldm:tintllc 
AnoIberorudY"''8SCO!Iduc!edinSemp)IO.,'aluacedw:adverwevcmfoilowin&SMC 
odminiwa,ionlOdtildm:tunde.IOyean durinllwpakmalari.tntnsmissionperiodin 
201$ in II hcalthpost.AtoIalpopuiationofl4.000childmlco'·cringthe II healthpoSl 
and Ila,OOO_",dcMdwithSMCfo.thefuurrotmdsporiod in lOIS. Thcobje<:ti,'eS of 
IhcllltdYWUlodflenninelho..tVttW cva11(AEj ",poninl C<tuldbl:impm""""ing 
smanpbr:tMtapplica'ionpmvi<!ed to !he vill"11e hcalt!t workm(CHWsj 
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TMy _rc u.inr:d w .... the $tIl8ltphoM~ W rcpon od,'~,,~ even! (AE) and Ute ,iv.rll' 
mo!h ........r c.ll«lu"'flClOr.ponsandod'·.<Se.".n!foJlowinStheodministBlionofSMC 
""dic;M'(AQ"SP).Ae!i"".urv.illan<._J.~mployr:dlOmOO1ilOringofehikln:nafter 
dosinahai1alt.npla~. U.in8tl1·mobil.phonel ••h nologyinrtpOrlingadvnxe-'.n! 
(AE) .• W. .. lofI9Il.hildrcnrcpr.sentlngJ.S% rq><>nedof.....,tin.QWAQandSP 
followina odmin;.tr1Ilion.Thc:moS!eommon""""'8the..J".IK.v.n!~vomitin&d\Jl' 
IOth.bit1.m ... o(IMAmo<liaquin.(AQ). Thi • • lUdy ..... ""ftdllCtCCllOrcportallodV<:fSC 
~uud!ol.)%.thi. \!lIII5 ..l ed\O.proi('Cli,·• •t TeaofSI%I1{9S%CI"10.24-O.99J).Thi. 
SllKIyh .... evalu.lodSMCand""ncl. ... i'''I)'.SMCbasred''''tdlhep. ... valenoeofmalari. 
In thi. age group in 8uri<ina h.., d"'ine tho Sllidyperiod(OruetzC1a1 .• lOlh 
It i. ..' imaledlhallhtnumbnof ..... Lari.cases.v.rIOdin20ISin.hildml<5)'canold 
duetoSMCin',""",ntion,inSahebandsu\).Sahelsoounuicsore246782.7JOO3.249611 
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.IS I l)O.21729S...:l2SOO2.andllOll.ln""'bc.<>fck.ths .,·crttdwc~12U.180.I JOO. 
7U. I ~% and 146 in 8u,kinl f ll$O. Gu ,1In. Ml h. 1'0'8<'" Nig<:n aand lhe: Gambi. 
~J.P«Iiv~ly . Rtdudnillh< numbcr or mal ... ilc_I OIId ....t hs"·illddini. . lyrtdua lleal lh 
I)'SLom rool and ....... roroWr priorityd.JUKI 1ft lhe heollh ' Y'IC'tn(Colhns. 2016) 
Tbi' MUdydtSip"""wnllocvo.Jualc!locimpld <>fSMCIOSi"i "'~·tfllionandcon!n>1 
lVOuP. U. inilllledifT=n«indifT=n<c approac:h """ lISCdl0 c,-.lUMclhcu..p.no(SMC 
inlhlllllldy. The .~tf8&clreolmcnlefT""l on lholtUltd~ estimatcd~ lhe 
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ronuvl Kt..~tiOO\.l bi .. bc1~n lhe~C>fl1JOl and 1M 'n1~"'~n1ioo KJOUII. The,rudy , ..... 0\11 
.. i"'rt<I""lionofpo;nl.,........I~ofmalari.byll%.24. 6·~ inp"riodP"'vlllenc(Of 
maJari .. 16.I%rcduclionln.....,"'i.and IO.2% mo:l<kraleIOKV=~(Dn.leIZ(1 
aJ .• 2018) . Thi ••l . ... ydidnol look.,1l1.1rcndO( INIIan.>eI&tedduthl...;\hinwpel'iod 
orSMc.alO1 .imilarly.lhc0100dyloolcedlllhcco'·. ..B <'and~ormolari&""""'i 
PriorloSMCimpk-~nll1ion;nUppaWes\Re&ionofGhanlin20'4.IMNMCPondW 
.., ..,nalh.lllthditf!C1O/'I.leleom mel sc<'erally 10 diKIW Ihc need for IhiI intavenlion in 
the ... gion.Thi ..... roUo ..' Cdbymkebollk. . mMiJ!3S"'ithfoodwdrugsautbori1y. 
informationdc-pwtonenl.~lof~hiklrmoffoirs.cbieftaincy~GbJina 
and lhc importarll:eof SMC 10 the pcople of tbc ..g ion 1$ f.lISwR"giOll._IWIbd .. 
theIClldinginmallrilmorbidity"""monaJi,yinw<:O\lOUy.1"hUoffcctthectoo:iG_ 
-,or,Thcrcuonforlhi• •l akd.ol6enmMi"ll ...... IORUthecideaofSMCondlbalits 
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ThiI"''Ufollo-.lby",rul~;zalionofSMC;n.lltheloaJFMltati'''''inwl'<'gionboth 
ImpOrt&Dc. ofSMC inlO,,"'OCItion in Lho ~8;orL Sensitization of SMC aclhf v.no.u 
wuona/. ThCll'ClllmmlofAmodilquine(AQJII'IdSull'adou..pyrimrthaminctochildn:a 
"II:.bclWH'nl-j91f1<m1ludurin&lbcpeak~·_·pcriodofmal.n._lIbo .... to 
SMCme<!;cineli.sIJi"ftlfo,ldaysiDwtUch.childwilJbceoasideredllSfulJydo$ed.fo, 
thalmonth. ThcfLnld.ly .• COIM1l111il)'healthYOIIII. . ccn ......' tliombo::w.&sclObouscdosing 
elitib\.ch;ldren~B;llemIforSMCintuvention,UJIOIImtcri"i . house,th.CHVexpl,.;" 
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IOmoth'",~8i., ... Ih.pw1>OKOrthc'nl ......,  .. iOt\thePOI.",ualrisk(IhI. ..l ldruvun 
~.UK';ok.ff<Clin..,.,..~hild"'n_huvomili",andskin ,_uon)ITIOIM","""sivm 
.... ",assuml . tx>ulthc sar"yoflhcmedicin«and in eue.childuperimecand form of 
...t ionatlerdosina.MallhperIlOMe'l1<tnoi""dlOhandlesuch • .;n;otionfreeofchlll'8e 
'Tlo:clIfIlfIIuni'yhealtltwh. .' t. ....... p<>IIenterinl . hoUK 11< 10 lind 0llI if the very child 10 
t..doscdl'lll.·. ....n bcfore<lo!inlt..&ins.and iftheehildl'lIOIeatmthe~ol""toerSall"w 
fIKIlhersl.,.... ..~ . .. to f....d the eNid boor"", doIinl t..sins. A child .. daocd with 
Amodiaquine + sutrfldoxincl'yrimC1hamine • ..., thc IiI3l day. day 2 AmOdil<;uineonly and 
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indo$iR& ... ,....."duri"i~KJWICyli""~maIarit;nfeaionil.rrI&JOI"public"r&hh 
nronaWl1IONIit)'f·WHOlln!mninencprevmtiv._. ... tinl""anancY(lPTp).~20I.) 
IPTprtventl,,(cl..l3pyil~formM....t..cifta ........ b....sminc:tlildrm < 5y-. 
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J. I SI. . dy .. nlnR 
TbcUp~rWnIRt&ionor(jhanaco,.., .... gOClpplucal_of.opptOXlmalcly178Jquan: 
JinpII,UWfllond Turnll)ondsevmdimclS(W.Wm.WIEasl.Si5S&lo£ost.N.oowl! 
NandomLamb .. iss;"lIIIdDoffian\lla_i~ I""I. The""&iOMle.opitaJilW .. "'bic:h;' 
Wli.thc:largUlpmSominantlylsiunicci!yinGhano. Wali.tbclanguag~oftbcWola. 
ondDapllr(:h\n~""'muNlllyinldligjble. 
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SMC implementalio/loo'o'o:redllllhotbendil lrk:1 in tlIfrclioll. in which tbe 5 poly 
cllnicJ.71 bc:lllhcemcn and 246CHPS cOIIIpllunds werc directJyinvolved in W day to 
...-F. ... nlchild"'nwitllad'"flVreaction foUO"'ill3lhcdotingofSMCmedkiMs. 
A1lthc1221COl1l1!11mitie:sjnlheregionpar1ic~intbcimplaneBGlionofSMCfrom 
2015to2018,Traininaofhealtll.t&ffs .. wtI1 U \"OIun~priOO"toSMCilnplmloeallltioo 
Wfredont.llldcdlllCatioclofSMC_OIIPlI3iDalltbe'4riolllce..etsIOFl 
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mo"'."'c"",gi"~"""'lIinform.houl!l1eimportaneeOrSMClI>dthcn~lO",cepllhe 
inl~r. ...n i""inonlCfl0mlU«mal"i. iJ\dd.n«~thi ••g cgroup.Volwnecrs"'....., 
lrained II> mo'·~ fmm house 10 hou.te doling eligible children bct",un!lle age ~oup 
Avolwu ••r aslfo<digibl.childm!andir!lleyhaveCOde .. orbreutfed~f_dMin&!lIe 
child",.rlf1ldaywi"'Sulpt..do~in.p)'ri_th.ami"" ...d Amodiaquine.Ibc",,!urueetafttr 
Thi.isononal)liCll!UIIdydesi", ...i n'Il«ondarydalllfrolUDHM1S2onchildrm&&es 
btl. .... tII)-S~monthJoIdOflsuspet;(fodmaJari.cucs.lCSIin&po$itiYe$rormalaria.childJm 
tdminfodd .... lOmalana.childrondyin&d .... lomaiari.anclLLlNdistributiolUlocl'lildrm 
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htl ...... I1 •• }.j9.-.lhaoid fTomwpmodofinkn'mI>OII (ht..,wlli lOIS 10201' 
lioonJIltlCIOSep&cmber_hro.)inUppa .....e IIRq>OftWIlwNonhmIR.e&-. D. . 
DIIfh,ldml""omtulforSMCandchlldmlwhown<:actuallydosodforSMCforlho: 
Pl'riod.o.""c"' II'WI"IlsltldttoredinDH1 MS2fromllllLhc5polydiniCl.71 hcaJlh 
ca\1CT1.2+6CHPS comjlOUllcbfromIllJWI227comm""'\I. .. wao:SMC ..... 0D>'~ill 
Lhc ...... ..,LhlhopofUftClcnundiIlIlW .... .flfca"'t.Uoruh.ip 
K..,..lm. .c hillg .... ....d IO_Mly matdo .... inlCfVallio!lpollp(l1~Well 
"'cianlondLhtcoa!n>lJP'O"Pt. ... Nonh .... rqjoa)illdwMOdlllcandp. ..i hlyoa..,. 
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Th;" H",ywu""nducled;n.lll~.I. .' ~ndi.lricIOflhe Uppel' W~1 "'gionofGhana 
",hich included both the ruralll1d wt..n population. TIl<" inl~"'~nlion 1arg<ted all hulthy 
thild""'<Syu,,(jmonthllO'9rnontho)"'ho~.'riMofp;.ningmaJarUo"'h<nlh.rainy 
........ ltarUinlhe.ntire.I. .... ndistrkuinlh~Upp<TWest",8ionfrom201~'o2018,ThiI 
~udy.usnin ... oecoodaryd&lOffOmDlHMS2f"""nalionaimallrilcon1JOIpmvamof 
011 children doled with SMC medidnel In Ihe Upper W. .,  region. TIlt.."u.o1population 
regi,..red for lhi u g< &rOUpt.lrJ('led for lhi s inlerVention_r• • 121719. 1222S9. 128111 
IIIId 12H14 I'f.petli .... ly from 20LS 10 201'. Th.SC' iftIupofchildml ", .... d<>sed forlh. 
Molori.dalaforchildt'fnbelow)monwand l bo".S9moow"iLlnol't>epuloftltis5!Udy 
during lh< period of the SMC int<'rV.noon. Om formillorio IlOl wilhinthepcriodnfSMC 
"';11 r'I(>I be pan ofthi,sinc• •• cept Clprured "ilhin Ih. pcriadofllmstudy 
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S~C dow ...... coll.,edd.ilyin!he rClPf~nat lhund "fcachdayseurc;sc b)/wmmuniIY 
bcallh ""IUltl«nOlld re""ned 10 !he health f. .. jlil;., suJl"rv;oor indw", for SMC 
monitorin~andsUJl"rv;liOflin!hecommunity.o.ta is lhm 'WCr;ated by regions teams of 
"0Iw1I«" in 1hr: f""ility le~.1 ., 1hr: md of 1M one allocaled for SMC medicines 
ThcDistric, Heallht.lanaacmenltearncolllledallf. .i liritsdataandrcconciltsallisslln 
uansfmed 10 lhe fub4iSlriclSl.~.I, n.e i ub-<fu.ml S<lj)CTVison flll'lhtranalyzcd lhedata 
_dirl.ll101hr:childrm population and co,'.raac illcao:hl:lOmlll.mitiQOIIdtrusr.rTCdto 
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S.\'C"!/I~ner retri<~a1 ,..,11 bt,,~I1 Jlored ~i . d«rronic rrWlandextemaldriVClO ensU1C 
tNllheex'l1IC,ed dl '" "keprconlllkntiilJ 00' leaked w any other person than rhe intended 
SMCda"' ....... ;mpo".drromDHIMS2forborhrh.inter\-ention~lIpond!ho""mpari..,n 
gn>lIp'i.e~celsilcctondother""vatiMcewtmi,luinnller>Cema/ArilinchildrcD <Syean 
(Nonhl:tn) and the intervention P'>"Il (upper ""es! region) ....... abo e~1rXICd from rhe 
llS$isrin!heprou..u.aandanaly,is.Thc prop:>nionofchildrnl"".......:I in rhe SMC 
fJ,-p.-(p,-PJ) 
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J"T __. I. ..p eo. '~'·I";.blo 
n..d<-pmd. ... OMt-rvoblovan ...l c'S ~maIan.d.cmoprC\lftOUOnthl.lplaYedlrolc 
uoRd'. .d n' .....o oil.."dc.lindurinIIl'lOSpcnod ..... m.oIy 
OchcrInd<-pc"d"'lV.".blos1hllcouJdinn""","~.uprc....lctou,",,,blSlLlN.IJl.S 
ond ICCM ..' crcldjuslCdfotin1hcmodri 
l.onKlutinlllnsec;tj~ide IlioSaedlOprciJWMwomcaand 
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chikl1'en ..- hortponlothc";I"'~ 
..i th(e-tmdrt""~.olbchcaltb 
fKiUI)' for pmpcr mllllaitn\Cn. 
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A~"" .. "";!t"'1"WO,*",hraJlh lef'lic~",,,,,,,,"accrcd>latl,,,,unilandthonalional 
matariaconU'OI po'OifMI(NMCP)1<>lOI1pm'1'1i"""''''v~K«U1<>malMia''Sdata('''''' 
OltlMS2 fr<)mLhool<:>'.nditiriclIof1ho upper wtlIl"'8!on for tho period on RMonoJ 
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lhc:~ompll'i""''''8JO ... Thetuaf\Cdpopulatlon(OfSMC(nttl'VnuiOfl~childtal 
bft'<o. ..... thc ....' .1.S9monw;nthcUppc:rWestRqlotLThcKlUlnumtaoldUldm1 
"'aiJlCftd and doted rOfSMC in 20". 2Ot6,20i1 ond20t, wcn: ...7 164 1IId'612J6. 
2J.617t-'21167S.'9IS21-''''01S2-' 416741and'6)1'11QPl1C1i~r· ThcIOUll 
r .bIrZ:TouIN"",lxrofCluldtml·S4rnonths"'!istem1lnC1doKd&om20IS-2011 
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~~~rcJ: SMCdosed 10 rn,ldrmbtlo.,. r,,~)urs"'U~WntRqion from 2015-
Theobovr paphisth~numbtTofchildrendoJf:d .,.;th SMC mcdicine:s.ccordqlOth< 
month5ondlhep<"""'laI:c'JI"r""",th. n.:bq,mino:ofSMCinJllly201S.m.pm:m~ 
illS\elodofthc"<)rrnalfaurl'OUlld::ilS""'''''ninthcgraphabo,,,,ln2017.tb<0I»..,,..,ror 
'hefo"'ro"""'"ofSMC .... .,%%ond201 •• Wr""'roundsorSMC_91%.(imaoaIly. 
thepcrcetlla&~co,-nq<rorlhefow )..,..p<riod ... thcUppuRegion .... 96% ... 'hidI 
WItS ·ioodsiIillOfl«C!lW«ofSMCbymoth .../ can=iivcs;lIwilltervnltion...p.n. 
The .'·~proportioftorchildtc:n<losN ... ,thSMC~inc:lforcadl)eu...;Ib20 I S 
~ni9S%lSwlowmw2016m:o.dina<;l"" .. whipeaforlhor""".re-pcriod.. 
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~:.::~; ~;;:;':"'~rmc~ in ....L an. pot""-'''' _ft, W>do:r' In tho Upper Wal..d 
SIUdard tk~;.tion 9S~. CI 
(S021.071·666S.606})andlhc ........ rOfch,ldRn~inIMNorth£nIRtploI., 
'1760.S""",1hs wilh. Sid Erro(lOI2nl .. 9S%CI (3nSI.79.41169.2II_1111ft is. 
bclWftftlhttwQ",ejolll(9S%CI: .<I2IHJ1-·296119l.p-".hle<O.OOI). 
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flguR'SIlbo't.nploi ... th.~ndgfmalari. deathlinthcUpp<T Wt:RR~nl'CCO<dzm) 
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oncm""th. nin~l«n (19)inl)l\Cmonth.",. .t nly(:w)deathsin_mnnth<..thitfysO: (J6) 
dQ!hs'nOl1cmorllll.dUrI)'kVU(J7)duthsinoncmonlll.fiftylWO(llldalthsiDone. 
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T. .... 5:malChi .. rOf_lupponlDlMupperWnlonclNonbcn~1O 
".ilNlrlMuu1menldfmorS/.1C 
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T.b~ ' ImpK.O(SMConchlldn:nd,;n~or rNl";'lnUpperWfStR.&ion 
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d. ..o malarill •• ("%CI.JI.5• . l0. • )P.val""'O.OO. whilctbr.venoct_~ffect 
oatbcw.d~1Cd2) .6% raIuctiooo(cho"""' < 5 ycancbthod"IO"""'III(· 
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nbl~ II .bove is malc~ins for ClImn>On ",ppon bel_.~ m. Upper WcSI and Nol1hcm 
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andma~imwnlcmp<"'I"",and";n foil panem ",ere uscd 10 rtUor..;h for common ,uppor1In 
Malcbod(ATE) 
UnU'e4ted UntrcaICd Ratio 
Trmp 
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fl",",6.boHC')l~Iht .......b erofdUldn-nl'tpon.:d.llwlocMtloolities ..; 1II 
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lud\Jwh,&hutdillnbution ,n July. AUiUSI. s.plembrrand No.·=ba ...... 10 lloo puk of 
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{NonbcmR.poaj ..a slJ.J1doiftC'Cd ......... Ihc_pcriocI 
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malWdc..J>ti"IIocVppc,WeslRqioninchildunb''''''ffftwa,ne>fl.S9moc1W",1oo 
n!ftive<lS ..' Cmnlic'. ... dori/lllMlull>malariltransmI. ._ fi'omJ"""20ISIO~ 
101'. SMC has I "1P',fk"", and proICC'tiwefTm I'orlluwmllariard.-ed"""",,,"" '''w 
UPllCfWntRepon 1th&>m:lIICed....JorialftOfbodil)'nmortolII)'IJIcluldmo.,.,}· 
S9montks duri ... tho: hill> lralWniuioaoealOll lOabouI 2l.6%in tho: Upptt 11,'C3I Rtpo... 
indiClillontNImalariamorbidil)'ond~il)' ........ lhit"POIIPwilll'ld. .... duruI.c 
llIitpu!<lI1In. ...l  ....... pcriod. Howner.Qdintuowindocat<dth.l""'poniorIofdliJdrQI 
~roc:ciffilSMCfo' lhcfil1tf'OWld ...- .sI4%anddccliMdI067%inthcfouzthrounciof 
SMCin MalitDia. ... eI .. _. 2(17). Thc:UppttW. .. SMCfirst..,...,.jO(SMC~ 
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Do.pil.lh.goodco,'.raseofSMCinlheUpptrW.RRo81ondunnglMhighuansmisSlon 
poriod.5% ofchild",n.,,,1.59 """,ths_RiII'.,lingposn,,''''for maIarUo .. theheallh 
r.dlilies. Thi s 5%pOsilivily""""'ll 'hi ••8 .gro.."c. ...i lh.rlxllr1'lOll3lhomnaininsj·~ 
thI,"~ .. no<<<>v.,.NforSMCd..;"ithein'''''''mlionporiodorchildrmtN.lVOlllilCdihc 
"'&ionw."",.ivin,SMCmcdicinu"1l5846.SH(SlhI411.099)mdinihcNonhml 
R·ii. .....h ild"'n"'ponin8~lMhoallhracili'i"Vtd'ostin8pOliliw.f. . m.alari.;.41760.5 
illl .....n tion8""up i• •i gnifie.antlydilTcmnfromwcontnllgroupby15913.64 
Ho~ve,.UlinBPropmsityS ..... M. . ldt.i"i'oO$limatctbeII"C8lm. .n dfcctofSMC 
of7,972485aI95'11oci(-SO.0S416.IU0279).WithIP·'-.J. .. of<O.OOI."TlIIMisl 
rNucuonof14dcalluintbeUP!'<rW.stR.giorIuarcsuJISSMCin_nIion.wit:h1 
.ignilie.I11P.vaI ... of<O.OOI.Thhstt.tph. ...- ..dthMSMCinlCr.'CIltioniotho:UppcrWesl 
Rogionfrom201S-2018n:duced signifiantly25.hildrmdcatbsfrolnmalari.opn""""tM 
ThiI.",""",.'lKIyobKrvcdlh~ llte'mldofmalariloundc:rfivedellhsin1benonher!t 
"&ion...shighcr1hanin1heUppnWtstrqion.andthisbapperlsinlhtpeMteaDI(lIiny 
-) ..h =malori.1fll\Smilsion_ i.btoWlltDbehjgh. Ho"'". ... AldiaIll'~ 
,Ito"", tIw SMChoullttpoteMili for .....j or public hctIth im"".';ntemuofll'lOlbidi'Y. 
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monali,y and the "'"" ofhe.11il >C"';" anribUl&blc: 10 malari. (Druetz. 201S) 
Comparati.ely. "fW1 f""" SMC in,.<vemion in the Upper West ReSion. III olhe' 
inler'. ..... "OIIbytMNMCP.""hULUN.IRS.ICCMandsentiMl.i'. .... allon goinS 
inte""'mioninbolh ... gion. 'o. ... ardslherc<lv<lMmofmalari.inchild. .... < Syears.Thc 
"""'thly .... nd.inredUCIionofdealhld. .. lOmalIriIintheUppt'WmRqionoouldbc 
dU<'omoth..-slcareai.m·lCc~"ofSMC;n""'Rcponleadi"'lOllighoo"erq,of 
childrendoscd ... iIilSMCn>edidnc: •. o..llool1ectcd fOf Iil. fo .... yausofSMC in the 
UppcrWn, R.gion.fo .... monlil. ruonkd ttt'O(Ojdeathloutoflloo I~ motIthsaod S 
SMC""c",cn'ion i.nOl.vailabl• • childrendyinsduclOmaiariape,monthlU,llCdfromJ 
Rcgionw.",malari.dc.thsstiUl"l'ftlaimlli&hd"'lOtbe~orSMCmlhat""&ioo 
StIIS()nali'yplayed.bi8rcl.ofmal&ri.burdmintbe~oqioo .. tbcyarebod!iDthe 
SobeJbchwilhth•  ...".,rainfallpMIcmdurinSthcpeaktronsmissionpcriod. 
theUppc'W. .. R.giondlll'inithelUShua:wni ..i ooofsasonlOapptOX;matcly""" ....." '" 
pc,monlhandthi. has.hown .signifICAntiml*ClofSMCintbeUppuWest Rcgioa.. 
compered(()thcNorUlcmlhl,~a~IY216e11hodurin&thepukoflhc 
Innlminionseasotl.ThJlsho. .. 'SlhatwflC"'th~""'othcrinleJVmtions IUCh .. thel""8 
lastinsinHCdcidnnr15(lLIN). indoor residull.pt'Ilyina (11tS)and int<&f'.ledco"u',"mity 
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<tiC buo managemonl of malaria (tCCM), SMC can Iven episodes of malaria and 
IIM<'Ccuarydtathod"",.,mllarilin .. veral,egioruinGh"""whotemaiarilan'KNlSundt, 
fi\'es«mslObt hiSh.OIho,mKlinlwlveshovolllhalifSMCisinlroduwl,.,,,,,,,' 
Sah.li"""oounlries .. ho~m.Jarilepisod •• at<:hishdurin&lhcpeaktranlm.issionperiod. 
il can.vonWlderflvcd• •! lubyl52000inlycar(Caim5etll .• 20J2).lllwalsob«n 
eslimaledtlwiCCes'IOSMCmaylwlV<:ptc:"entcdo'"ttIOmillionmalweasesaod60,OOO 
d.i.uibulionoflM<hi~n"S~ancld. Oi$O.ggregatillJllMdatlby.g:roup"WO\IId 
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CO!'o'CL USION AI'I I) RECOMMENDAnONS 
Th.C<>'· ••• II.ofSMCinIMUppcrW• • !Rc~onfourtllcenti .. foury.arpcriod ....a saJmos. 
WIi'~ ...I I><' ...... .,n9-4% ...d 91%. cxc.p.in2016 ....... IhcSMCroW1dJwhnt'twOinslad 
oflhcnorm.lfourroundsandllti."'''''.Co. ..r I&.99%,lben: ..... utislic.aJsignillcaou 
diff. ..n c:.in llt."'""bctwcenlhcchildren~.tinl!P'>'iti""formalari.inthcUpp<TWes\ 
OItII.!thcNanhcmRciPoN{95% CI- . .42ISS.ll .2967L98)P."aJ~.(l0l . 'l'henumdof 
mallri ......J  anddc.rhs in children <Sye. ........ hightrlnllt. NonhmIrq;01I(15dcaths 
in on< monllt) .. C<lmparedlOllt. Uppcr Wcst Rcsion whid._dcd (0 dcaW in four 
SMC i. OM tbe bell in.crwn6on toaddftssmoJari.morbidi'yondmc:rnali!y in ehiJdmt < 
",, 10 othcr"&iOfU to curb dealhs in IInder fi,~ duc 10malario by the NMio:mal mal",;. 
o.."'C<lllecwd durinsroulin. monitorinSoctivitiesst\oWdbcdi$ogreptedinonlcr lOshed 
lii/H on pcIIlibl. lncquilitSofCO""'"l!ctcross"itSond SC!lderofbencficiariQ 
University of Ghana http://ugspace.ug.edu.gh
Acc: ..... A . ... M. ..... TO. S. (2017)_ IMPAC TSTOItY ACCELERATINOACCESS 
M. (2016). SaflOlyofMUONI M.tuiaChcmop.~·va!lK>n (SMC) wQ Sulfado.int-
~"". ~and<q""l)'of"-«aIo"'-'T"""""ddivcryo( 
ScaIonIIIMIIan.~(SMCllOdaiIdrm""'IO.SmtpI 
kk"'ljfc.tponl.8(I j. HS9.bUpt:fIdoi .. ".,1010lllt4 1$91.(111·2Jt7&-2 
Cai ....... M .• Roc •• fdtn:t. A .. Gank T .• WiI-..A. L •. Oil.llo. D .• MlIIi. ... , . J. •• 
Om:n ..o od.8. M. (2012).orsasonalm&laria~m.NaIUTt 
C_MlNfbQ:. J,I-9. /mps:fldoi.orJlIO.IOllhocommJll79 
CoIlilIs..D. (2016). Thl:roSIaDdimpl<10rACCESS.SMCOneofW$ crilicllbltritn lQ 
DiI--'f. . S~LC..MobImw.A.. T. ...... T .• Ko .... D. T~DiI_H .• 
Dicko.A.(2017j.Muswi"'tI:Ioimplclof---.J......,..~U 
"'" of.....w...maI..,;.conlrOl in Kill, M.tJi. AI.IoJoIInttII. 11f(1j.)25 
hllps:fldoLor&I I0.11161, 129J6.(1I7·1971• • 
Druotx.T. (201'1. Evlll ....i onofdita:landinclirocteffecu orXl.!Onal ma!"';. 
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Ch"mOp",v~"tio"i"M.Ii. &knfl/k RriK"ls,6( I ), 8I o4 
hnp."'doi.orWlo. t DJ8I"" S98.01 1.2~7~.6 
DnlcIz.T .• c.,..,..,.u.T"'mbl.y. N .• Millo,o.T. • Kouanda.S .• LY,A., Bi~"' .. &: 
Haddod.S.(20IS). lmfY"I",·. lualiOllOfseasonalmal&ri.o chetTlOP"""""liOllw>eiC1" 
",. ." incpo"orn> implementation: A qllASi.npmmmtal study in ButI<J"" r...,., 
hnps"I<:\oLorgllo .4269iajtmh.17.()S99 
Ghan.SlaIislica.lSe.vkc(GSS),Ghano HellthSc-mc<:(GIIS).4 ICFlnt=lational 
(2D I 5),Gha",,/M"'asrap/ricondHro/lhSIIf"W)I10II. o,.--;CW1O<riJ/ 
Eqwili/wiw",Mode/lillK: CO"'P"IQlIoMlAklhodslPtd ApplI(OI/iJIU. R.ock¥ille, 
Mubiru. D. . B)"abuboij .. R.. Bwanika. J. B., M"i" •. J. E.. MIOgWDbe..G.,Kauwa.F. M~ 
Diaz. T. (20 15). Evaluation of in1egnlted comrnWliIycasc: mllnqC1nC:nliDeighl 
distriC\.!ofCenInJUpnd.o.PLoSONE.IDlS).I_ ll 
Mp"lIdoi.0f&/Io. l 17IIjQ\lntai.pone.01)4761 
Ndil~,J.'L.A .• Dilllo.I..NDia) t.Y .• KO<Kvidj; ... E. . Aw. I..T&irou. F 
University of Ghana http://ugspace.ug.edu.gh
(lOlb). Evalu.lionDfTwDSI"negicsf<l1CDnununily.Based S.fCly Moniwring 
<.Iurinll SCI5OII.IM II.lri.Chemop<"'"CfllionCampoigllSin SC .... Gal . Compaml...,;th 
lhoNllionIISpoor.n«>uJ Rcp<>r1inKS}'Jlmt. PIw''''''UlificaiMediciM,J1(l).IB9-
200. "l1po~ldDi.orgI10. IOO1/0.40291}..OI8.02)2·. 
Ndi.~.J ._LA .• Diallo.l.NDlly• . Y .• Ko\ICvidj in.E. . A,.,.I..Tairou.F. •.. . MiUipn,P 
(2018b). EvalualionofT""oSuaIegio,fo,Conununity-8a$cd Safoty MonilOrinG 
Noov;gnon.J .• Al)'fflcy.G. C .. lssah.S. . Ansah.P• • &'Malm.K.L.(2011i).COOI· 
WHO. (201 1). Seasonal Malari.Cl>omoprevenuooWilltSulfitdoxinc:_l")"rilDCllwnino 
WHO.(201S).Thi' }·.lV·I Wotidmalari • ..,ponll'aJance..~"""".· Wo'ldJH"J/I. 
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U.1I0 f lnt.nni! ... n!p"'''''n!j'·.''''. ..... n!inp..-gn&lICy(lPTpl. (2011l1.WHO.R.tri.,·W 
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AP~ENI)IX : DATA EXTRACTID!II TOOL 
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