Indirect benefits of seasonal malaria chemoprevention for non-malarial pediatric infections and routine antibiotic use in real-world programmatic settings: a pre-post study using positive and negative controls

12 Jan 2026
Elisabeth A Gebreegziabher, Mamadou Ouattara, Mamadou Bountogo, Boubacar Coulibaly, Valentin Boudo, Thierry Ouedraogo, Elodie Lebas, Huiyu Hu, Kieran S O'Brien, Michelle S Hsiang, David V Glidden, Benjamin F Arnold, Thomas M Lietman, Ali Sié, Catherine E Oldenburg

Objective: To assess the benefits of Seasonal Malaria Chemoprevention (SMC)—the monthly administration of sulfadoxine-pyrimethamine and amodiaquine—beyond malaria prevention in real-world program settings.

Methods: We conducted a pre-post comparison of non-malarial diagnoses (pneumonia, diarrhea, acute malnutrition) and antibiotic prescription rates during SMC administration weeks versus a three-week post-intervention period in rural Burkina Faso. Data was obtained from clinic surveillance at 51 health facilities, a population-based census, and National Malaria Control Program data on SMC timing. Poisson regression models with person-weeks as an offset and standard errors clustered by health post estimated changes in rates. Interaction terms assessed variation across SMC cycles. Positive (malaria diagnoses, antimalarial prescriptions) and negative (injury) control outcomes were used to evaluate potential unmeasured confounding.

Results: Compared to administration weeks, modest declines were observed in pneumonia, diarrhea, and acute malnutrition diagnoses, as well as in antibiotic prescription rates during the post-SMC period. Absolute reductions were 0.7 (95% CI: 0.3–1.0), 0.2 (95% CI: 0.1–0.4), 0.05 (95% CI: 0.001–0.09), and 0.90 (95% CI: 0.4–1.4) per 1,000 person-weeks, respectively (corresponding IRRs: 0.86, 0.83, 0.71, and 0.88). Positive control outcomes also declined, with malaria diagnoses and antimalarial prescriptions decreasing by 3.7 (95% CI: 2.6–4.8) and 3.6 (95% CI: 2.5–4.7) per 1,000 person-weeks (IRRs: 0.62 and 0.63). Injury rates (negative control) remained stable (0.02; 95% CI: −0.03 to 0.07). Reductions varied across SMC cycles and were most pronounced following the final round.

Conclusion: SMC may have additional benefits beyond malaria prevention, including reductions in common pediatric infections and subsequent routine antibiotic use.

Clinical trial: Not applicable.