To protect pregnant women and young children from malaria, simple prevention methods have proven effective. However, they don’t always reach the most vulnerable individuals. The Sucoppa research project will take place in Benin from June 2024 to June 2028 with the support of L’Initiative. It aims to collaboratively develop better awareness methods with the communities. Encounter with the two researchers leading this project.
Gilles Cottrell
epidemiologist and biostatistician, is a researcher at the Institute of Research for Development (IRD).
Armel Djenontin
medical entomologist, is a lecturer at the University of Abomey-Calavi (Benin) and a research associate at the Entomological Research Center of Cotonou.
What are the best methods of prevention against malaria today?
Armel Djenontin : For the past five months, Benin has begun receiving stocks of vaccines to protect children under two years old. The RTS,S (tested since 2019) and R21 (since December 2023) vaccines reduce the proportion of severe cases of the disease but still only protect a fraction of the population for a limited duration. Until very recently, the only means of prevention was protection against mosquito bites.
Gilles Cottrell : The two main pillars of malaria prevention in pregnant women remain the use of insecticide-treated bed nets and prevention through intermittent preventive treatment (IPTp), which involves taking sulfadoxine-pyrimethamine from the fourth month of pregnancy. If women already have diagnosed malaria, they receive another treatment. For children under 5 years old, seasonal malaria chemoprevention (SMC) is implemented. This preventive treatment starts from the beginning of the transmission season and combines the intake of sulfadoxine-pyrimethamine with that of amodiaquine.
Why specifically target pregnant women and young children?
Gilles Cottrell : These are the two most vulnerable populations. Children under five represent the vast majority of malaria-related mortality. An infection during pregnancy can cause placental problems, leading to prematurity, low birth weight, and other complications.
Gilles Cottrell : First of all, many pregnant women do not always have access to mosquito nets. Distribution is rather well done in the public sector, but private health centers often distribute mosquito nets to pregnant women infrequently. In addition, there are frequent shortages, even in the public sector. Moreover, malaria prevention represents only a small part of the work of maternity medical teams.
Armel Djenontin : We found that many pregnant women do not see the importance of replacing their mosquito net with a new, impregnated one. Many consider that the mosquito net will be used to protect the newborn. Therefore, they wait until the birth to use the mosquito net received during their follow-up appointment.
Gilles Cottrell : This clearly indicates a lack of awareness during prenatal consultations, where midwives do not have time to explain that pregnancy is a time when both mother and child are more exposed and vulnerable, and that the mosquito net should be replaced. The message struggles to get across.
What are your recommendations for improving the situation?
Gilles Cottrell : First, the private sector must have the same access to malaria control tools as the public sector. In the field, we found that some health zone coordinators and logisticians do not have precise knowledge of the organizations that distribute malaria control tools: their training is essential. Finally, the issue of administrative burden is central. A midwife told us, “I signed up to save lives, not to write reports all day”.
Armel Djenontin : We also recommend strengthening the quality control of mosquito nets because not all samples we collected from the stocks were effective. Our last recommendation is the one that inspired the Sucoppa project: strengthening community engagement and involving others besides pregnant women, especially their partners.
What does the Sucoppa project, defined as an “innovative community awareness intervention”, entail concretely?
Gilles Cottrell : The goal is to find ways to increase knowledge and perception of the importance of malaria control while listening to communities that have their reasons for not accepting certain strategies.
Armel Djenontin : Successive studies have indeed revealed a lack of ownership of information by pregnant women and those in contact with them. We need to find ways to address this. The first year of the project will be devoted to monitoring a cohort to collect epidemiological, entomological, and socio-anthropological information.
Then, based on the initial results, we will co-create new awareness content with the communities, which will be deployed by community health workers in Benin.
Gilles Cottrell : I would add that even though pregnant women and young children will be overrepresented in the cohort, Sucoppa will target the entire population. This is to ensure that we also reach asymptomatic malaria carriers.
How will this co-construction process unfold?
Armel Djenontin : In three steps. We will organize a series of workshops to present the cohort monitoring results, propose, and validate the content, and finally train those who will use this content, especially health workers.
The whole point of this study is to start without preconceptions or certainty about the groups to target or the messages to convey. We will share the results of cohort monitoring with community representatives, and they will propose the most suitable messages. As scientists, we will only be there to verify their accuracy.
Gilles Cottrell : It is important that the proposals are easy to implement, with resources available everywhere in Benin. This is why the project will include a testing phase in about ten villages. If effectiveness is demonstrated, it will then be possible to scale up this type of intervention to the entire country. The end of the project will hopefully mark the beginning of scaling up.
