Seasonal Malaria Chemoprevention (SMC), is recommended in the Sahel region of Africa for children under 5 years of age, for up to 4 months of the year. It may be appropriate to include older children, and to provide protection for more than 4 months. We evaluated the effectiveness of SMC using sulfadoxine-pyrimethamine plus amodiaquine over 5 months in children under 10 years of age, in Saraya district in southern Senegal in 2011. 24 villages, including 2301 children 3-59 months old and 2245 aged 5-9 years, were randomized to receive SMC with community case management (CCM), or CCM alone. In all villages, community health workers (CHWs) were trained to treat malaria cases with artemisinin combination therapy after testing with a rapid diagnostic test (RDT). In SMC villages, CHWs administered SMC to children aged 3 months to 9 years, once a month for 5 months. Children were followed from July to December. The primary outcome was malaria (fever or history of fever with a positive RDT). The prevalence of anaemia and parasitaemia was measured in a survey at the end of the transmission season. Molecular markers associated with resistance to SMC drugs were analysed in samples from incident malaria cases, and from children with parasitaemia in the survey.

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