Completed Research

Seasonal Malaria Chemoprevention in Guinea

University of Toronto

In Guinea, malaria is the leading cause of death (28 per cent) for children under five — who already have an overall mortality rate of 89 per 1,000. Evidence shows that seasonal malaria chemoprevention (SMC) is effective in reducing the incidence of malaria among children under five in areas of highly seasonal malaria transmission.

The Hard to Reach

Children under the age of five in Guinea who are at the highest risk of developing complications due to contracting malaria.

Key Takeaways

SMC for children under the age of 5 in Guinea has achieved a mean 71.6 per cent coverage rate for a highly dispersed population, in a region with poor quality infrastructure, at the height of the rainy season. Children have among the lowest access to health services in the country, so SMC is likely to have a disproportionately high impact for them. Four major themes explain the program’s success:

  1. Hyperlocal delivery: Logistics and communications were prioritized at the most granular level to adapt the distribution strategy to the unique needs of different locales.
  2. Multilevel engagement and coordination: Stakeholder needs and responsibilities at all levels of healthcare, government and external partnerships were coordinated to use each actor’s strengths.
  3. Integrated monitoring and evaluation: Both collection and use of monitoring and evaluation data were incorporated into the program-delivery process to quickly identify and respond to issues as they arose.
  4. Global supply chain management: The initial coalition was able to aggregate pharmaceutical demand across countries to gain support from manufacturers.


This research was made possible through the Reach Alliance, a partnership between the University of Toronto’s Munk School of Global Affairs & Public Policy and the Mastercard Center for Inclusive Growth. Research was also funded by the Ralph and Roz Halbert Professorship of Innovation at the Munk School of Global Affairs & Public Policy. We express our gratitude and appreciation to those we met and interviewed. This research would not have been possible without the help of Dr. Paul Milligan from the London School of Hygiene and Tropical Medicine, ACCESS-SMC, Catholic Relief Services, the Government of Guinea, and other individuals and organizations in providing and publishing data and resources. We are also grateful to Dr. Kovana Marcel Loua, Director General of the National Institute of Public Health in Guinea and professor at the Gamal Abdel Nasser University of Conakry, Guinea. Dr. Loua has been instrumental in the development of this research through advising on key topics, facilitating ethics board approval in Guinea, and providing data and resources.

This research was vetted and received approval from the Ethics Review Board at the University of Toronto. This research was conducted virtually during the COVID-19 pandemic in compliance with local public health measures.