A Retrospective Evaluation of Commodity Management of Sulphadoxine Pyrimethamine + Amodiaquine and Pharmacovigilance during Seasonal Malaria Chemoprevention Campaign in Nigeria

Abstract

Background: The seasonal malaria chemoprevention (SMC) campaign provides malaria preventive medicines to healthy eligible children aged 3-59 month in the Sahel region of Africa. The campaign has helped reduce malaria burden among this age group in sub-Sahara Africa, but inadequate data exist on its supply chain management and pharmacovigilance reporting. To better understand its challenges and uncover areas to direct existing resources for commodity security and reporting of medication safety, this research evaluates the commodity management of Sulphadoxine Pyrimethamine + Amodiaquine (SP+AQ), a drug of choice in SMC and pharmacovigilance reporting during the 2019 campaign in 5 Northern states in Nigeria.Methods: A descriptive cross-sectional study design was used, with a total of 1,189 health facilities (HFs) selected using a multi-stage cluster sampling in Jigawa, Katsina, Sokoto, Zamfara and Yobe States. The health facilities (HFs) were assessed using a structured questionnaire for distribution practices, compliance to good storage practices, staff training in pharmacovigilance (PV) and availability of pharmacovigilance reporting forms. Data were collected using the SurveyCTO data collection tool.Results: Overall, inventory tools were available in 92.2% of the HFs. HFs with non-updated inventory tools ranges from 3% in Jigawa to 23% in Sokoto. Delivery documents were not sighted in 22% and 19% of facilities in Katsina and Sokoto states respectively. Storage practices across the facilities were generally fair with the exception of a significant lack of risk mitigation tools like fire extinguishers, with its availability ranging from 9% in Yobe to 38.6% in Jigawa. An observation of sampled tools showed a significant number of entry errors and missing entries. PV forms were available in 84% of the HFs sampled and 91.6% had at least one personnel trained on PV which varied across the states from 95.6% to 67.7% for the reporting tools and 97.3% to 79.2% for health facility workers (HFWs) trained in Jigawa and Sokoto respectively.Conclusions: Commodity management of SP+AQ during SMC implementation in Nigeria is less than optimum and can negatively impact on commodity security during the campaign. A focused capacity building of HFWs responsible for commodity management, provision of fire extinguishers and PV reporting tools will help address the observed gaps in addition to improved supply of commodity management tools to health facilities.