Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach

Abstract

Background SMC was adopted in Nigeria in 2014 and by 2021 was being implemented in 18 states, over four months between June and October by 143000 community drug distributors (CDDs) to a target population of 23million children. Further expansion of SMC is planned, extending to 21 states with four or five monthly cycles. In view of this massive scale-up, the National Malaria Elimination Programme undertook qualitative research in five states shortly after the 2021 campaign to understand community attitudes to SMC so that these perspectives inform future planning of SMC delivery in Nigeria. Methods In 20 wards representing urban and rural areas with low and high SMC coverage in five states, focus group discussions were held with caregivers, and in-depth interviews conducted with community leaders and community drug distributors. Interviews were also held with local government area and State malaria focal persons and at national level with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, those in local languages translated into English, and transcripts analysed using NVivo software. Results In total, 84 focus groups and 106 interviews were completed. Malaria was seen as a major health concern, SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because it allowed them to continue daily tasks, and allowed time for the CDD to answer questions. Barriers to SMC uptake included perceived side-effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective, and local shortages of drugs. Conclusions Recommendations from this study were shared with all community drug distributors and others involved in SMC campaigns during cascade training in 2022, including the need to strengthen communication about the safety and effectiveness of SMC, recruiting distributors from the local community, greater involvement of state and national level pharmacovigilance coordinators, and stricter adherence to the planned medicine allocations to avoid local shortages. The findings reinforce the importance of retaining door-to-door delivery of SMC.

Field testing of user-friendly perennial malaria chemoprevention packaging in Benin, Côte d’Ivoire and Mozambique

“…The causes of malaria were well understood by carers, CHWs and health workers and preventive measures such as ITNs were widely known. These findings are consistent with studies in African countries with high malaria prevalence [ 36 – 40 ]. However, respondents were aware of a lack of knowledge and understanding within certain sections of the community, such as those without formal education.…”

“…However, respondents were aware of a lack of knowledge and understanding within certain sections of the community, such as those without formal education. Perceptions and knowledge of malaria aetiology and risk, and more generally health literacy, have been shown to influence the adoption of chemoprevention by caregivers [ 34 , 40 , 41 ]. For SMC, sensitisation and education efforts directed at caregivers were associated with improved coverage [ 41 ].…”

“…Rather, it was thought key to emphasize the verbal explanation of adverse events by health professionals to caregivers, initiating a more conversational approach that would enable concerns to be addressed and to encourage caregivers to attend the clinic should adverse events occur. The balance between provision of sufficient information on potential adverse events and raising unnecessary concerns has not been well examined, and this is an area which could benefit from further qualitative study, particularly in the context of strengthening pharmacovigilance systems [ 13 , 40 , 52 , 53 ].…”

Receipt of seasonal malaria chemoprevention by age-ineligible children and associated factors in nine implementation states in Nigeria

“…Malaria is a significant public health concern in Nigeria, with the country accounting for 38.4% of global malaria deaths in children under 5 years [ 1 ]. To reduce the burden of malaria in this age group, Nigeria adopted seasonal malaria chemoprevention (SMC) as a malaria prevention strategy in 2014 [ 2 , 3 ]. SMC typically involves the intermittent administration of a combination of two antimalarial medicines—sulfadoxine–pyrimethamine and amodiaquine (SPAQ)—to children aged 3–59 months during the peak malaria transmission season, typically coinciding with the rainy season [ 4 ].…”

Results from phase one of a hybrid effectiveness-implementation study to assess the feasibility, acceptability and effectiveness of implementing seasonal malaria chemoprevention in Nampula province, Mozambique

“…This multi-source approach in spreading the information about SMC and its objectives in this context worked effectively. The involvement of community members has been identi ed as a key advantage in delivering SMC and malaria messages at community level by other studies [29][30][31]. Bene ts of SMC have been already…”