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

Abstract

Background: As part of implementation quality standards, community distributors are expected to ensure that only age-eligible children (aged 3 – 59 months) receive seasonal malaria chemoprevention (SMC) medicines during monthly campaigns. There is uncertainty about the extent to which SMC medicines are administered to ineligible children. This study therefore aimed to assess the magnitude of this occurrence, while exploring the factors associated with it across nine states where SMC was delivered in Nigeria during the 2022 round. Methods: We extracted data from representative end-of-round SMC household surveys and analyzed data of 3,299 caregiver-child pairs sampled from nine SMC-implementing states in Nigeria. Prevalence of receipt of SMC medicines by ineligible children was described by child-, caregiver- and SMC-related factors. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with the occurrence. Results: 30.30% (95% CI: 27.80 – 32.90) of ineligible children sampled received at least one dose of SMC medicines in 2022, the majority (60.60%) of whom were aged 5-6 years while the rest were aged 7-10 years. We observed higher odds of an age-ineligible child receiving SMC among caregivers who had poor knowledge of SMC age eligibility (OR: 1.79, 95% CI: 1.24 – 2.57, p=0.002), compared with those who were knowledgeable of age eligibility. Higher odds of receipt of SMC were also found among age-ineligible children whose caregivers had higher confidence in the protective effect of SMC against malaria (OR: 2.01, 95% CI: 1.3 – 4.2, p=0.007), compared with those whose caregivers were less confident. Conversely, ineligible children whose caregivers were older than 20 years had lower odds of receiving SMC than those whose caregivers were younger; with lower odds among children of caregivers aged 20-29 years (OR: 0.48, 95% CI: 0.28 – 0.81, p = 0.007), 30-39 years (OR: 0.41, 95% CI: 0.24 – 0.69, p=0.001), and 40-49 years (OR: 0.52, 95% CI: 0.29 – 0.91, p=0.024). Conclusions: This study contributes important evidence on the magnitude of the receipt of SMC by age-ineligible children, while identifying individual and contextual factors associated with it. The findings provide potentially useful insights that can help inform and guide context-specific SMC implementation quality improvement efforts.