Abstract
To prevent malaria among children aged 3-59 months in areas with high seasonal transmission, seasonal malaria chemoprevention (SMC) is recommended. In Chad, there is evidence of SMC administration to children aged older than 5 years (referred to as "leakage"). This study aimed to understand the reasons for leakage and explore the feasibility and acceptability of extending the delivery of SMC to children aged 5-10 years in Chad. We conducted a mixed-methods study in Massaguet health district with a cross-sectional survey to determine SMC coverage for children aged up to 10 years after SMC cycles 1 and 3 (n=90 and n=100 caregivers surveyed, respectively) and at the end of cycle 4 (n=101 caregivers surveyed). We conducted 14 key informant interviews at the national and district level and 8 focus group discussions with community distributors and caregivers. In the compounds surveyed, there were no children aged 5-10 years in cycle 1. In cycles 3 (n=1 children) and 4 (n=16 children), there was 100% (95% confidence interval [CI]=2.5, 100.0) and 62.5% (95% CI=35.4, 84.8) coverage of SMC in children aged 5-10 years, respectively. Extension of SMC to older children was considered acceptable, but there were concerns about feasibility and ensuring the sustainability of the current program in children aged 3-59 months. Key informants acknowledged the need to secure additional funding to pilot SMC in older age groups and were uncertain about the impact of the current SMC program at scale. Key informants considered extending SMC to children aged 5-10 years acceptable but did not deem it a current priority. They expressed an urgent need to address leakage and reinforce both the sustainability and quality of the current SMC program.
Highlights
To prevent malaria among children aged 3–59 months in areas with high seasonal transmission, seasonal malaria chemoprevention (SMC) is recommended
Health facilities are supplied with drugs through the national logistics chain, and SMC is delivered by community distributors who are supervised by health center managers
The program is under the supervision of the Provincial Health Delegation and the National Malaria Control Program (NMCP) with support from the Department of Pharmacy, Drugs, and Pharmacopoeia
Summary
To prevent malaria among children aged 3–59 months in areas with high seasonal transmission, seasonal malaria chemoprevention (SMC) is recommended. Conclusion: Key informants considered extending SMC to children aged 5–10 years acceptable but did not deem it a current priority. They expressed an urgent need to address leakage and reinforce both the sustainability and quality of the current SMC program. To reduce the burden of malaria among children, the World Health Organization recommends the use of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) to prevent malaria in children aged 3– 59 months in areas with high seasonal transmission of Delivering Seasonal Malaria Chemoprevention for Children Aged 5–10 Years www.ghspjournal.org. In most settings in the Sahel, seasonal malaria chemoprevention (SMC) is implemented door-to-door by volunteer community distributors[6] during the high transmission season. Community distributors are trained on contraindications of the drugs, how to administer the drugs, and how to complete monitoring records as described elsewhere.[4,6]
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