Abstract
BackgroundSeasonal Malaria Chemoprevention (SMC) is currently recommended for children under five in areas where malaria transmission is highly seasonal. We explored children’s caregivers’ and community health workers’ (CHWs) responses to an extended 5-month SMC programme.MethodsThirteen in-depth interviews and eight focus group discussions explored optimal and suboptimal ‘uptake’ of SMC to examine facilitators and barriers to caregivers’ uptake.ResultsThere did not appear to be major differences between caregivers of children with optimal and sub-optimal SMC uptake in terms of their knowledge of malaria, their perceptions of the effect of SMC on a child’s health, nor their understanding of chemoprevention. Caregivers experienced difficulty in prioritising SMC for well children, perceiving medication being for treatment rather than prevention. Prior to the study, caregivers had become accustomed to rapid diagnostic testing (RDT) for malaria, and therefore blood testing for malaria during the baseline survey at the start of the SMC programme may have positively influenced uptake. Facilitators of uptake included caregivers’ trust in and respect for administrators of SMC (including CHWs), access to medication and supportive (family) networks. Barriers to uptake related to poor communication of timings of community gatherings, travel distances, absence during SMC home deliveries, and limited demand for SMC due to lack of previous experience. Future delivery of SMC by trained CHWs would be acceptable to caregivers.ConclusionA combination of caregivers’ physical access to SMC medication, the drug regimen, trust in the medical profession and perceived norms around malaria prevention all likely influenced caregivers’ level of uptake. SMC programmes need to consider: 1) developing supportive, accessible and flexible modes of drug administration including home delivery and village community kiosks; 2) improving demand for preventive medication including the harnessing of learnt trust; and 3) developing community-based networks for users to support optimal uptake of SMC.
Highlights
Background there is evidence of decreasing malaria morbidity and mortality globally, malaria remains an important contributor to child mortality in sub-Saharan Africa [1]
Caregivers had become accustomed to rapid diagnostic testing (RDT) for malaria, and blood testing for malaria during the baseline survey at the start of the Seasonal Malaria Chemoprevention (SMC) programme may have positively influenced uptake
Future delivery of SMC by trained community health workers’ (CHWs) would be acceptable to caregivers
Summary
Background there is evidence of decreasing malaria morbidity and mortality globally, malaria remains an important contributor to child mortality in sub-Saharan Africa [1]. In 2012, the World Health Organization (WHO) recommended seasonal malaria chemoprevention (SMC) [3] for the control of malaria in children under five where malaria transmission is highly seasonal, primarily the Sahel sub-region of sub-Saharan Africa [4]. SMC is “the intermittent administration of full treatment courses of an antimalarial medicine during the malaria season to prevent malarial illness” [3] and is delivered up to four times at monthly intervals during the peak malaria transmission period in the area. Seasonal Malaria Chemoprevention (SMC) is currently recommended for children under five in areas where malaria transmission is highly seasonal. We explored children’s caregivers’ and community health workers’ (CHWs) responses to an extended 5-month SMC programme
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