Delivery of seasonal malaria chemoprevention with enhanced infection prevention and control measures during the COVID-19 pandemic in Nigeria, Burkina Faso and Chad: a cross-sectional study

Abstract

Background Seasonal malaria chemoprevention (SMC) is a WHO-recommended intervention for children aged 3–59 months living in areas of high malaria transmission to provide protection against malaria during the rainy season. Operational guidelines were developed, based on WHO guidance, to support countries to mitigate the risk of coronavirus disease 2019 (COVID-19) transmission within communities and among community distributors when delivering SMC. Methods A cross-sectional study to determine adherence to infection prevention and control (IPC) measures during two distribution cycles of SMC in Nigeria, Chad and Burkina Faso. Community distributors were observed receiving equipment and delivering SMC. Adherence across six domains was calculated as the proportion of indications in which the community distributor performed the correct action. Focus group discussions were conducted with community distributors to understand their perceptions of the IPC measures and barriers and facilitators to adherence. Results Data collectors observed community distributors in Nigeria (n = 259), Burkina Faso (n = 252) and Chad (n = 266) receiving IPC equipment and delivering SMC. Adherence to IPC indications varied. In all three countries, adherence to mask use was the highest (ranging from 73.3% in Nigeria to 86.9% in Burkina Faso). Adherence to hand hygiene for at least 30 s was low (ranging from 3.6% in Nigeria to 10.3% in Burkina Faso) but increased substantially when excluding the length of time spent hand washing (ranging from 36.7% in Nigeria to 61.4% in Burkina Faso). Adherence to safe distancing in the compound ranged from 5.4% in Chad to 16.4% in Nigeria. In Burkina Faso and Chad, where disinfection wipes widely available compliance with disinfection of blister packs for SMC was low (17.4% in Burkina Faso and 16.9% in Chad). Community distributors generally found the IPC measures acceptable, however there were barriers to optimal hand hygiene practices, cultural norms made social distancing difficult to adhere to and caregivers needed assistance to administer the first dose of SMC. Conclusion Adherence to IPC measures for SMC delivery during the COVID-19 pandemic varied across domains of IPC, but was largely insufficient, particularly for hand hygiene and safe distancing. Improvements in provision of protective equipment, early community engagement and adaptations to make IPC measures more feasible to implement could increase adherence.

Evaluation of practices and attitudes of caregivers influencing adherence to seasonal malaria chemoprevention in children under five years of age: the case of Rural Embangweni, Mzimba District, Malawi

“…According to the statements provided by caregivers, a high level of adherence to the dosing regimen was observed among the children, with 89.4% taking their second dosage and 80.2% taking their third. These findings are consistent with previous research conducted in Mozambique and Chad by Wharton-Smith et al [11] and Ward et al [15], who assessed adherence using caregiver testimonies. The high level of adherence may be attributed to the fact that the SMC drugs were well tolerated by the children.…”

“…Thus, while the program is well received, distributors need to adhere to the recommended dosage and maintain communication with caregivers to emphasize the importance of taking medications as prescribed on subsequent days, potential adverse events, and appropriate actions to take if they occur [7,21,32]. However, our data suggest that only 66% of caregivers reported starting the first dose while the distributor was directly observing the patient, indicating that distributors may have left the entire blister pack in the house with instructions for a later caregiver to administer the medication, as observed in Mozambique, Burkina Faso, and Chad [10,11,15]. In a qualitative study by Kajubi et al [18], CHWs attributed this inconsistency to their heavy workload, which prevented them from returning to the home later in the day to ensure that they could administer the medication while the child was present.…”

“…Several factors can influence adherence during SMC, such as CHW-related factors, patient-related factors, and patient-CHWs interaction [2,12,13]. Poor adherence can occur when CHWs fail to explain the correct medication administration method, its benefits, and adverse drug responses and to consider the caregivers' living conditions, such as a lack of clean water at home [2,14,15]. Previous campaign experience and social networks, including friends and neighbors, who can alleviate concerns and boost faith in the effectiveness of medications, have been linked to the use of medications and adherence during SMC [16] (see Table 1).…”

Barriers against and strategies for malaria control during the COVID-19 pandemic in low- and middle-income countries: a systematic review

“…In Nigeria, Burkina Faso, Chad and Zimbabwe, the community's engagement in malaria campaigns was restricted due to COVID-19. For example, Ward et al (2021), reported difficulty implementing door-to-door delivery of SMC (A23). Furthermore, lack of political will was one of the challenges of malaria elimination strategies (A13).…”

Using the role model approach to optimise caregiver administration of sulfadoxine- pyrimethamine amodiaquine to children aged 3–59 months in Burkina Faso, Chad and Togo: findings from an evaluation

“…While this approach had many advantages, such as building caregivers' capacity to administer the remaining doses of AQ, several challenges arose. A previous study conducted by Malaria Consortium in 2020 found that some caregivers refused to administer SMC medicines to their children or did not administer them correctly (7). To address the challenges associated with, and nd local existing solutions to, improve SPAQ administration within selected communities, the role model approach was designed, implemented and evaluated to optimise administration in Burkina Faso, Chad and Togo.…”