Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: An End User Perspective Study

Abstract

Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Although a large number of publications have reported on the efficacy and safety profile of these interventions, little literature exists on end-user experience. The objective of this study was to provide insights on the perceptions and attitudes towards seasonal malaria chemoprevention (SMC) and intermittent preventive treatment of infants (IPTi) to identify drivers of and barriers to acceptance. A total of 179 in-depth qualitative interviews were conducted with community health workers (CHWs), health center managers, parents of children receiving chemoprevention, and national decision makers across eight countries in sub-Saharan Africa. The transcribed verbatim responses were coded and analyzed using a thematic approach. Findings indicate that, although SMC is largely accepted by end users, coverage remained below 100%. The main causes mentioned were children's absenteeism, children being sick, parents' reluctance, and lack of staff. Regarding IPTi, results from participants based in Sierra Leone showed that the intervention was generally accepted and perceived as efficacious. The main challenges were access to water, crushing the tablets, and high staff turnover. SMC and IPTi are perceived as valuable interventions. Our study identified the key elements that need to be considered to facilitate the expansion of these two interventions to different geographies or age groups.

Keywords: children and infants; end user; implementation; intermittent preventive treatment of infants (IPTi); malaria chemoprevention; seasonal malaria chemoprevention (SMC).

Figure 1

Chemoprevention geographical representation, including interventions that are currently implemented or piloted.

Figure 2

SPAQ perception by (a) health center managers and (b) community health workers.

Figure 3

Barriers to SMC implementation at (a) the health center level and (b) the community health worker level.

Figure 4

SMC improvements that could be implemented at (a) the health center manager level, (b) the community health worker level, and (c) the parent level.

Figure 5

Main issues reported about the Expanded Programme on Immunization.