Implementation quality of seasonal malaria chemoprevention: a qualitative study exploring the perspectives of caregivers and community distributors in Burkina Faso and Chad

BACKGROUND AND AIMS
Seasonal malaria chemoprevention (SMC) is a preventive treatment for malaria, targeting children aged 3 to 59 months. Since 2012, the World Health Organization recommends SMC in the Sahel region where malaria transmission follows a seasonal pattern. There is strong evidence of the efficacy of SMC programmes in reducing mortality and morbidity for malaria. However, little research has been done to assess the quality of SMC campaigns. To improve the quality of its SMC programmes, Malaria Consortium has developed a framework of quality standards supporting the improved implementation of the intervention. Building on this newly developed framework, this study aims to better understand the quality of SMC programme implementation.

METHODS
An exploratory qualitative study, based on secondary data collected after two SMC campaigns implemented in Burkina Faso and Chad in 2019, was performed. The dataset consisted of 16 focus group discussions conducted with caregivers and community distributors (CDs) involved in the campaigns. The data was analysed using thematic analysis.

RESULTS
Overall, both SMC campaigns were well accepted by the communities. Implementation and coverage of the interventions were considered adequate by the participants, while information about the delivery of SMC was well communicated and reached most of the community members. However, difficulty in ensuring adherence to SMC treatment was noted, as were concerns around adverse drug reactions, the spreading of rumours, and the difficult working conditions of the CDs. Other challenges regarding the implementation of SMC were setting-specific, such as the timeliness of the campaign not being optimal in Burkina Faso, or the lack of involvement of female caregivers in mobilisation activities in Chad.

CONCLUSIONS
SMC is a critical prevention strategy in the global fight against malaria. This study provides relevant insights and recommendations around future design of SMC campaigns and pinpoints the need for ongoing research on the quality of implementation.