Compliance With Guidelines on Seasonal Malaria Chemoprevention in Kwara State, Northcentral Nigeria
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Published on: February 13, 2019
C O Agomo1, E Shekarau2, N C Ogbulafor2
1Department of Medical Laboratory Science, College of Medicine of the University of Lagos, Lagos, Nigeria Email: coagomo@unilag.edu.ng. Tel: +234-8122592251.
Insights
Seasonal malaria chemoprevention (SMC) compliance was good in Kwara State, with high drug administration and ingestion rates. However, home visits by lead mothers showed poor compliance, indicating areas for improvement in malaria prevention programs.
Area of Science:
- Public Health
- Tropical Medicine
- Pharmaceutical Sciences
Background:
- Seasonal malaria chemoprevention (SMC) is crucial for reducing malaria in children aged 3-59 months in seasonal transmission areas.
- Sulphadoxine-pyrimethamine plus amodiaquine (SPAQ) is administered monthly during peak transmission seasons.
Purpose of the Study:
- To assess compliance with SMC guidelines by community drug distributors in Kwara State.
- To identify areas of strength and weakness in SMC implementation.
Main Methods:
- Structured interviews with caregivers of eligible children using the KoboCollect app.
- Data collection focused on caregiver demographics, drug administration, and adherence to SMC protocols.
Main Results:
- High SMC coverage (88.5%) and caregiver information receipt (88.7%).
- Direct observation showed high SPAQ administration (91.5%), second dose delivery (96.0%), and full drug ingestion (89.3%).
- Poor compliance noted in lead mother home visits (77.4%); low SPAQ administration to over-age children (10.0%).
Conclusions:
- Overall good compliance with SMC implementation guidelines in Kwara State.
- Significant variations in performance across LGAs and poor compliance in lead mother home visits.
- Commendable self-reported SMC coverage by caregivers.
Background:
Seasonal malaria chemoprevention (SMC) is an effective strategy for reducing malaria morbidity and mortality in children aged 3-59 months in areas with seasonal malaria transmission. Sulphadoxine-pyrimethamine plus amodiaquine is given to an eligible child at monthly intervals during the peak malaria transmission season. The aim of this study was to determine the level of compliance with SMC guidelines by community drug distributors during SMC implementation in Kwara State.
Method:
Caregivers of eligible children from six Local Government Areas were interviewed using a structured questionnaire on the KoboCollect app downloaded on hand-held android devices. The questionnaire was composed of questions on caregiver's demographics, SMC drug administration, and adherence to SMC protocol.
Results:
A total of 1,314 caregivers were interviewed, most of them were female 1076 (81.9%), married 1200 (91.3%) and literate 795 (60.5%). The mean SMC coverage for the 4 cycles was 1183(88.5%). SMC information was received by 1166 (88.7%) of caregivers. Most of the caregivers 1166 (88.7%) heard about SMC. Overall, SPAQ administration was directly observed in most cases 1169 (91.5%), second dose was given 1226 (96.0%) and drugs were fully ingested 1140(89.3%). Poor compliance was observed in home visits by lead mothers 988 (77.4%). The report of adverse drug reactions was low 132 (10.3% [95% CI: 8.8-12.3%]), the commonest being severe vomiting 50 (37.9%). There were significant (P<0.05) variations in SMC implementation across the 6 LGAs in virtually all the performance indicators. SPAQ administration to over-age children was low 128 (10.0%).
Conclusion:
Overall, the compliance with SMC implementation guidelines in Kwara state was good though significant differences in performance were observed across the six LGAs. Home visits by lead mothers were generally poor. The self-reported coverage of SMC by caregivers was commendable.
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