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Community acceptability of Seasonal Malaria Chemoprevention of morbidity and mortality in young children: A qualitative study in the Upper West Region of Ghana.

ABSTRACT: BACKGROUND:Malaria remains a major public health problem, especially in sub-Sahara African countries. The Malaria Control Program of Ghana has implemented Seasonal Malaria Chemoprevention (SMC) intervention in the Upper West Region in 2015. This preventive drug has been recommended by WHO as very safe and effective in preventing malaria in children under five years. This study assessed community acceptability of the SMC intervention in the Lawra district of Northern Ghana. METHODOLOGY:This was a qualitative study where focus group discussions and in-depth interviews were conducted with community-based health volunteers and parents whose children received the SMC drug. Purposive sampling method was used to select study participants. The interviews were recorded with consent of study participants. All interviews were transcribed and coded into emergent themes using Nvivo 10 software before thematic content analysis. RESULTS:Study participants perceived that the introduction of the SMC intervention in the area had helped to reduce the prevalence of malaria among children less than five years of age. Parents held the view that the drug was very good in preventing malaria. The results also showed high acceptability of the SMC intervention by parents and other community members. Parents reported that they were willing to allow their children to receive the drug and wished the intervention could continue in the district for children to continue to benefit. Nonetheless, negative attitude on the part of few parents made them not to allow their children to receive the drug. CONCLUSION:The interpretation of our data showed high acceptability of the SMC by stakeholders in the study area. However, intensive and continued health education on the benefits of the SMC drug could help to further improve acceptability of the program.

SUBMITTER: Chatio S

PROVIDER: S-EPMC6524792 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Community acceptability of Seasonal Malaria Chemoprevention of morbidity and mortality in young children: A qualitative study in the Upper West Region of Ghana.

Chatio Samuel S Ansah Nana Akosua NA Awuni Denis A DA Oduro Abraham A Ansah Patrick O PO

PloS one 20190517 5

<h4>Background</h4>Malaria remains a major public health problem, especially in sub-Sahara African countries. The Malaria Control Program of Ghana has implemented Seasonal Malaria Chemoprevention (SMC) intervention in the Upper West Region in 2015. This preventive drug has been recommended by WHO as very safe and effective in preventing malaria in children under five years. This study assessed community acceptability of the SMC intervention in the Lawra district of Northern Ghana.<h4>Methodology ...[more]

PMID: 31100072

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Project description: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.

Project description:BackgroundThere is limited knowledge on cost of treating malaria in children under-five years in northern Ghana which poses a challenge in determining whether interventions such as the National Health Insurance Scheme (NHIS) and Community-based Health Planning and Services (CHPS) have reduced the economic burden of malaria to households or not. This study examined the malaria care seeking and cost of treatment in children under-five years in the Upper West Region of Ghana.MethodsThe study used a cross-sectional, quantitative design and data were collected between July and August 2016 in three districts in the Upper West Region of Ghana. A total of 574 women who had under-five children were interviewed. Socio-demographic characteristics of respondents, malaria seeking patterns for under-five children with malaria as well as direct medical and non-medical costs associated with treating under-five children with malaria were collected from the patient perspective. Analysis was performed using STATA 12.ResultsOut of 574 women visited, about 63% (360) had children who had malaria and sought treatment. Most treatment was done at formal health facilities such as the health centres (37%) and the CHPS (35%) while 3% had self-treatment at home. The main reason for choice of place of treatment outside home was nearness to home (53%). The average direct medical and non-medical costs associated with treating an under-five child with malaria were US$4.13 and US$3.04 respectively. The average cost on transportation alone was US$2.64. Overall, the average direct medical and non-medical cost associated with treating an under-five child with malaria was US$4.91(range: minimum = US$0.13 -maximum = US$46.75). Children who were enrolled into the NHIS paid an average amount of US$4.76 compared with US$5.88 for those not enrolled, though the difference was not statistically significant (p-value = 0.15).ConclusionsThe average cost to households in treating an under-five child with malaria was US$4.91. This amount is considerably high given the poverty level in the area. Children not insured paid a little over one US dollar for malaria treatment compared to those insured. Efforts to improve enrolment into the NHIS may be needed to reduce the cost of malaria treatment to households. Construction of more health facilities near to community members and at hard to reach areas will improve access to health care and reduce direct non-medical cost such as transportation costs.

Project description:Background SMC was adopted in Nigeria in 2014 and by 2021 was being implemented in 18 states, over four months between June and October by 143000 community drug distributors (CDDs) to a target population of 23million children. Further expansion of SMC is planned, extending to 21 states with four or five monthly cycles. In view of this massive scale-up, the National Malaria Elimination Programme undertook qualitative research in five states shortly after the 2021 campaign to understand community attitudes to SMC so that these perspectives inform future planning of SMC delivery in Nigeria. Methods In 20 wards representing urban and rural areas with low and high SMC coverage in five states, focus group discussions were held with caregivers, and in-depth interviews conducted with community leaders and community drug distributors. Interviews were also held with local government area and State malaria focal persons and at national level with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, those in local languages translated into English, and transcripts analysed using NVivo software. Results In total, 84 focus groups and 106 interviews were completed. Malaria was seen as a major health concern, SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because it allowed them to continue daily tasks, and allowed time for the CDD to answer questions. Barriers to SMC uptake included perceived side-effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective, and local shortages of drugs. Conclusions Recommendations from this study were shared with all community drug distributors and others involved in SMC campaigns during cascade training in 2022, including the need to strengthen communication about the safety and effectiveness of SMC, recruiting distributors from the local community, greater involvement of state and national level pharmacovigilance coordinators, and stricter adherence to the planned medicine allocations to avoid local shortages. The findings reinforce the importance of retaining door-to-door delivery of SMC. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-023-04547-w.

Dataset Information

Community acceptability of Seasonal Malaria Chemoprevention of morbidity and mortality in young children: A qualitative study in the Upper West Region of Ghana.

Publications

Community acceptability of Seasonal Malaria Chemoprevention of morbidity and mortality in young children: A qualitative study in the Upper West Region of Ghana.

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