Malaria Consortium Chad Country Office, N'Djamena, Chad.
Malaria Consortium, London, United Kingdom.
Glob Health Sci Pract. 2022 Feb 28;10(1). doi: 10.9745/GHSP-D-21-00161.
To prevent malaria among children aged 3-59 months in areas with high seasonal transmission, seasonal malaria chemoprevention (SMC) is recommended. In Chad, there is evidence of SMC administration to children aged older than 5 years (referred to as "leakage"). This study aimed to understand the reasons for leakage and explore the feasibility and acceptability of extending the delivery of SMC to children aged 5-10 years in Chad.
We conducted a mixed-methods study in Massaguet health district with a cross-sectional survey to determine SMC coverage for children aged up to 10 years after SMC cycles 1 and 3 (n=90 and n=100 caregivers surveyed, respectively) and at the end of cycle 4 (n=101 caregivers surveyed). We conducted 14 key informant interviews at the national and district level and 8 focus group discussions with community distributors and caregivers.
In the compounds surveyed, there were no children aged 5-10 years in cycle 1. In cycles 3 (n=1 children) and 4 (n=16 children), there was 100% (95% confidence interval [CI]=2.5, 100.0) and 62.5% (95% CI=35.4, 84.8) coverage of SMC in children aged 5-10 years, respectively. Extension of SMC to older children was considered acceptable, but there were concerns about feasibility and ensuring the sustainability of the current program in children aged 3-59 months. Key informants acknowledged the need to secure additional funding to pilot SMC in older age groups and were uncertain about the impact of the current SMC program at scale.
Key informants considered extending SMC to children aged 5-10 years acceptable but did not deem it a current priority. They expressed an urgent need to address leakage and reinforce both the sustainability and quality of the current SMC program.
为预防季节性传播较高地区 3-59 月龄儿童罹患疟疾，推荐采用季节性疟疾化学预防（SMC）。在乍得，有证据表明对 5 岁以上儿童（称为“漏服”）进行了 SMC 管理。本研究旨在了解漏服的原因，并探索在乍得将 SMC 扩大至 5-10 岁儿童的可行性和可接受性。
我们在马萨盖特卫生区开展了一项混合方法研究，在 SMC 周期 1 和 3 之后（分别对 90 名和 100 名照顾者进行了调查）以及周期 4 结束时（对 101 名照顾者进行了调查）进行了一项横断面调查，以确定 10 岁以下儿童的 SMC 覆盖率。我们在国家和地区两级进行了 14 次关键知情人访谈，并与社区分发人员和照顾者进行了 8 次焦点小组讨论。
在所调查的大院中，没有 5-10 岁儿童处于周期 1。在周期 3（n=1 名儿童）和 4（n=16 名儿童）中，5-10 岁儿童的 SMC 覆盖率分别为 100%（95%置信区间[CI]=2.5，100.0）和 62.5%（95% CI=35.4，84.8）。将 SMC 扩大到大龄儿童被认为是可以接受的，但人们对可行性以及确保目前针对 3-59 月龄儿童的方案的可持续性表示担忧。关键知情人承认需要获得额外资金来为大龄儿童试点 SMC，并对当前 SMC 方案的规模影响表示不确定。
关键知情人认为将 SMC 扩大至 5-10 岁儿童是可以接受的，但他们并不认为这是当前的优先事项。他们迫切需要解决漏服问题，并加强目前 SMC 方案的可持续性和质量。
