Malaria Consortium, 33 Pope John Paul Street, Maitama, Abuja-FCT, Nigeria.
Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK.
Malar J. 2024 Jan 2;23(1):4. doi: 10.1186/s12936-023-04825-7.
Differences between urban and rural contexts in terms of sociodemographic characteristics, geographical features and risk perceptions may lead to disparities in coverage and related outcomes of community-based preventive interventions, such as seasonal malaria chemoprevention (SMC). This study investigated urban-rural differences in SMC coverage and other programme outcomes, as well as child and caregiver characteristics of target populations in nine implementing states in Nigeria during the 2022 SMC round.
This is a comparative cross-sectional study based on comprehensive end-of-round household surveys conducted in nine states where SMC was delivered in Nigeria in 2022. Data of 11,880 caregiver-child pairs were included in the analysis. Rural-urban differences in SMC outcomes and child and caregiver characteristics were assessed, first by using Pearsons' chi-square test for independence for categorical variables. Univariate multilevel mixed-effect logistic regression models, with random intercepts for cluster units, were used to quantify the strength of association between location and each SMC coverage and related outcomes.
Significant urban-rural differences were observed in caregivers' sociodemographic characteristics, such as age, gender, level of education, occupation status and health-seeking behaviour for febrile childhood illnesses. Disparities were also seen in terms of SMC coverage and related outcomes, with lower odds of the receipt of Day 1 dose direct observation of the administration of Day 1 dose by community distributors, receipt of the full three-day course of SMC medicines and receipt of SMC in all cycles of the annual round among children residing in urban areas, compared with those residing in rural areas. Similarly, urban-dwelling caregivers had lower odds of being knowledgeable of SMC and believing in the protective effect of SMC than rural-dwelling caregivers.
Findings highlight observable urban-rural disparities in SMC programme delivery and related outcomes, as well as target population characteristics, underscoring the need for context-specific strategies to ensure optimal delivery of SMC and improve programme implementation outcomes in urban settings.
城乡在社会人口特征、地理特征和风险认知方面存在差异，这可能导致基于社区的预防干预措施（如季节性疟疾化学预防（SMC））的覆盖范围和相关结果存在差异。本研究调查了尼日利亚 2022 年 SMC 轮次期间 9 个实施州中城乡之间 SMC 覆盖率和其他方案结果以及目标人群中儿童和照顾者特征的差异。
这是一项基于在尼日利亚 2022 年提供 SMC 的 9 个州进行的全面轮末家庭调查的比较性横断面研究。共纳入了 11880 对照顾者-儿童对的数据进行分析。使用卡方检验（Pearson's chi-square test for independence）对 SMC 结果和儿童及照顾者特征的城乡差异进行评估，首先对分类变量进行独立评估。然后，使用具有聚类单位随机截距的单变量多层混合效应逻辑回归模型，量化位置与每种 SMC 覆盖率和相关结果之间的关联强度。
在照顾者的社会人口特征方面，如年龄、性别、教育程度、职业状况和儿童发热性疾病的就医行为，观察到显著的城乡差异。在 SMC 覆盖率和相关结果方面也存在差异，与居住在农村地区的儿童相比，居住在城市地区的儿童接受第 1 天剂量直接观察社区分发者给予第 1 天剂量、接受完整的三天 SMC 药物疗程和在年度轮次的所有周期中接受 SMC 的可能性较低。同样，与农村地区的照顾者相比，城市居民的照顾者对 SMC 的了解程度和对 SMC 保护作用的信任程度较低。
研究结果突出了 SMC 方案实施和相关结果以及目标人群特征方面的可观察到的城乡差异，强调需要制定针对具体情况的策略，以确保在城市环境中优化 SMC 的提供，并改善方案实施结果。
