Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
Malaria Consortium, London, UK.
Malar J. 2024 Jul 19;23(1):216. doi: 10.1186/s12936-024-05034-6.
Recommended since 2012 by the World Health Organization (WHO), seasonal malaria chemoprevention (SMC) is a community-based intervention to prevent malaria in children in African regions where malaria transmission follows a seasonal pattern. Following the publication of consolidated WHO guidelines for malaria, SMC is expected to reach more children in new geographies in future years. Though SMC has been shown to reduce malaria-related morbidity and mortality, there is potential for quality improvement of the intervention implementation. Assisted by ten quality standards from a framework developed by Malaria Consortium, this paper aims to better understand the quality of SMC implementation and identify potential barriers to quality delivery of SMC.
A qualitative thematic analysis on data collected after the annual SMC rounds implemented in Burkina Faso and Chad in 2019 was conducted. Sixteen focus group discussions conducted with caregivers and community distributors were analysed. Three selected quality standards for SMC delivery; planning and enumeration; community engagement; and administration of SMC medicines provided overarching quality themes under which subthemes were identified.
Eight subthemes relating to the three quality standards were identified. Although SMC was well accepted by communities in both settings, common barriers to the quality delivery of SMC were identified including difficulty ensuring adherence to the SMC administration protocol; difficulties reaching mobile populations; concerns around adverse drug reactions; rumours, and concerns about SMC safety; and community distributors' working conditions. Context-specific barriers included: the suboptimal timeliness of the SMC round in Burkina Faso, and the lack of involvement of female caregivers in mobilization activities in Chad.
In the context of increased adoption of SMC, this paper provides relevant insights and recommendations for the improved implementation of SMC programmes. These include the integration of strategies addressing communities' concerns around adverse drug reactions, gender-specific mobilization strategies, and attention to community distributors' working conditions. It also highlights the importance and utility of further, robust research on the quality of SMC delivery.
自 2012 年以来，世界卫生组织（WHO）推荐季节性疟疾化学预防（SMC），这是一种基于社区的干预措施，旨在预防疟疾在疟疾传播呈季节性模式的非洲地区的儿童中传播。随着 WHO 疟疾综合指南的发布，预计未来几年将有更多儿童在新的地理区域受益于 SMC。尽管 SMC 已被证明可降低疟疾相关发病率和死亡率，但该干预措施的实施质量仍有提高的空间。本研究在疟疾联盟制定的框架下，通过 10 项质量标准来辅助，旨在更好地了解 SMC 实施的质量，并确定 SMC 优质交付的潜在障碍。
对 2019 年在布基纳法索和乍得进行的年度 SMC 轮次后收集的数据进行了定性主题分析。分析了对照顾者和社区分发者进行的 16 次焦点小组讨论。选择了 SMC 交付的三个质量标准：规划和计数；社区参与；以及 SMC 药物的管理，为这些标准提供了概括性的质量主题，在这些主题下确定了子主题。
确定了与三个质量标准相关的 8 个子主题。尽管 SMC 在这两个地区都得到了社区的广泛认可，但也发现了一些常见的 SMC 优质交付障碍，包括难以确保遵守 SMC 管理方案；难以接触到流动人口；对药物不良反应的担忧；谣言和对 SMC 安全性的担忧；以及社区分发者的工作条件。具体的障碍包括：布基纳法索 SMC 轮次的时间不理想，以及乍得缺乏对动员活动的女性照顾者的参与。
在 SMC 广泛采用的背景下，本文为 SMC 项目的改进实施提供了相关的见解和建议。这些建议包括解决社区对药物不良反应的担忧、针对特定性别进行动员策略以及关注社区分发者的工作条件等策略。它还强调了进一步开展关于 SMC 交付质量的稳健研究的重要性和实用性。
