Abstract
Given the current scale of Seasonal Malaria Chemoprevention (SMC) in the Sahel region in Africa, and its expansion into new geographies, the SMC presents an opportunity to reach more children under age five with additional life-saving interventions. Following an initial implementation research study in 2019 to test the feasibility and acceptability of co-implementing vitamin A supplementation (VAS) with SMC campaign in one local government area (LGA) in Sokoto, Nigeria, we conducted a follow-up study in two LGAs (Katagum and Giade) in Bauchi state, to answer additional questions on safety, equity, feasibility in different settings (rural and urban), acceptability and cost of the integrated campaign.
We employed a convergent mixed methods approach using multiple data sources including cross-sectional pre and post-intervention surveys on 540 children aged 6-59 months assessing coverage of the intervention (previously reported), adverse drug reactions reported (safety) and background demographics of household members among others; programmatic cost analysis using the ingredient method; focus group discussions (FGDs) among health workers, caregivers and Community Drug Distributors (CDDs), and key informant interviews (KIIs) among stakeholders. Ethical clearance was obtained from Bauchi State internal ethics review board.
Adverse drug reactions (ADRs) reported at baseline was 8.0% compared to 1.6% at end line (pvalue=0.05), types of reactions reported, vomiting, skin rash, loss of appetite, fever, diarrhoea did not differ between baseline and endline. There was no significant difference between children who did or did not receive the two interventions at endline in terms of age, sex, wealth index, caregiver’s educational status or religion. However, children living in urban areas had lower odds of receiving both interventions compared to those living in rural areas (SMC, OR=0.21 [95% CI = 0.10 to 0.41], VAS, OR=0.58 [95% CI=0.37 to 0.92]). The total cost for SMC only was $149,718.76 in cycle 3 (baseline) and SMC+VAS at $171,258.12 in cycle 4 (endline). It costed $0.9 to reach each child with SMC only and $1.1 to reach the same child with both SMC and VAS.
This study demonstrates the viability of the SMC platform to deliver VAS safely and equitably at a mere additional cost of $0.2 per child. It also amplifies the need to explore the factors responsible for limited reach of children in urban areas using the current delivery approach.