More than four decades later, malaria is still a major public health issue in many countries, and a leading cause of sickness and loss of life, especially in the sub-Saharan African region, which bears a disproportionate burden of the disease. The seasonality of malaria transmission in the region has sparked interest in seasonal strategies for prevention, known as seasonal chemoprevention (SCP). This approach involves administering antimalarial drugs to at-risk communities before and during peak transmission periods. SCP is a promising malaria prevention intervention showing great initial impact in controlling malaria but questions around community perspectives and perceptions of the strategy are urgent, especially now, to ensure programmatic success and sustainability. This article synthesizes community perspectives on seasonal chemoprevention, outlines the challenges, and recommends ways to improve this important prevention intervention against malaria.
What is Seasonal Chemoprevention?
Seasonal chemoprevention (SCP) is the mass distribution of antimalarial drugs to populations to prevent disease during times of expected peak malaria transmission, most commonly to children below the age of five years and pregnant women, who are particularly susceptible to the severity of malaria.
Goal: The primary goal of SCP is to reduce the malaria burden and malaria-related morbidity and mortality by maintaining therapeutic drug concentrations in the blood to avoid high-risk periods. By preventing new infections, SCP reduces the overall burden of disease and decreases the burden on healthcare services.
Community Perspectives on SCP
1. Positive Reception and Acceptance
- Health benefits: Residents welcome SCP for the demonstrated reduction of human malaria. Most families report a reduction in the frequency of clinical symptoms of malaria that results in fewer clinic visits, reduced morbidity, and even mortality. SCP also brings parents peace of mind that their children remain protected during the rainy season.
- Increased awareness: SCP programs are frequently accompanied by an educational component that educates communities about how they can prevent and treat malaria. Increased awareness can help people to recognize the value of seasonal chemoprevention and facilitate adherence to the program.
2. Challenges and Concerns
- Challenges with Adherence to the SCP Regimens: The most commonly reported challenges relate to issues of adherence to SCP regimens, whereby communities do not fully appreciate the importance of completing the course of the medication (potentially leading to the loss of efficacy), or where the timing of SCP administration does not match the times that are convenient within communities (eg, at midnight) and/or its frequency does not align with community practices or schedules (as seen in the timeliness of community responses in CSA).
- Side effects and misconceptions: Different members of the community express concerns about the side effects of these medications since there are several misconceptions about the safety and even safety of these medications. Fears and misconceptions around drug safety can also negatively impact willingness to participate in SCP. Educating communities about the safety and efficacy of these medications is necessary to help alleviate these fears.
- Logistical Barriers: SCP implementation is burdened by logistical barriers such as late deliveries or access issues. There may be delays in arriving, and in remote or rugged areas residents might not receive the drugs, or they might have problems accessing the drugs. This has the potential to negate the impact of the program.
3. Community Involvement and Empowerment
- Local engagement: Local engagement is key to successful SCP programs because it helps to engage the citizenry in the planning and implementation stages. These conversations enable programs to utilize local leaders, health workers, and volunteers as both a means of engaging the community and building trust. Involving communities early, particularly for source communities vulnerable to migration and upstream users such as farmers, can ensure SCP programs meet the specific contextual and cultural needs of the community through a platform that addresses legitimate fears. Community involvement can also help to facilitate communication and reach specific populations and age groups.
- Feedback Mechanisms: Feedback is a critical ingredient to ensure the continued implementation of impactful SCP programs. Engaging in periodic consultations with community members, whether it is in a one-on-one with individuals or group discussions, will help identify any problems, give them a platform to share suggestions, and subsequently adjust the features or activities of the intervention as necessary for its maximum impact and acceptance.
Strategies for Enhancing SCP Programs
1. Education and Awareness Campaigns
- Universal education: Sufficient information in clear language on the nature of malaria, the importance of SCP, and its completion is critical. This information should be disseminated to health-care workers and to the community to facilitate consistent messaging.
- Myths Busted: Make a concerted effort to debunk and provide corrective information regarding myths and misinformation about SCP medications. This includes information about the safety and effectiveness of SCP drugs.
2. Strengthening Supply Chains
- Organized Distribution: The reason many communities lack access to certain drugs is because of inefficient distribution. Greater logistical preparedness could help to eliminate this issue. Increased distribution efficiency will involve enhancing the drug logistics as well as hiring more healthcare workers on the ground. Better coordination of supply chains, better local stock present, and an adequate stock forecast hold promise in helping overcome logistical hurdles.
- Local Partnerships: Forming partnerships with local organizations and community groups can help get SCP medications further down the distribution chain and into the hands of more people. Using local networks can help overcome challenges with transportation and outreach.
3. Monitoring and Evaluation
- Monitoring adherence: Systems might be established to track adherence to SCP regimens, such that adherence issues can be caught early. For example, families might be followed frequently during the early stages of an SCP treatment regimen, to assess if patients are taking their medications and to provide extra support if needed.
- Routinely evaluating impact: SCP programs should be routinely evaluated for their impact, the extent to which they have been effective, and areas for improvement. Evidence on program outcomes and feedback from the community can inform the iterations of SCP programs to improve their impact on the ground.
4. Community Engagement and Empowerment
- Involving Community Leaders: Successful SCP programs can engage local leaders and influencers in the communities to endorse and solidify ownership of the SCP program, and also to act as leaders and advocates during training and support visits.
- Strengthen Local Capacity: Build the capacity of local health workers and volunteers to support SCP programmesAdapt SCP programs to local volunteer roles and capabilities local personnel in skills most needed for each promising local SCP program provides emergency medical supplies and essential drugs and nutrients where appropriate.
Success Stories and Best Practices
1. Case Study: Senegal
Community health workers have supported the scaled-up Senegal Comprehensive Product (SCP) initiative, which has combined invasive zoo pulverization with faith-based dissemination strategies, community outreach, and strong supply chain management, reducing malaria at its most endemic during the season by more than 30 percent.
2. Case Study: Nigeria
SCP programs in countries including Nigeria and Burkina Faso are participating in larger malaria control initiatives involving the distribution of insecticide-treated bed nets and indoor residual spraying. An SCP program in Malawi has reported that its success has stemmed from being community-driven, with citizens guiding and overseeing program planning to the highest levels of the government.
eliciting the seasonal chemoprevention (SCP) approach as a potential tool to alleviate the burden of malaria and potentially eliminate the disease in areas where the malaria vector is seasonal Encountering community perceptions, adherence concerns, and logistical barriers are all important considerations for SCP programs.
These SCP programs can be optimized locally through investment in education, community engagement, and the logistical prerequisites, as well as by allowing and encouraging communities to participate in planning and implementation processes, dispel common misconceptions, and bolster the supply chain.
Although the road to elimination will be long and arduous, especially when different actors have to work together with limited resources, an SCP approach can contribute substantially to bringing down reported malaria incidence and enhancing the health and prosperity of affected communities, if it addresses the broader needs of these communities.
