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Seasonal Malaria Chemoprevention Survey in Northern Nigeria 2018

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Seasonal Malaria Chemoprevention Survey in Northern Nigeria 2018 SEASONAL MALARIA CHEMOPREVENTION SURVEY IN NORTHERN NIGERIA 2018 Final Report OPM Nigeria January 2019 Seasonal Malaria Chemoprevention Survey in Northern Nigeria 2018 Table of Contents Table of Contents 2 List of tables and figures 3 Acknowledgement 4 List of Abbreviation 5 Executive Summary 6 1 Introduction 8 1.1 Overview of Malaria Consortium’s Seasonal Malaria Chemoprevention (SMC) Programme 8 1.2 Rational of the SMC Programme 9 2 Methodology 10 2.1 Sampling Methodology 10 2.2 Sample Size Determination 12 2.3 Sampling Strategy 12 2.4 Area covered by the survey 13 2.5 Data Collection and Management 14 2.6 Ethical Approval and Confidentiality of Data Sets 15 2.7 Survey instruments 15 3 Results 17 3.1 Survey completion rate 17 3.2 SMC Coverage by Cycle 20 3.3 Understanding of SMC card use 24 3.4 Non-Treatment 25 3.5 General Health Concerns and Behaviours 26 3.6 General Adverse Reaction 29 3.7 SMC Card Usage and Retention 31 3.8 Treatment with the DOT by CHW and Caregivers 32 3.9 Caregiver Knowledge and Perception 33 3.10 General Knowledge and Behaviour related to SMC 34 4 Conclusion and Recommendation 35 Annex A Other Tables 38 Annex B List of Facilities and Communities Replaced 39 Annex C OPM Survey Management Team 51 Annex D Questionnaire 52 © Oxford Policy Management 2 Seasonal Malaria Chemoprevention Survey in Northern Nigeria 2018 List of tables and figures Table 1: Distribution of interviews across study sites .................................................................................. 17 Table 2: Age distribution of children in the survey ....................................................................................... 17 Table 3: Distribution of children surveyed across the states ....................................................................... 18 Table 4: Survey and SMC programme completion rate ............................................................................... 19 Table 5: Proportion of Children 3 – 59 months who were treated with SMC by cycle .................................. 21 Table 6: Proportion of children five years and above who were treated with SMC by cycle ........................ 22 Table 7: Proportion of caregivers with SMC Card ....................................................................................... 24 Table 8: Reasons for children under 5 not receiving SMC .......................................................................... 25 Table 9: Reasons for refusing to allow child to receive treatment ............................................................... 25 Table 10: Compounds not visited and child fever rate ................................................................................ 26 Table 11: Comparative trend in children 3-59 months treated and not treated ............................................ 26 Table 12: Children 3 – 59 who had fever health seeking behaviour ............................................................ 27 Table 13: Test outcome of children 3 – 59 who were treated and not treated who had fever ...................... 27 Table 14: Comparative trend in mosquito nets coverage among children treated and not treated .............. 28 Table 15: Reasons child did not sleep under a mosquito net ............................................................... 28 Table 16: Compounds not visited and children sleep under mosquito net ................................................... 28 Table 17: Comparative trend in IRS (Anyone sprayed the interior walls of dwelling against mosquitoes at any time in the past 6 months) .................................................................................................................... 29 Table 18: Child Immediate Reaction to Drug .......................................................................................... 29 Table 19: Child reaction to medication after given ...................................................................................... 30 Table 20: Reactions to medication .......................................................................................................... 30 Table 21: SMC card and usage ................................................................................................................ 31 Table 22: CHW administered first dose to the child and left some tablets ................................................... 32 Table 23: CHW residency status ................................................................................................................ 32 Table 24: Evaluating the literacy level of caregiver ..................................................................................... 33 Table 25: Understanding of the use of AQ tablet ................................................................................... 33 Table 26: Understanding of the purposes of SMC ................................................................................. 34 Table 27: Key communication channel for caregivers ........................................................................... 34 Figure 1: Proportion of children 3 – 59 months who were treated with SMC by cycle ................................. 21 Figure 2: Proportion of children over five years who were treated with SMC by cycle ................................. 23 Figure 3: Proportion of children 3 – 59 months and above 5 years who were treated with SMC at least 3 cycles and all cycle ..................................................................................................................................... 23 Figure 4: Proportion of respondent that reported receipt of an SMC card and those that had it available for inspection at the time of survey .................................................................................................................. 24 Tab 1: Health Facilities per State ................................................................................................................ 10 Tab 2: Sample Breakdown ......................................................................................................................... 12 Tab 3: Field work schedule ......................................................................................................................... 14 Tab 4: Summary Of SMC Coverage Survey questionnaire ......................................................................... 16 © Oxford Policy Management 3 Seasonal Malaria Chemoprevention Survey in Northern Nigeria 2018 Acknowledgement This study was made possible through funding by the Malaria Consortium. This report presents findings from the Seasonal Malaria Chemoprevention survey carried out in Sokoto, Zamfara, Katsina and Jigawa states. Oxford Policy Management (OPM) wishes to register its sincere thanks to the staff and management of Malaria Consortium for their support during the survey. We also like to thank the state coordinators, support staff, research assistants and survey team members for their countless contributions towards the success of this survey. We are especially most grateful to the households that gave their time to participate in this exercise. © Oxford Policy Management 4 Seasonal Malaria Chemoprevention Survey in Northern Nigeria 2018 List of Abbreviation CAPI Computer Assisted Personal Interview CI Confidence Interval CHW Community Health Worker CU5 Children Under Five DOT Directly Observed Treatment HH Household LGA Local Government Area OPM Oxford Policy Management MC Malaria Consortium SP-AQ Sulfadoxine-pyrimethamine and amodiaquine SMC Seasonal Malaria Chemoprevention © Oxford Policy Management 5 Seasonal Malaria Chemoprevention Survey in Northern Nigeria 2018 Executive Summary Seasonal malaria chemoprevention (SMC) is defined as the intermittent administration of full treatment courses of an antimalarial medicine during the malaria season to prevent malarial illness by maintaining therapeutic antimalarial drug concentrations in the blood throughout the period of greatest malarial transmission. The SMC protocol requires four monthly cycles of drugs distribution, roughly overlapping the rainy season, when mosquitos are most active, and transmission is highest. A cross-sectional survey was conducted to evaluate the coverage level of the SMC treatment programme in Zamfara, Katsina, Sokoto and Jigawa states comparing eligible children aged 3-59months treated in the programme with the number of eligible children (3-59months) in the states. The survey sought to provide the percentage of the total number of eligible children in the various states, who received the SMC treatment. The programme covered in Jigawa (5 LGAs) and Katsina (4 LGAs), Sokoto (all 23 LGAs) and Zamfara (all 14 LGAs). There were two sets of respondents for this study: primary caregivers of children under the age of five and heads of compounds. A primary caregiver in this survey refers to any individual, aged 15 years or over, with the primary responsibility for the feeding and daily care of at least one child under the age of five, in a household where he or she has been resident prior to the start of the SMC programme or one month before the last cycle of the treatment. The data analysis was done using STATA 14, all indicators of interest were calculated in proportion by state and an average across all the states. The confidence interval (CI) of 95% was used to provide a range of values around the estimate within which selected result can be expected to fall. Majority of the tables are descriptive. The findings from this survey showed that 88% of the
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